From the breakdown of psychiatry during nazism and the Nuremberg Code, to the materialist neuropsychological model in contemporary science and society: A bioethical analysis / De la quiebra de la psiquiatría durante el nazismo y el Código de Nüremberg al modelo neuropsicológico materialista en la ciencia y la sociedad contemporáneas: Un análisis en clave bioética

Abstract The breakdown of German psychiatry with the coming to power of the National Socialist regime in 1933 resulted in a revival after the war of bioethical issues, the immediate effect of which was the enactment of the Nuremberg Code. In many ways, this breakdown was the result of the historical evolution of psychomedical knowledge and the mass dissemination of reductionist discourses and ideas that created a breeding ground for tragedy. The cyclical discourse of psychic materialism, which has been repeated for centuries in the history of science in different formulations, can, if not properly interpreted, lead to far-reaching appropriations and risks, to which due attention must be paid. The latest manifestation of this issue, the view of mental life as basically cerebral, neurological, biochemical, and determinist, a view that has not been managed or presented adequately to the public, could become the basis for perverse new perspectives and applications in the current context of research and academic activity.

Resumen La llamada "quiebra" de la psiquiatría alemana en 1933, tras la llegada al poder del régimen nacionalsocialista, tuvo como resultado una reactivación de la cuestión bioética, cuyo efecto inmediato fue la promulgación del famoso Código de Nuremberg. En más de un sentido, tal ruptura fue el resultado del devenir histórico del conocimiento psicomédico, así como de la difusión masiva de discursos e ideas reduccionistas que terminaron por generar un caldo de cultivo propicio para la tragedia. El discurso cíclico del materialismo psíquico, que se reedita en la historia de la ciencia, en diferentes formatos y formulaciones, desde hace siglos, no bien interpretado, puede inducir apropiaciones y riesgos de largo alcance a los que se debe prestar la debida atención. Así, el último episodio de este asunto, la visión de la vida mental como vida básicamente cerebral, neurológica, bioquímica y determinista, no bien gestionado y presentado a la opinión pública, aunado a las condiciones actuales de la actividad investigadora y académica, podría convertirse en piedra angular de nuevas perspectivas y aplicaciones perversas de este asunto.

Ethicizing history. Bioethical representations of Nazi medicine.

The article presents and analyzes different approaches of U.S. bioethicists in comprehending the Nazi medical crimes after 1945. The account is divided into two sections: one dealing with discussions on research ethics and the Nuremberg Code up until the 1970s and the other ranging from the 1970s to the present and highlighting bioethics' engagement with Nazi analogies. The portrayal of different bioethical scholars, institutions, and documents-most notably Henry K. Beecher, Jay Katz, the Belmont Report, the Hastings Center, Arthur L. Caplan, and Robert M. Veatch-provides a nuanced interpretation of the motives that bioethicists held and the strategies that they applied to establish an understanding of the Nazi medical crimes and their relation to contemporary bioethical issues. In this, the different approaches shared a common goal: To integrate the Nazi medical crimes into an ethical framework by means of selective acknowledgments and representation of their history.

Human Infection Challenge Experiments: Then and Now.

In the midst of the Covid-19 pandemic, ethicists, researchers, and journalists have recommended studies that deliberately infect healthy volunteers with the coronavirus as a scientific means of expediting vaccine development. In this essay, we trace the history of infection challenge experiments and reflect on the Nuremberg Code of 1947, issued in response to brutal human experiments conducted by Nazi investigators in concentration camps. We argue that the Code continues to offer valuable guidance for assessing the ethics of this controversial form of research, with respect particularly to the acceptable limits to research risks and the social value of research necessary to justify exposing human participants to these risks.

The American Neurological Association's Book "Eugenical Sterilization: A Reorientation of the Problem" Through the Lens of Contemporaneous Book Reviews.

