Annas, G.J. and Grodin, M.A., The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation (New York: Oxford University Press, 1992); Shuster, E., “Fifty Years Later: The Significance of the Nuremberg Code,” N. Engl. J. Med 337 (1997): 1436–40; Ambroselli, C., L’Ethique Medicale (Paris: University Presses of France, 1988): 91–116.Google Scholar

Descartes, R., The Philosophical Works of Descartes, trans. Haldane, E.S. and Ross, G.R.T. (Cambridge: Cambridge University Press, 1967): at 211.Google Scholar

Mann, Jonathan has also suggested the human rights tree model, with the UDHR as a trunk, although without including either bioethics or health law: “The Universal Declaration can be thought of as the trunk of the human rights tree, with the UN Charter as its roots. The two major branches, the two major International Covenants on Civil and Political Rights, and on Economic, Social and Cultural Rights, emerge from and expand upon the trunk with further elaboration through many important treaties and declarations.” Mann, J., “Human Rights and AIDS: The Future of the Pandemic,” reprinted in Mann, J. et al, eds., Health and Human Rights: A Reader (New York: Routledge, 1999): at 223.Google Scholar

e.g., Jonsen, A.R., The Birth of Bioethics (New York: Oxford University Press, 1993); Rothman, D., Strangers at the Bedside (New York: Basic Books, 1991). Jonsen noted that although his 1992 conference in Seattle on which his book was based had the same title, “my colleagues and I knew that disciplines are not born; they grown slowly, gradually taking a shape distinct enough to merit a name. In truth, bioethics emerged in the years after World War II…This book [The Birth of Bioethics] designates the forty years between 1947 and 1987 as the era during which bioethics emerged as a distinct discipline and discourse. In 1947, the Nuremberg Tribunal…promulgated the Nuremberg Code.” (viii-xii). See also Jonsen, A.R., “The Birth of Bioethics,” Hastings Center Report 23, no.6 (1993): Supp. 1–4.Google ScholarPubMed

See, e.g., Grodin, M.A., Annas, G.J., Glantz, L.H., “Medicine and Human Rights: A Proposal for International Action,” Hastings Center Report 23, no. 4 (1993): 8–12.CrossRefGoogle Scholar

Beecher, H.K., “Ethics and Clinical Research,” N Engl. J. Med. 274 (1966): 1354–60. A more persuasive argument is that Beecher’s actions were not the beginning of something new, but a “largely opportunistic and measured response” to retain professional dominance in the face of a growing “political, social and cultural climate that challenged the status quo and the power of medical science” [including Joseph Fletcher’s 1954 classic book, Morals and Medicine]…Looking at it retrospectively, [“whistleblowing”] was not just a master stroke in image management, but in the calculated preservation of professional power.” Schmidt, U., Justice at Nuremberg: Leo Alexander and the Nazi Doctors’ Trial (New York: Pal-grave MacMillan, 2004): 283.Google Scholar

As Beecher put it in 1970: “The Nuremberg Code presents a rigid act of legalistic demands…The Declaration of Helsinki, on the other hand, presents a set of guides. It is an ethical as opposed to a legalistic document, and is thus a more broadly useful instrument than the one formulated at Nuremberg.” Refshauge, W., “The Place for International Standards in Conducting Research for Humans,” Bulletin of World Health Organization 55 (1977): 133–35 (quoting Beecher). See also Advisory Committee on Human Radiation Experiments, Human Radiation Experiments: Final Report (New York, Oxford University Press, 1996): 85–92.Google Scholar

Caplan, A.L., “How did Medicine go so Wrong?” in Caplan, A.L., ed., When Medicine Went Mad: Bioethics and the Holocaust (Totowa, NJ: Humana Press, 1992): 53–92. An edited transcript of the Hastings Center conference, Biomedical Ethics and the Shadow of Nazism, was publishedasa supplement to the Hastings Center Report in August 1976. On the long relationship of national security and bioethics see also Moreno, J. D., “Bioethics and the National Security State” Journal of Law, Medicine & Ethics 32 (2004): 1980–208.CrossRefGoogle Scholar

