CHAPTER 6

DOCTORS OF NOTORIETY

EUTHANASIA.

HUMAN EXPERIMENTATION.

MEDICAL ETHICS

The Hippocratic Oath was written in the 5th.century B.C. and was intended to be affirmed by each doctor on entry into the medical profession. Many of the professed basic principles of professional behaviour in the Western World have remained unchanged throughout the recorded history of medicine. One English translation of the Hippocratic Oath reads as follows:

“ I swear by Apollo, the physician, and Aesculapius and Health and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none other. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

“I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and, in like manner, I will not give to a woman a pessary to produce abortion. With purity and with holiness, I will pass my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females, or males, of freemen or slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted me to enjoy life and the practice of the Art, and respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot” (1). The Declaration of Geneva (1947), amended by the World Medical Assembly in 1968, is the modern restatement, by the World Medical Association, of the Hippocratic Oath. The International Code of Medical Ethics, which applies both in times of peace and war, is based on the Declaration of Geneva.

The World Medical Association’s 1973 resolution on “Discrimination in Medicine” reads as follows:

“Whereas: The Declaration of Geneva, adopted and published by the World Medical Association, states, inter alia, that ‘I (a medical practitioner) WILL NOT PERMIT considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient’;

“THERFORE, BE IT RESOLVED, by the 27th. World Medical Assembly meeting in Munich, that the World Medical Association vehemently condemns colour, political and religious discrimination of any form in the training of medical practitioners and in the practice of medicine, and in the provision of health services for the peoples of the world” (2).

The Oath, the Declaration and the Resolution have been observed more in the breach than in the compliance, as this chapter will show.

The fact that, in living memory, Western doctors have, of their own volition, been directly involved in genocide, mass murder and human experimentation, as well as a great many other infractions of medical ethics, must lead many ordinary people to ponder on the nature and qualities of the young men and women who go in for the study of medicine and qualify as doctors, some of whom later become leading members of a supposedly caring profession. Although, as Gould says in his “The Medical Mafia” (3), there is no reason to believe that the medical register contains a higher proportion of criminals and hypocrites than is present in the ranks of other professions or occupations, Bennet(4) describes a collection of characteristics in certain British medical students and young doctors, especially those heading for the popular specialities of surgery and internal medicine. Bennet goes on to state that these characteristics would earn them a place, not without distinction, on Adorno’s F (for Fascism) scale for measuring authoritarian tendencies (5).

This collection of authoritarian characteristics is especially pronounced in those seeking positions in teaching hospitals, where opportunities for perpetuating accepted value systems abound; the collection of characteristics includes a partiality for academic subjects characterized by masses of precise information. This collection of characteristics includes a tendency to identify with the powerful groups in society coupled with tough and insensitive attitudes to disadvantaged and minority groups, such as racial minorities and homosexuals, as well as women.

In his description of the ‘authoritarian syndrome’ as applied to the medical profession (a medical version of the F scale) (6), Bennet identifies many of the qualities of doctors, especially those in the major specialities in the teaching hospitals, as follows:

GERMAN DOCTORS AND NATIONAL SOCIALISM

The guiding philosophical principle of recent, and not so recent, dictatorships as well as that of capitalist democracies, would appear to be in keeping with the teaching that the idea of utility and cost-effectiveness should be pre-eminent in all political, economic and social thinking and planning and that moral, ethical and humanitarian considerations should take second place. Science, including medical science,becomes subordinated to the guiding philosophies of these political systems.

In the dictatorship that obtained in Germany under national socialism, this principle was followed to its logical conclusion. Medical science, under national socialism, collaborated with this trend in the following enterprises:—

- the mass extermination of the chronically sick in the interest of saving on ‘useless’ expenses to the community as a whole;

- the mass extermination of those considered socially disturbing or racially or ideologically unwanted;

- the individual, inconspicuous extermination of those considered disloyal within the ruling group; and,

- the ruthless use of ‘human experimental material’ for medico-military research (7).

All this, of course, occurred in the climate of violence that obtained under national socialism, the German version of fascism. We would do well to dwell for a moment on the climate of violence: only thus can the chain of causality of fascistic mass violence be fully understood.

