Using Data from Nazi Medical Experiments

"Even so every good tree bringeth forth good fruit; but a corrupt tree bringeth forth evil fruit. A good tree cannot bring forth evil fruit, neither [can] a corrupt tree bring forth good fruit. Every tree that bringeth not forth good fruit is hewn down, and cast into the fire. Wherefore by their fruits ye shall know them."

Gospel of Matthew 7:17-20

I. Fruits of the Poisoned Tree

Nazi doctors conducted medical experiments on prisoners in a variety of concentration and extermination camps throughout Europe, most infamously in Auschwitz, Ravensbrück, Sachsenhausen, Dachau, and Mauthausen. The unfortunate subjects were coerced or tricked  into participating in the procedures, which often ended in agonizing death or permanent disfigurement.

The experiments lasted a few years and yielded reams of data on the genetics of twins, hypothermia, malaria, tuberculosis, exposure to mustard gas and phosphorus, the use of antibiotics, drinking sea water, sterilization, poisoning, and low-pressure conditions. Similarly, the Japanese conducted biological weapons testing on prisoners of war.

Such hideous abuse of human subjects is unlikely ever to be repeated. The data thus gathered is unique. Should it be discarded and ignored, having been obtained so objectionably? Should it be put to good use and thus render meaningful the ultimate sacrifices made by the victims?

There are three moral agents involved in this dilemma: the Nazi Doctors, their unwitting human subjects, and the international medical community. Those who conducted the experiments would surely have wanted their outcomes known. On a few occasions, Nazi doctors even presented the results of their studies in academic fora. As surely, their wishes should be roundly and thoroughly ignored. They have forfeited the right to be heard by conducting themselves so abominably and immorally.

Had the victims been asked for their informed consent under normal circumstances (in other words: not in a camp run by the murderous SS), they would have surely denied it. This counterfactual choice militates against the publication or use of data gathered in the experiments.

Yet, what would a victim say had he or she been presented with this question:

"You have no choice but to take part in experiment (E) and you will likely die in anguish consequently. Knowing these inescapable facts, would you rather that we suppress the data gathered in experiment (E), or would you rather that we publish them or use them otherwise?"

A rational person would obviously choose the latter. If death is inescapable, the only way to render meaningful an otherwise arbitrary, repugnant, and cruel circumstance is to leverage its outcomes for the benefit of future generations. Similarly, the international medical community has a responsibility to further and guarantee the well-being and health of living people as well as their descendants. The Nazi experiments can contribute to the attainment of this goal and thus should be reprinted, studied, and cited - but, of course, never emulated or continued.

But what about the argument that we should never make use - even good use - of the "fruits of a poisoned tree" (to borrow a legal term)? That we should eschew the beneficial outcomes of evil, of the depraved, the immoral, the illegal, or the unethical?

This argument flies in the face of reality. We frequently enjoy and consume the fruits of irredeemably poisoned trees. Museum collections throughout the world amount to blood-tainted loot, the by-products of centuries of colonialism, slavery, warfare, ethnic cleansing, and even genocide; criminals are frequently put behind bars based on evidence that is obtained unethically or illegally; countries go to war to safeguard commercial interests and continued prosperity; millions of students study in universities endowed with tainted money; charities make use of funds from dubious sources, no questions asked. The list is long. Much that is good and desirable in our lives is rooted in wickedness, sadism, and corruption.

II. The Slippery Slope of Informed Consent

In the movie "Extreme Measures", a celebrated neurologist is experimenting on 12 homeless "targets" in order to save millions of quadriplegics from a life of abject helplessness and degradation. His human subjects are unaware of his designs and have provided no informed consent. Confronted by a young, idealistic doctor towards the end of the film, the experimenter blurts something to the effect of "these people (his victims) are heroes". His adversary counters: "They had no choice in the matter!"

Yet, how important is the question of choice? Is informed consent truly required in all medical and clinical experiments? Is there a quantitative and/or qualitative threshold beyond which we need ask no permission and can ethically proceed without the participants' agreement or even knowledge? For instance: if, by sacrificing the bodies of 1000 people to scientific inquiry, we will surely end up saving the lives of tens of millions, would we be morally deficient if we were to proceed with fatal or disfiguring experimentation without obtaining consent from our subjects?

Taken a step further, we face the question: are decision-makers (e.g., scientists, politicians) ethically justified when they sacrifice the few in order to save the many? Utilitarianism - a form of crass moral calculus - calls for the maximization of utility (life, happiness, pleasure). The lives, happiness, or pleasure of the many outweigh the life, happiness, or pleasure of the few. If by killing one person we save the lives of two or more people and there is no other way to save their lives - such an act of desperation is morally permissible.