A rewriting of the intellectual history of American bioethics is beyond the scope of this essay, but my guess is that virtually anywhere one begins to dig in American bioethics, one will end with World War II. The best known examples are from two of the fields intellectual founders: Jay Katz and Hans Jonas. Both were born in Germany and had family members killed in the Holocaust, and the bioethics-related writings of both grew out of their reflections on the war and the concentration camps. Jay Katz, for example, published what is still the leading text on human experimentation in 1972 (Experimentation with Human Beings [New York: Russell Sage, 1972]), and the Nuremberg Doctors’ Trial was central to this collection of primary sources. His star student, and assistant in this project, Alex Capron, went on to be a leader in American bioethics himself, and I don’t think it’s an accident (although he may) that he is currently the ethicist for one of the major “health and human rights” organizations in the world, the World Health Organization. Jay Katz himself was a member of two major U.S. bioethics panels that examined scandals: the Tuskegee Study Panel in 1972, and the President’s Advisory Council of Human Radiation Experiments (1994–95). The Nuremberg Code was the centerpiece of the latter report – although attempts to distance bioethics from it continued. See supra note 7. Hans Jonas was, of course, extremely prolific. His bioethics was also much broader than just medicine, but included the entire biosphere. Nonetheless, it was grounded in the Holocaust and the dehumanization of Auschwitz, where his mother was murdered. It is no accident that his own star pupil is now the head of America’s bioethics council, Leon Kass.Google Scholar

The most comprehensive text on international human rights, and the one I rely on heavily in this conclusion is Steiner, H. and Alston, P., International Human Rights in Context: Law, Politics, Morals, 2d ed. (New York: Oxford University Press, 2000). On applying a human rights analysis to a major health concern see Cook, R. J., Dickens, B.M., Fathalla, M.F., Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law (Oxford: Clarendon Press, 2003).Google Scholar

Fox, R., “Medical Humanitarianism and Human Rights: Reflections on Doctors without Borders and Doctors of the World,” reprinted in Mann, Jonathan, et al, eds., Health and Human Rights: A Reader (New York: Routledge, 1999): 417–35. With her colleague Judith Swazey, she has accused American bioethics of being based on “Anglo-American analytic philosophical thought [and thus projecting] an impoverished and skewed expression of our society’s cultural tradition.” Tom Beauchamp (co-author with James Childress of the leading theoretical text on American bioethics, Principles of Biomedical Ethics, 5th ed., (New York: Oxford University Press, 2001) recently described the Fox/Swazey thesis as “surprisingly influential,” although given the isolation of American bioethics from the rest of the world, no surprise is warranted. Beauchamp, T.L., “Does Ethical Theory Have a Future in Bioethics?” Journal of Law, Medicine & Ethics 32 (2004): 209–217. Fox and Swazey have had more uncomplimentary things to say about American bioethics. For example, “if bioethics is…more than medical – if it is an indicator of the general state of American ideas, values, and beliefs…then there is every reason to be worried about who we are, what we have become, what we know, and where we are going in a greatly changed and changing society and world.” Fox, R.C. and Swazey, J. P., “Medical Morality is not Bioethics: Medical Ethics in China and the United States,” Perspectives in Biology and Medicine 27 (1984): 336–60. And on the narrow focus of American bioethics, “One of the most urgent value questions…[unexplored in bioethics] is whether as poverty, homelessness, and lack of access to health care increase in our affluent country, it is justifiable for American society to be devoting so much of its intellectual energy and human and financial resources to the replacement of human organs.” Fox, R.C. and Swazey, J.P., “Leaving the Field,” Hastings Center Report 22, no. 5 (1992): 9–15.Google Scholar

My colleague Michael Grodin and I followed up our conference on the 50th anniversary of the Nuremberg Code at the Holocaust Memorial Museum by founding our own physician NGO – but combining it with lawyers as well: Global Lawyers and Physicians. See <www.glphr.org> for details.+for+details.>Google Scholar

For an excellent account of the origins of the UDHR see Glendon, M.A., A World Made New: Eleanor Roosevelt and the Universal Declaration of Human Rights (New York: Random House, 2001).Google Scholar

President’s Bioethics Council, Beyond Therapy: Biotechnology and the Pursuit of Happiness (Washington DC: President’s Bioethics Council, 2004); See also Pollack, R., The Missing Moment (New York: Houghton Mifflin Co., 1999): at 155–60.Google Scholar

Rushdie, S., Step Across This Line: Collected Nonfiction 1992–2002 (New York: Random House, 2002): at 381.Google Scholar

Saramago, J., “From Justice to Democracy by Way of the Bells,” closing speech of the World Social Forum, Porto Alegre, Brazil, Jan. 22, 2002, at <www.terraincognita.50megs.com/saramagoalt.html> (last visited September 21, 2004). See also Farmer, P. and Campos, N.G., “New Malaise: Bioethics and Human Rights in the Global Era,” Journal of Law, Medicine, & Ethics 32 (2004): 243–51, and Farmer, P., Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: U. of California Press, 2003) 213–46.Google Scholar