The fascist transformation of medicine, which was not confined to Germany alone (8), began in 1920, with the publication in Leipzig of “The Release of Destruction of Life Devoid of Value”, by Binding and Hoche. The jurist Karl Binding and the psychiatrist Alfred Hoche were two prominent scientists. Their book, which advocated that the killing of ‘worthless people’ be released from penalty and be legally permitted, was so, popular that, within two years, a second edition was printed.

The concept of ‘life devoid of value’ or ‘life without worth’, therefore, derives not from German fascism but but from this book. The authors then go on to elaborate on this idea in the most chilling terms. They reject sympathy and pity and go on to stress the unacceptable cost, in terms of money and labour, of keeping these mental patients alive and of caring for them. The authors, at the time of writing the book, had not heard of Hitler. Both authors were eminent men, and, because their book influenced the thinking of a whole generation, played an important role in a specific period. Hoche was the professor of psychiatry and director of the psychiatric clinic at the University of Freiburg. His teachings had a considerable influence on American psychiatry. Karl Binding was professor of jurisprudence at the University of Leipzig and an authority on criminal law. His son, Rudolf Binding, was also a jurist who openly advocated fanaticism.

A growing movement within medicine demanded the elimination of people of marginal value, a group which the Fascists defined as ‘useless eaters’. Eliminating people of marginal value, who are primarily ‘consumptive’ rather than ‘productive’ became the basic strategy of fascist medicine.

Long before the fascists took open charge in Germany, a propaganda barrage was directed against the traditionally compassionate attitudes, present in some circles, towards the chronically ill. Calls were made for the adoption of utilitarian systems. A whole literature had laid the groundwork for a hypernationalistic and superman-orientated culture. Decent people who loved their homes and their children were brought around to picture themselves as heroes, and they then became willing to kill others who, like them, loved their homes and their children. The ‘enemies’ were all those within and without the country who were officially declared so. The justification of, and exhortation to, violence occurred throughout society, as when a well-known psychiatrist and philosopher wrote: “The creative spirit justifies war and destruction” (9). In a fascist propaganda film, entitled, “I accuse”, a woman suffering from multiple sclerosis is finally killed by her husband, a doctor, to the accompaniment of soft piano music rendered by a sympathetic colleague in an adjoining room. In high school mathematics classes, children were asked to work out how many new housing units could be built and how many marriage-allowance loans could be given to newly wedded couples for the amount of money it cost the state to care for the crippled, the criminal and the insane (10).

To blame fascist mass violence on individual leaders is to give them more credit than they are entitled to. It is a detraction from the true causes of events. Hitler did not harness great forces and then, having freed them, set them in motion; on the contrary, very conscious forces set him in motion. Fascism is a historical event and the outcome of concrete processes. In pre-fascist Germany, unemployment and inflation reached catastrophic proportions resulting in profound changes in attitudes.

The gulf, between the disadvantaged, the denied and the unemployed, on the one hand, and those who profited from the system, on the other, became wider. Looking for a way out, the majority of the people were ready to accept a false saviour as well as a false scapegoat.

Adolf Hitler, who had made a name for himself by advocating ruthless methods, came to power, backed by the industrial magnates, the big bankers, and the landed nobility. In return, he gave them a rearmed authoritarian Germany, maintained by violence. The investment in Adolf Hitler made by the industrial magnates Krupp and Thyssen paid off handsomely. During the post-war German ‘economic miracle’, the Thyssen industrial concern became one of the largest in Europe, and Krupp, who had used slave labour extensively, became one of the richest men in Europe. German industry had indeed won the Second World War (11).

The mass killing of mental patients by the fascists in Germany was organised like a good modern community psychiatric project. Involved in the organisation were a whole chain of mental hospitals and institutions, university professors of psychiatry and directors and staff members of mental hospitals, agencies for transport, registration of victims and the installation of crematory furnaces and, finally, the process of extermination.