BACKGROUND: In 1936, the American Neurological Association (ANA) published the book "Eugenical Sterilization: A Reorientation of the Problem" in response to what the first author of the book described as a positive reception to a paper presented at the ANA's 1935 annual meeting. The conclusions of the presentation were approved by the organization during the same meeting. As evidenced by the publication of several book reviews in a variety of medical journals, the book garnered some attention. METHODS: Reviews of the ANA's book were sought using PubMed, Google Scholar, and Embasa. Also, the book's title was used to search the World Wide Web. RESULTS: The search yielded four reviews, all published in 1937. The reviews make evident a positive opinion of the ANA's book's authors' recommendations including the option for "selective sterilization" of patients with conditions such as Huntington disease, Friedreich ataxia, and epilepsy. In addition, reviewers highlighted the book's authors' assessment that "the feebleminded [breed] docile, servile, useful people who do the dirty work of the race, [as] servants fulfilling a social function." CONCLUSIONS: Although the book's authors did not advocate for all-out eugenical sterilization, they did little to counter the popular opinion that patients with certain neurological diseases were a drain on society. In addition, they espoused a positive vision of the feebleminded's role as servants who can do undesirable work. This message was disseminated through book reviews.

Rescuing Informed Consent: How the new "Key Information" and "Reasonable Person" Provisions in the Revised U.S. Common Rule open the door to long Overdue Informed Consent Disclosure Improvements and why we need to walk Through that door.

There is substantial published evidence showing that countless people enroll each year in ethically deficient clinical trials. Many of the trials are problematic because the quality of the science used to justify their launch may not be sufficiently vetted while many other trials may lack requisite social value. This poses the question: why do people volunteer for them? The answer resides in large part in the fact that informed consent practices have historically masked, rather than disclosed, the information that would alert research candidates to the ethically problematic nature of the trials. The "reasonable person" and "key information" provisions in the revised US Common Rule create the opportunity to correct this historical shortcoming. Two sources are employed to shed light on what the "key information" is that should be disclosed to a "reasonable person": the original disclosure aims of the Nuremberg Code, as well as an extensive body of meta-research evidence. Those sources jointly support a range of new disclosures in the informed consent process that would unmask the heretofore undisclosed information. The resulting proposed new disclosures pertain to the overall success prospects of clinical trials, the quality of the prior research that both forms the basis of clinical trials and informs assessment of their risks and benefits, the potential social value of clinical trials, and the commercial purposes of clinical trials.

Can there be a moral obligation to participate in biomedical research?

In clinical medicine, the moral obligation to care for the individual patient is absolute. Patient care means at least and by negative terms to minimize any risk of treatment. In this context, the question arises about the compatibility of clinical ethics and human biomedical research ethics. Or conversely, is there a common ground between the two? At the opposite end of the field between clinical ethics and biomedical research ethics is the proposal of an obligation to participate in biomedical research, which is argued for on the basis of biomedical knowledge being a public good available to the community as a whole. While patient accrual during a clinical investigation would certainly be facilitated by obligatory research participation, and the data obtained would be-at first sight-more representative for the population studied, the still feasible refusal to participate would be stigmatizing and as such detrimental for the patient-physician relation. This essay seeks to provide a reply to the titled question by focusing on aspects such as individual vs common medical claims, shared grounds between the two and an important document of medical research ethics, that is the Nuremberg code.

Personalized Medicine: Ethical Aspects.

In our time of genome-based personalized medicine, clinical research and clinical medicine are accelerating at a quick pace. Faster and cheaper DNA sequencing and protein profiling, microfluidic devices for capturing blood biomarkers, nanoparticles for precise drug delivery and enhanced imaging, rapid computational analysis of massive data inputs, and other technological wonders coalesce to create a kind of Moore's Law for medicine. Needs are obvious, knowledge grows, capital becomes available, but these factors are not entirely sufficient to make health more achievable. Personalized medicine also requires social acceptability, not only for accuracy and efficacy but also because medicine is a moral domain. This chapter deals with medical ethics that determine the choices a society makes regarding healthcare; and it has not always been a steady, morally correct course of progress. Indeed, medical ethics has largely derived from socio-scientific calamities in the past. Personalized medicine, with its enhanced capacity to access the individuality of illness, must have a continuously evolving feedback mechanism-the most important element being the physician-patient relationship-which is its ethical footing.

More Declassified Evidence Implicates CIA Physicians in Unethical Research.

In 2010, in an article in this journal, I argued that declassified documents implicated Central Intelligence Agency (CIA) physicians in the conduct of unethical research on enhanced interrogation using detainee subjects. The focus, then as now, is upon physicians at the Office of Medical Services (OMS). The 2010 article highlighted the heavily redacted "Draft OMS Guidelines on Medical and Psychological Support to Detainee Interrogations" (the Draft). This commentary focuses upon the recently declassified final version of that document revealing further culpable evidence of unethical human subject research. The commentary locates that unethical research in historical context and the development of the Nuremberg Code. The commentary also locates enhanced interrogation in contemporary political context and considers how to hold OMS physicians accountable for the conduct of unethical human research using detainee subjects.

