Historical advancements in research ethics
Despite the atrocities of the past, it took time for research ethics to take off. Let’s explore how we arrived at a universally accepted practice.
Historically, the Nuremberg Code, the Helsinki Declaration and the Belmont Report stand out as the three most important documents guiding ethical conduct of research internationally. Let’s take a quick look at how they came about.
1. Nuremberg Code (1947)
The inhumane crimes committed under the guise of ‘medical research’ in Germany during World War II ultimately lead to the development of the Nuremberg Code of 1947 (Moreno et al, 2017). The Code documented 10 principles to promote human rights during research and was borne from the horrifying testimonies revealed during the Nuremberg Trials (Ghooi, 2011). These had commenced two years earlier when high ranking Nazi doctors were called to account for their war crimes.
While we’re talking about all things ethical, you might be interested to know that although the Imperial Japanese Army also carried out inhumane experiments during World War II, the Japanese scientists were never put on trial. It was later revealed that the USA struck a secret deal at the time, guaranteeing their protection in exchange for the research data collected from their experiments (Fischer, 2006).
Another interesting point is that after the Nuremberg Code was released, the researchers of the day were highly offended at the thought they needed ethical direction. They indignantly maintained their own moral codes were more than up to the task of guiding their research conduct. The general consensus was that documents like the Nuremberg Code were only required for ‘barbarians’ who didn’t know any better. Most felt they were above such direction.
Although it was largely dismissed at the time and never adopted as law in any country, the Nuremberg Code is historically significant (Moreno et al, 2017). It was the first international code of research ethics. It marked the beginning of internationally recognised considerations for ethical human research and is considered to be a ‘founding document of what we now consider to be ‘research ethics’ today’ (Guraya et al, 2014).
2. The Declaration of Helsinki (1964)
After the release of the Nuremberg Code, more international guidelines followed to promote ethical research within medicine. The most significant is the Declaration of Helsinki. Published by the World Medical Association in 1964, it was revised in 1975 to include the requirement to involve an independent ethics committee to assess research protocols (Guraya et al 2014). The latest version (2001) continues to guide biomedical researchers throughout the world.
The Helsinki Declaration is an important document in that it gives a framework of values and standards for good ethical conduct in medical and other health-related research. But it is also important in the sense that it gives power to authorities, funding agencies and publishers to support or not support a given research project (Allebeck, 2009).
3. The Belmont Report (1979)
The USA also commissioned a historically significant guideline: ‘Ethical Principles and Guidelines for the Protection of Human Subjects’. However, the long winded title was more popularly known as The Belmont Report. It was named after the conference centre where the commission’s meeting took place (Fischer, 2006). Although acknowledging the value of other guidelines, it aimed to move away from a ‘list of regulations’ to develop a set of core principles that researchers could apply to a greater range of ethical dilemmas, namely:
- Respect for persons (human dignity)
- Justice (Fischer, 2006).
Watch Professor Robert Levine, co-author of The Belmont Report, as he discusses his thoughts on the history of research ethics and comments for future consideration.
This is an additional video, hosted on YouTube.
The development of ethics as we know it today
These three documents show a progression. The Nuremberg Code established core principles relating to the ethical conduct of human research and brought these to an international forum. The Helsinki Declaration then narrowed the focus to a specific industry - the medical industry - and introduced a specific framework of regulations to guide research in this area. The Belmont Report moved beyond regulations to the underlying principles that shape our understanding of ethical behaviour today.
How far do you think we have come?
Read the following quote and post your response to this question in the comments section below.
We pride ourselves in having come so far and learned so much in the past 60 years about how to respect patients’ rights, but when a giant company like Merck tries to hide data about a blockbuster drug because it may be harming some patients, we must ask ourselves — how far have we come? (Marks, 2006)
Allebeck, P (2009). A New Helsinki Declaration - but what about public health research? European Journal of Public Health, 19(2).
Fischer, B. A. (2006). A Summary of Important Documents in the Field of Research Ethics. Schizophrenia Bulletin, 32(1).
Ghooi, R. B. (2011). The Nuremberg Code–A critique. Perspectives in Clinical Research, 2(2).
Marks, Andrew R. (2006). Doctors from hell: The horrific account of Nazi experiments on humans. Journal of Clinical Investigation, 116(1).
Moreno, J.D., Schmidt, U. & Joffe, S. (2017). The Nuremberg Code 70 Years Later. JAMA Network
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