It was not that psychiatrists gave up doctoring to become executioners; psychiatrists used their medical training and status to aid the process of extermination. These schemes were proposed and carried out primarily by doctors acting without any direct orders from the National Socialist (Nazi) Party. They were not under coercion; furthermore, all this soon became a matter of routine for them. They had accepted, and were putting into practice, an ideology founded on racism and elitism. Propagating the belief that some human beings were blighted and flawed, or racially undesirable and, thus, no longer deserved to live, the ideology had released the forces of terror, violence and genocide.

The programmes of death went under the name of ‘euthanasia’. Euthanasia is, in truth, the relief of the pain and suffering, associated with some deaths, by medical means. The victims of the national socialist death programmes were not dying, nor were they in pain. Except for a minor disability, many of them were otherwise healthy.

So efficient were these death programmes that the number of patients in the psychiatric hospitals of Berlin dropped in 1945 to a quarter of the number present in 1939. Many large mental institutions in Germany and Austria were closed completely. About 275,000 psychiatric patients were exterminated between 1939 and 1945, about half of whom could have been treated and discharged to live a socially useful life outside hospital. The indications for extermination were later extended to include the unfit, misfits, and undesirables. What is more surprising is that thousands of normal men and women permitted their parents or grandparents to be disposed of in this manner without much protest. By September 1939, it was known throughout the Berlin population that the residents of homes for the aged were being exterminated.

Similarly, large numbers of children were also exterminated by the German fascists. The children came from psychiatric hospitals, institutions for mental defectives, children’s homes, university paediatric clinics, children’s hospitals and paediatricians themselves. Prior to their extermination, all children were assessed by a commission of three experts, a psychiatrist and two paediatricians. Women physicians were active in the murder of these children, many of whom suffered only from a minor mental or physical defect. Few of them had hereditary conditions. The compulsory sterilization law of 1933, under which mass sterilizations of physically and mentally handicapped persons took place, was the forerunner of the mass killing programmes of psychiatric patients.

The psychiatric doctors made themselves into gods with the power to act as judges over life and death. There was no command from Adolf Hitler or, indeed, from any other high fascist functionary ordering the doctors to exterminate those suffering from mental defect or disease. The doctors acted on their own. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures; they were the judges who pronounced a sentence of life or death in every individual case; they were the executioners who carried out the sentences or handed over their patients for execution. The evidence is very clear that the psychiatric doctors did not have to work in the extermination hospitals and centres; they could, further, refuse to do certain tasks without fear of censure. Hitler gave no order to kill mental patients indiscriminately.

In the middle of 1940, after thousands of patients had been killed in psychiatric institutions, the fascist Justice Minister Guertner wrote to fascist Minister Hans Lammers saying, “The Fuehrer has decided to enact a law" (for putting mental patients to death) (12). The psychiatrists, on their own initiative, took the most extreme measures against their patients. They were responsible for their own decisions and their own acts. This was proved beyond any shadow of a doubt in the trials of these doctors after the war had ended.

The psychiatrists’ mobilization for killing patients went as smoothly as the mobilization of men as soldiers to fight against the enemy. The backbone of the whole project was the experts. These men were not fascist puppets; amongst them were twelve senior professors who had made their careers and reputations in psychiatry, and had contributed greatly to the science of psychiatry, long before the fascist take-over.

For example, Dr Max de Crinis was senior professor of psychiatry at the University of Berlin, and director of the psychiatric department at the famous Charite Hospital; prior to this, he had been chief physician of the psychiatric clinic at the University of Graz. Werner Villinger was senior professor of psychiatry at the University of Breslau. Dr Carl Schneider was senior professor of psychiatry at the University of Heidelberg. Professor Paul Nitsche was director of several state hospitals in Sonnenstein, Saxony. Dr Werner Heyde was professor of psychiatry at the University of Wurzburg. Dr Berthold Kihn was the professor of psychiatry at the University of Jena, where, in the past, Hegel, Fichte, Schiller and Heckel had taught and where Karl Marx and composer Schumann received their doctorates. Dr Friederich Manz was professor of psychiatry at Koenigsberg from 1939-1945, and professor of psychiatry at the University of Munster in the early fifties. In 1948, he was an official delegate from Germany at an international mental hygiene meeting in London, when the World Federation for Mental Health was founded for the purpose of furthering good human relations (13). That psychiatrists were not under duress to work in the extermination programmes is illustrated by the examples of two, viz., Dr Gottfried Ewald, professor of psychiatry at the University of Gottingen, and a younger psychiatrist, Dr Theo Lang. The former refused to join in the programme and the latter actually tried to stop it. Both came to no harm, either physically or professionally.