Let us consider a mitigated form of "coercion": imagine a group of patients, all of whom are suffering from a newly-discovered disease. Their plight is intolerable: the affliction is dehumanizing and degrading in the extreme, although the patients maintain full control over their mental faculties. The doctors who are treating these unfortunates are convinced beyond any reasonable doubt that by merely observing these patients and subjecting them to some non-harmful procedures, they can learn how to completely cure cancer, a related group of pathologies. Yet, the patients withhold their informed consent. Are we justified in forcing them to participate in controlled observations and minimally invasive surgeries?

The answer is not a clear-cut, unequivocal, or resounding "no". Actually, most people and even ethicists would tend to agree that the patients have no moral right to withhold their consent (although no one would dispute their legal right to "informed refusal"). Still, they would point out that, as distinct from the Nazi experiments, the patients' here won't be tortured and murdered.

Now, consider the following: in a war, the civilian population is attacked with a chemical that is a common by-product of certain industrial processes. In another conflict, this time a nuclear one, thousands of non-combatants die horribly of radiation sickness. The progression of these ailments - exposure to gas and to radiation - is meticulously documented by teams of army doctors from the aggressor countries. Should these data be used and cited in future research, or should they be shunned? Clearly the victims did not give their consent to being so molested and slaughtered. Equally clearly, this unique, non-replicable data could save countless lives in the event of an industrial or nuclear accident.

Again, most people would weigh in favor of making good use of the information, even through the victims were massacred and the data were obtained under heinous circumstances and without the subjects' consent. Proponents of the proposition to use the observations thus gathered would point out that the victims' torture and death were merely unfortunate outcomes of the furtherance of military goals ("collateral damage") and that, in contrast to the Nazi atrocities, the victims were not singled out for destruction owing to their race, nationality, or origin and were not subjected to gratuitous torment and mortification.

Let us, therefore, escalate and raise the moral stakes.

Imagine a group of patients who have been in a persistent vegetative state (PVS, or "coma") for well over 20 years, their lives maintained by expensive and elaborate machinery. An accidental scientific discovery demonstrates that their brain waves contain information that can effectively and thoroughly lead to a cure for a panoply of mental health disorders, most notably to the healing of all psychotic states, including schizophrenia-paranoia. Regrettably, to obtain this information reliably and replicably, one must terminate the suspended lives of many comatose people by detaching them from their life-support units. It is only when they die convulsively that their brains produce the aforementioned waves. Should we sacrifice them for the greater good?

This depends, many would say. If the patient does not recover from PVS within 1 month, the prognosis is bad. Patients in PVS survive for years (up to 40 years, though many die in the first 4 years of their condition) as long as they are fed and hydrated. But they very rarely regain consciousness (or the ability to communicate it to others, if they are in a "locked-in" state or syndrome). Even those who do recover within days from this condition remain severely disabled and dependent, both physically and intellectually. So, PVS patients are as good as dead. Others would counter that there is no way to ascertain what goes on in the mind of a comatose person. Killing a human being, whatever his or her state, is morally impermissible.

Still, a sizable minority would argue that it makes eminent sense to kill such people - who are not fully human in some critical respects - in order to benefit hundreds of millions by improving their quality of life and functionality. There is a hierarchy of rights, some would insist: the comatose have fewer rights than the mentally ill and the deranged and the "defective" are less privileged than us, normal, "full-fledged", human beings.

But who determines these hierarchies? How do we know that our personal set of predilections and prejudices is "right", while other people are patently wrong about things? The ideology of the Nazis assigned the mentally sick, the retarded, Jews, Gypsies, and assorted Slavs into the bottom rung of the human ladder. This stratification of rights (or lack thereof) made eminent sense to them. Hence their medical experiments: as far as the Nazis were concerned, Jews were not fully-human (or even non-human) and they treated them accordingly. We strongly disagree not only with what the Nazis did but with why they acted the way they did. We firmly believe that they were wrong about the Jews, for instance.

Yet, the sad truth is that we all construct and harbor similar ladders of "lesser" and "more important" people. In extreme situations, we are willing to kill, maim, and torture those who are unfortunate enough to find themselves at the bottom of our particular pecking order. Genocide, torture, and atrocities are not uniquely Nazi phenomena. The Nazis have merely been explicit about their reasoning.

Finally, had the victims been fully informed by the Nazi doctors about the experiments, their attendant risks, and their right to decline participation; and had they then agreed to participate (for instance, in order to gain access to larger food rations), would we have still condemned these monstrous procedures as vociferously? Of course we would. Prisoners in concentration camps were hardly in the position to provide their consent, what with the conditions of hunger, terror, and disease that prevailed in these surrealistic places.

But what if the very same inhumane, sadistic experiments were conducted on fully consenting German civilians? Members of the Nazi Party? Members of the SS? Fellow Nazi doctors? Would we have risen equally indignantly against this barbarous research, this consensual crime - or would we have been more inclined to embrace its conclusions and benefit from them?