Soldiers as subjects of medical research: Comments on Hassidim et al. on ethical standards of the Israel Defense Force.

In 2008 a group of former soldiers of the Israel Defense Force (IDF) sued the Ministry of Defense and others, claiming they had suffered from medical problems that resulted from an IDF medical experiment in which they had participated in the 1970s. There was no compelling medical evidence with respect to causal relationships between their participation in the experiment and their later medical problems. The President of the District Court, Justice Hila Gerstl, appointed me, with the consent of the parties, to write a deposition with respect to the ethical aspects of the case. My comments in the sequel rest on my deposition, applying not only to the case that had been under discussion but also to each and every case of experimentation. My arguments, strictly confined to the ethical aspects of the case, as opposed to the legal aspects and the debated facts, were not in favor of either party. As a result the state and the former soldiers reached an agreement approved by the court. One of the major points made in that deposition is that the Nuremberg and Helsinki principles follow from those of medical ethics in general, except for the requirement to have an Institutional Review Board (IRB). A second major point is that under very strict conditions, more than what is usually required, soldiers may participate in medical experiments administered by their military force. However, new conscripts during their first months of their service should not take part in medical experimentation within their military force.

Discussion on the Moral Principles and Norms of Experiment on Human Being in Nuremberg Code / 中国医学伦理学

Firstly, this article discussed the significance of medical ethics enacted by Nuremberg Code from three aspects. Thereafter, it introduced the fundamental principles of Nuremberg Code in regulating the aspect of human experiment, which included that the subjects should voluntarily agree to the experiment and informed con-sent, the experiment should be guided by scientific ideas, beneficial to society and harmless to subjects. Finally, it pointed out the basic norms of Nuremberg Code in the aspect of human experiment that the researchers must tell subjects the relevant information about the strictly assessed risk and danger, the experiments should carry on based on the standardized animal experiments, and subjects should have the freedom to decide whether they want to quit the experiments.

Problemas éticos en la experimentación psicológica. Asch, Milgram y Zimbardo en cuestión / Ethical issues in psychological experimentation. Asch, Milgram and Zimbardo concerned

En todo experimento se plantea la necesidad de aislar variables y manipularlas. Esta constituye una primera dificultad metodológica para el investigador de Ciencias sociales. Un rasgo de estas ciencias es la interacción de múltiples variables en un contexto situacional, lo que hace muy difícil aislarlas adecuadamente. A esta dificultad se le suma la manipulación de una de ellas, llamada independiente y la medición de los efectos que provoca su modificación en la variable dependiente. A las dificultades estrictamente metodológicas se le agregan los recaudos éticos, que en el desarrollo de la psicología como ciencia se fueron incrementando y especificando. Este trabajo analiza los experimentos de Asch, Milgran y Zimbardo para observar cómo responde cada uno de ellos a los puntos planteados por el Código de Núremberg, la Declaración universal de principios éticos para psicólogas y psicólogos y la Declaración Universal UNESCO 2005

Financial conflicts of interest in biomedical human subject research.

The purpose of this paper is to examine the past, present and future of financial conflict of interest regulation in biomedical human subject testing. Part I will briefly review the forces giving rise to the current controversy. Part II will examine the more influential ethical codes on human subject testing and argue that they are inconclusive on the subject of financial conflicts of interest. Part III will examine the various regulations now in place and identify their serious flaws. Part IV will critique the leading proposals for reform. The Conclusion will synthesize the best features of the various proposals for reform and suggest improvements left unaddressed by these proposals.

Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados.

BACKGROUND: The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. METHODS: A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003. RESULTS: The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) CONCLUSION: The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.

Module one: introduction to research ethics.

This module will introduce you to the ethical concepts underlying applied ethical decision-making in the area of research involving human participants. We will also learn what the issues are that people involved in research on research ethics are concerned with. Ethics without an understanding of historical and legal context makes arguably little sense. It is for this reason that this module will begin with a brief history of research ethics and ends with a brief overview of the relevant national and international guidelines pertaining to ethical issues in research involving human participants.