Those who had been most actively engaged in the killing, in addition to the medical directors of large well-known state hospitals, were world renowned professors of psychiatry. They were neither appointees of the fascist regime nor products of fascism. Their thinking was, instead, in parallel with that of the fascists in that violence played a large part in their approach to social problems.

Dr Werner Catel served, during the Second World War, on the Reich Commission for the Scientific Registration Of Hereditary and Constitutional Severe Disorders, one of the functions of which was to identify for child euthanasia (i.e.extermination) children who were physically malformed, handicapped or even of below average intelligence. Thousands of children were killed as a direct result of the deliberations of this Commission. The children were killed slowly and painfully by increasing doses of Luminal or other drugs and, later, by slow starvation. A lesser number were killed by lethal injection. For his pains, Dr Catel was appointed, after the war, to the post of professor of paediatrics at the University of Kiel and head of its paediatric clinic.

Such a serious attitude had been taken towards the whole idea of the elimination of the ‘useless eaters’, that, by 1941, four murder schools had been founded in Germany and Austria. These gave instruction in the assembly-line method of mass murder. After the methods had been successfully tried out on mental institution patients, they were applied to the Jews and some of the civilian populations of the occupied countries. Professor Julius Hallervorden (after whom the brain disease, Hallervorden-Spatz disease, is named) asked the co-ordinating committee of the extermination programmes to send him the brains of the victims. The brains were to be removed, preserved and shipped to him.

The killings went on until 1945. The resistance of the churches was sporadic, isolated and piece-meal. For example, in one case, religious sisters were permitted to carry on work as nurses in medical institutions which participated in the extermination programmes, as long as they were not asked to participate in any way in the programme.

The churches’ attitude was that the programmes had become a ‘fait accompli’; the forces of death had become too entrenched. There was one change, however. German soldiers at the front, in 1941, had learnt that Germans were killing Germans at home, their aged relatives were disappearing and that gas chambers had been built to dispose of the chronically ill and the handicapped.

The soldiers feared that if they were to become chronically disabled as a result of war wounds, they, too, might end up in the gas chambers. Morale became seriously affected, so much so, that the Reich government officially announced that all death programmes were to be halted. What happened, instead, was that the gas chambers were dismantled and moved to the East, and the programmes continued as before.

In the months and years after the war, the German courts (of the Federal Republic), like the British courts in the colonies, not only demonstrated great leniency towards the mass murderers, but even went as far as to offer pseudo-philosophical reasons for their horrendous crimes and inhumanity. A court in Munich ruled that the extermination of mental patients was manslaughter, not murder. Another court showed great sympathy for the criminals, describing them as ‘burned-out human husks’, and ‘poor, miserable creatures’. Other courts spoke of ‘a tragic conflict of duties’, of ‘human weaknesses which do not deserve moral condemnation’. It is interesting also to note that none of the Nazi judges who, in the years 1939-1945, sent innumerable innocent men and women to their deaths were brought to trial by the Allies.

In his statement(14) to Military Tribunal No. 1, Nuremburg, Dr Andrew C. Ivy, Medical Scientific Consultant to the prosecution, said that “this Nazi infamy was not merely the infamy of a few crazed, psychologically twisted practitioners. It appears that fewer than two hundred German physicians participated directly in medical war crimes; however, it is clear that several hundred more were aware of what was going on. Now it appears evident to me that this “witches’ sabbath” of medical crime was only the logical end result of the mythology of racial inequality and of the gradual but finally complete encroachment on the ethics and freedom of medicine by the Nazis when they were in the process of gaining control of the German government. And this process, so far as I know, went unopposed by the German medical profession.

