The origin of the Code began in pre–
World War II German politics, particularly during the 1930s and 1940s. Starting in the mid-1920s, German physicians, usually proponents of
racial hygiene, were accused by the public and the medical society of
unethical medical practices. The use of racial hygiene was supported by the German government in order to promote an
Aryan race. Racial hygiene extremists merged with
National Socialism to promote the use of biology to accomplish their goals of racial purity, a core concept in the Nationalist ideology. Physicians were attracted to the scientific ideology and aided in the establishment of the National Socialist Physicians' League in 1929 to "purify the German medical community of '
Jewish Bolshevism'." Criticism was becoming prevalent; Alfons Stauder, member of the Reich Health Office, claimed that the "dubious experiments have no therapeutic purpose", and Fredrich von Muller, physician and the president of the
Deutsche Akademie, joined the criticism. , the chief defendant in the U.S. military tribunal that resulted in the Nuremberg Code In response to the criticism of unethical human experimentation, the
Weimar Republic (Germany's government from 1919 to 1933) issued "Guidelines for New Therapy and Human Experimentation". The guidelines were based on
beneficence and
non-maleficence, but also stressed the legal doctrine of
informed consent. The guidelines clearly distinguished the difference between therapeutic and non-therapeutic research. For therapeutic purposes, the guidelines allowed administration without consent only in dire situations, but for non-therapeutic purposes any administration without consent was strictly forbidden. However, the guidelines from Weimar were negated by
Adolf Hitler. By 1942, the Nazi party included more than 38,000 German physicians, who helped carry out medical programs such as the
Law for the Prevention of Hereditarily Diseased Offspring. After World War II, a series of trials were held to hold members of the Nazi party responsible for a multitude of
war crimes. The trials were approved by President
Harry Truman on 2 May 1945, and were led by the United States, Great Britain, and the Soviet Union. They began on 20 November 1945, in
Nuremberg, Germany, in what became known as the
Nuremberg trials. In the trial of
USA v. Brandt, which became known as the "
Doctors' Trial", German physicians responsible for conducting unethical medical procedures on humans during the war were tried. They focused on physicians who conducted inhumane and unethical human experiments in
concentration camps, in addition to those who were involved in over 3.5 million
sterilizations of German citizens. Several of the accused argued that their experiments differed little from those used before the war, and that there was no law that differentiated between legal and illegal experiments. This worried
Andrew Ivy and
Leo Alexander, who worked with the prosecution during the trial. In April 1947, Alexander submitted a memorandum to the United States Counsel for War Crimes outlining six points for legitimate medical research. An early version of the Code known as the Memorandum, which stated explicit voluntary consent from patients is required for human experimentation, was drafted on 9 August 1947. On 20 August 1947, the judges delivered their verdict against
Karl Brandt and 22 others. The verdict reiterated the Memorandum's points and, in response to expert medical advisers for the prosecution, revised the original six points of the Memorandum to ten points. The ten points became known as the Code, which includes such principles as
informed consent and absence of
coercion; properly formulated
scientific experimentation; and
beneficence towards experiment participants. It is thought to have been mainly based on the
Hippocratic Oath, which was interpreted as endorsing the experimental approach to medicine while protecting the patient.
Authorship 'controversy' The Code was initially ignored, but gained much greater significance about 20 years after it was written. As a result, there were substantial rival claims for the creation of the Code. Some claimed that
Harold Sebring, one of the three U.S. judges who presided over the
Doctors' trial, was the author.
Leo Alexander, MD and
Andrew Ivy, MD, the prosecution's chief medical expert witnesses, were also each identified as authors. In his letter to
Maurice Henry Pappworth, an English physician and the author of the 1967 book
Human Guinea Pigs, Andrew Ivy claimed sole authorship of the code. Leo Alexander, approximately 30 years after the trial, also claimed sole authorship. However, after careful reading of the transcript of the Doctors' trial, background documents, and the final judgements, it is more accepted that the authorship was shared and the code grew out of the trial itself. ==The ten points of the Nuremberg Code==