“As a result, the world witnessed the catastrophe of a national medical group which let itself be ruled by a false political ideology and found a notable number of its members committing murder under the (false) defence of political expediency and superior orders...................What happened to the medical profession of Germany is stern testimony to the fact that acceptance of or even silence before (racial supremacy) and the rest of the trappings of racism, acquiescence in or even silence before the violation of sacred professional ethics, the service by medical men of any goal but truth for the good of humanity, can lead to dishonour and crime in which the entire medical profession of a country must, in the last analysis, be considered an accomplice”. In the Appendix(15), Mitscherlich adds: “......(we have seen) the doom awaiting a science that permits itself to be swept along by a political ideology, apparently in the direction of its own goals, only to see itself suddenly engaged in the organisation of murder”.

Hitler began his mass murders by granting ‘mercy deaths’ to the ‘incurably ill’; he intended then to extend the extermination programme to cover ‘genetically-damaged ‘Germans (patients with congenital heart and lung diseases). However, extermination programmes of this nature can be directed against any given group. as the principle of selection is dependent only on circumstantial factors. It is quite conceivable that, in the automated, computerized, robotized economy of a not too distant future, men may be tempted to exterminate all those whose intelligence quotient, for example, is below a cerain level (16).

Finally, the question that must have been in many minds when the full truth of German genocide came out after the war. Why did not the tens of thousands in the concentration camps fight back against the hundreds of guards? There are many things worse than death and the SS saw to it that none of these horrors was, at any time, very far from the their victims’ minds and imagination. A former inmate of Buchenwald described what happened in the concentration camp: “The triumph of the SS demands that the tortured victim allow himself to be led to the noose without protesting, that he renounce and abandon himself to the point of ceasing to affirm his identity. And it is not for nothing. It is not gratuitously, out of sheer sadism, that the SS men desire his defeat. They know that the system which succeeds in destroying its victim before he mounts the scaffold..........is incomparably the best for keeping a whole people in slavery. In submission. Nothing is more terrible than these processions of human beings going like dummies to their deaths”. The SS tortured resisters to death so thoroughly, and they let this be widely known throughout the occupied territories, that most of their victims preferred the comparatively easy death the Nazis offered them - before the firing squad or in the gas chamber.

RACISM AND GENOCIDE

Race prejudice, whatever its origin, is potential violence. Racial discrimination is latent violence which leads to violence itself. Racism is a convenient method to avoid the acknowledgement of unwelcome socio-economic factors. Killing, and mass killing, does not come naturally. It needs psychological preparation and a rationalization for taking life. This can be provided by race prejudice and the villification of the victim. The victim is seen as a stereotype and later as sub-human, no longer entitled even to mercy. Violence is thus made acceptable. If one race considers itself human and another an essentially inhuman force, then it desires not only its complete subordination but also its extermination (17).

Dehumanization leads to the explanation, justification and propagation of violence. Violence tolerated is violence encouraged. Racial prejudice is imbibed from the social environment and, if not corrected at this level, leads inevitably to violence. Race riots are a violent and complex social phenomenon. A major race riot is an abortive urban revolution.

At the trial, in 1987, of Klaus Barbie, the former Lyons (in France) Gestapo Commander, Nabil Bouaita, of the Algiers Bar, in a lengthy digression into the question of crimes against humanity over the years and around the world, said that, alas for humanity, history is rich in genocides. Jean-Martin Mbemba, of the Bar of Brazzaville, detailed French colonial actions resembling those of the Nazis, citing, in particular, the construction of the Brazzaville railway, where, he said, 17,000 black men had died for the first 90 miles of the railway. He also cited the Setif massacre in Algeria on VE Day, 1945, when the death of 103 Europeans was followed by the murder of 15,000 Algerians. Jacques Verges, the leader of Barbie’s defence team, added numerous examples along the same lines, including the crimes of the 1000 British who, in the months and years following their disembarkation at Botany Bay, went on to massacre 300,000 native Australians.

Following protests in the courtroom. Verges asked, “If crimes against humanity only apply in some parts of the world, they risk being no more than a propaganda device whereby the victors usurp all human values” (18).

Holder describes in the British periodical, ‘Third World First’ how the English brought enough racist baggage to Australia, in 1778, to sink the continent. The carriers of this baggage were over 1000 people, two-thirds of who were the brutalized dregs of British society for whom life in Britain was “poore, nasty, brutish and short”. The predominance of men in the white colony ensured the kidnapping, enslaving and violent abuse of black women. As the natives were unilaterally declared ‘the King’s subjects’ before they were conquered, all resistance was ‘rebellion’, a criminal act deserving punishment.

Native Australian resistance to invasion by the British is the world’s best kept secret, as it is the victor who writes the history books. Over a period of a hundred and fifty years, one of the longest wars of conquest in history, 80% of the native Australian population were killed. All these facts have been concealed by the myth of peaceful settlement (19).

THE AMERICAN SCENE IN REGARD TO HUMAN EXPERIMENTATION

One definition of what constitutes a medical experiment was given by Professor McCance, professor of Experimental Medicine at the University of Cambridge, when he said: (20) “We should, I think, for present purposes, regard anything done to the patient which is not generally accepted as being for his direct therapeutic benefit or as contributing to the diagnosis of his disease, as constituting an experiment, and falling, therefore, within the scope of the term, experimental medicine”.

A more philosophical definition contained in a Netherlands Ministry of Health report goes on as follows: (21)

“Intervention in the psychic and/or somatic integrity of man which exceeds in nature or extent those in common practice. Such an intervention may be an act either of commission or omission”.

Dr Guttentag, of the University Medical School, California, defined medical experimentation as: (22) “Experiments on the sick which are of no immediate value to them but which are made to confirm or dispute some doubtful or suggestive biological generalization. Recently this type of experiment has become more and more extensive”.

In 1986, a United States House of Representatives subcommittee detailed the many experiments that were carried out on humans in the United States between 1945 and 1971 (23). The later experiments, at least, were undertaken when the experimenters were fully aware of all the consequences. The subjects were exposed to toxic doses of radioactivity, and they had no hope of benefiting from it themselves. Consent had not been obtained where the subjects had been prisoners, the mentally ill in institutions or the terminally ill in hospitals. In other instances, where ‘informed consent had been obtained, it was unlikely that the subjects had been aware of all the dangers. The report then went on to give examples (24). Between 1961 and 1965, for instance, 20 elderly ‘volunteers’ from the nearby New England Age Centre were injected, at the Massachusetts Institute of Technology, with radium or thorium, in order to study the metabolism of these substances. The subjects had been tricked into believing that the experiments had been planned to study the changes involved in the ageing process. The experiments had been of no benefit to these residents of an elderly peoples’ home, and there had been no follow-up.

In another example quoted, over 100 prisoners from Washington and Oregon state prisons were subjected, between 1963 and 1971, to testicular irradiation in order to determine a sterilizing dose. The projects were funded by the Atomic Energy Commission to the tune of $ 1.5 million. There was no long term follow up to detect the onset of testicular tumours. Between 1945 and 1947, 18 hospital patients including a 5 year old, with allegedly short expectations of life, were injected with plutoniun to measure the quantity retained in the body. The subjects received between 1.6 and 98.0 times the permissible occupational dose at that time. The subjects were deceived into thinking that these were experimental treatments for their very serious illnesses. In actual fact, the patients were not suffering from fatal illnesses and there had been no informed consent, Seven of the patients lived for more than 10 years, four for more than 25 years, and one was alive 36 years after the experiment. During 1946 and 1947, six tramps, who were either alcoholics, simply homeless or mentally disturbed, were offered a bed and comforts in hospital provided they agreed to take part as subjects in certain medical experiments. Having been assessed as having good renal function, these subjects were then injected with increasing doses of uranium-234 and uranium235 to determine the dose necessary to produce renal injury.

These experiments were all instances in which ethical standards were breached and the code of ethics on human experimentation, as stated in the Declaration of Geneva in 1947, amended by the World Medical Association in 1964 and revised as the Declaration of Helsinki in 1975, was violated.

THE BRITISH EXPERIENCE IN HUMAN EXPERIMENTATION

In 1967, a British consultant physician, M.A. Pappworth, published a report on the implications of medical research on both the medical profession and on the men, women and children who are the subjects of medical experiments (25). It would appear that very few lay persons have any idea of the issues involved and, amongst the medical profession itself, the majority of doctors are either genuinely ignorant of both the immensity and complexity of the matter, or wish to ignore it.

According to Pappworth, it had become a common occurrence in the sixties for doctors in research, in the United Kingdom, to take risks, with patients, of which risks the patients themselves were frequently unaware, and to submit these patients to mental and physical hazards which were in no way necessitated by, or connected with, the treatment of the illnesses from which they were suffering. In some cases, the recovery of patients was deliberately retarded in order that the investigation of a particular condition could be extended.

Dr Pappworth’s experience must mirror that of other doctors, in Britain, who, from time to time, have attempted to free themselves and their patients from the clutches of what Donald Gould called the British “Medical Mafia” (26).

In the preface to his book “Human Guinea-Pigs: Experimentation on Man”, Dr Pappworth says: “During private discussions of this subject, I have frequently been attacked by doctors who contend that, by such publication, I am doing a great disservice to my profession, and, more especially, that I am undermining the faith and trust that lay people have in doctors.

"For a long time there have been rumours that I intended to publish this book and, as a result, I have been subjected to frequent telephone calls, almost entirely from strangers, in an attempt to persuade me to abandon the project.

“Other doctors and lay people have attempted to persuade me that the wiser course would be to continue to attempt to publish my views, in medical journals and so avoid completely any discussion outside professional circles. An important fact is that those journals which publish accounts of the worst types of experiments (in Britain) do not have correspondence columns. When I have spoken on this subject of human experimentation to medical societies, the usual reaction has been, “This does not concern us, as we do not do such things”, and the problems are ignored. Mundane, material matters of pay, status and terms of service, would, in contrast, produce a lively discussion”.

For several years, a few doctors on both sides of the Atlantic had been attempting to bring to the attention of their colleagues certain practices which were becoming increasingly common in hospital practice under the name of clinical research. Clinicians appeared, temporarily at least, to have forgotten that sick people in hospital had common rights and were hoping to be cured. In the conspiracy of silence, however, that obtains amongst the self-selecting elite of one of Britain’s prestigious professions, there had been censorship of expressions of protest, and Dr Pappworth goes on to describe how his efforts to publicise human experimentation in Britain had been thwarted by the editor of ‘The Lancet’, Britain’s oldest current medical journal (27). (In Britain, medical experiments are never carried out on private patients, whether they occupy private beds in National Health Service hospitals, or whether they are in hospitals run by private medical agencies).

Few family doctors are really aware of what goes on in many teaching hospitals, to which they send their patients, nor do many consultants or budding consultants who are not involved in human experimentation. It is not unknown for clinicians involved in research to work in secret behind closed doors within large teaching hospitals. The large teaching hospitals in Britain have become dominated by consultants whose main interest is research. These doctors have become so intent on achieving scientific and technical advances that they see research as the great business of medicine and the treatment of the patient himself as something of much less importance.

A Bostonian, Dr Szent-Gyorgi, speaking in 1961 at an international medical congress, had this to say: “The desire to alleviate suffering is of small value in research -such a person should be advised to work for a charity. Research wants egotists, damned egotists, who seek their own pleasure and satisfaction, but find it in solving the puzzles of nature” (28).

There are doubtless a great many British consultants who would agree with the above. In fact, a great deal of time is spent by newly qualified and younger doctors in working on medical experiments to assemble data or perfect a new technique which may not be of the slightest value. Research, however ill-conceived it may be, enables an aspiring young doctor to obtain material for publication. All publications received from teaching hospitals , by custom, also bear the name of the professor or head of department, even though his contribution may have been minimal. Hence the bias, at interviews for the post of hospital consultant, towards the candidate who is able to detail the greatest number of research publications on his curriculum vitae. The interviewing committees themselves are dominated by the regional professor, the representative of the Royal College (of medicine, surgery or whatever, depending on the nature of the post in question and the speciality) and the region’s senior medical staff in the speciality. Because the facilities for recognised research are usually controlled by the regional university’s professors, it will be seen that the process for the reproduction of Britain’s medical elite is already well under way at this stage.

In the pursuit of research and a long list of publications to add to his credit, a young doctor is diverted from obtaining useful clinical experience at an early stage in his career. The diversion of a considerable number of young doctors, often for prolonged periods, has only been made possible by the recruitment of medical graduates from the poorer countries of the Third World to work in the service units of the NHS and thus keep the health service going.

A British cardiologist, Sir John Parkinson, however, had this to say about British medical research at an International Congress of Cardiology (29). “In my view, we encourage good men, inept for research, to sacrifice their time and energy upon it, when they should be perfecting themselves as bedside physicians...........Advances in medicine comprise two seperate stages; first, the discovery of something new and valuable as the result of investigation; secondly, the application of that new discovery to the benefit of the individual patient. The same man may not be the right one for both stages though he can be. Though commoner than aptitude for research, the power to apply new and old knowledge judiciously is not given to everyone. It requires a gift - namely clinical judgement. This will ripen to clinical wisdom only by constant association with the sick”.

In the first part of his report (30), Dr Pappworth describes experiments many of which were performed in National Health Service hospitals in Britain (or, before 1948, in local authority and voluntary hospitals) between 1945 and 1966. These were experiments on infants and children, pregnant women, mental defectives and the mentally sick, prison inmates, the elderly, the experimenters themselves, non-patient volunteers, on patients awaiting operations, as extensions of operations, and on patients with heart disease. Dr Pappworth also describes instances when patients were used as controls in experiments, when illness was induced in patients, and when research was done on patients with kidney diseases. He goes on to say(31): “This is a terrible thing to have to say, but - apart from the fact that many of the victims of the Nazi doctors were inmates of concentration camps which the subjects of contemporary experimenters are not - where can we draw the line between the experiments done in Germany between 1939 and 1945 and some of those, recorded in the (i.e. Dr Pappworth’s) book, which have been done between 1945 and 1966 (nearly covering the first two decades of the National Health Service)?”.

Dr Pappworth then goes on to quote Victor von Weizeacher (from the book “The Death Doctors” (Elek)): “There can really be no doubt that the moral indifference to the sufferings of| those selected for euthanasia and experiments was favoured by a medical ideology which puts human beings on the level of a molecule, or a frog, or guinea-pig. Today, everyone is aware of that fact with the exception, it must be feared, of certain doctors who still cannot recognize the truth owing to their special pre-occupation”. As Dr Bean of Iowa said, in the fifties, (32): “The degradation of physicians in Germany exemplifies the decline and fall of a group whose moral obligations went by default in a single generation. The house would not have fallen had not many of the timbers been rotten. Descent into the gas chambers by doctors of infamy had its beginnings in disregard for patients. The patient, however humble, and however ill, in whatever degree derelict and forlorn, has sacred rights which the physician must always put ahead of his burning curiosity.”

Bernal (33) wrote that the physician’s main function, prior to the advent of scientific medicine, was to give hope to the patient and comfort to his relatives. With the increased efficiency and rationalization in medical practice based on scientific development, physicians began to make distinctions in the handling of acute and chronic diseases. In a society increasingly concerned with cost-effectiveness, an attitude of contempt combined with unconscious hostility has developed within the medical profession towards patients with chronic diseases who cannot be rehabilitated with current treatment methods.

Chronic invalids, for whom there are, at present, no effective remedies, have become a threat to the medical profession’s delusions of omnipotence. Under authoritarian governments and regimes, the ruling elite claims that all is being done for the best for the people as a whole, and that provision for health care must be looked at in terms of utility, efficiency and productivity. The fascists’ medical institutions that dealt out death were the ‘reductio ad absurdum’ of planning for health care based, not on humane compassion, but on rational principles and economy. Eliminating those of marginal value, who are ‘primarily consumptive rather than productive’ is the basic strategy of fascist medicine (34).

A lecturer at the University of Manchester’s School of Nursing was quoted as saying, to the ‘Nursing Times’ in 1987 (35) that: “British nurses are often involved in euthanasia, deliberating shortening life, as well as omitting life-prolonging treatments”. She went on: “The difficulty in assessing the extent of these practices is obvious, given their illegality and the pressure not to “tell on colleagues”. Authoritarian governments and regimes think in destructive rather than in ameliorative terms in dealing with social problems. The destructive principle, once unleashed would engulf the whole personality and then be directed against one’s entire surrounding world.

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