Twentieth-Century Ethics of Human Subjects Research: Historical Perspectives on Values, Practices, and Regulations (review)

The essays in this edited volume were originally presented as a conference on this subject in 2001. Editors Volker Roelcke and Giovanni Maio ambitiously sought to look across the course of a century and a host of nations in exploring ethics as a historically contingent schema of moral reasoning and policy to regulate the behavior of investigators. The premise of the volume is that ethical discourse and decision-making are shaped by the interplay of ideas, interests, and institutions. It is, then, inherently political.

The volume is organized to reflect debates before and after the Second World War. Essays by Barbara Elkeles, Étienne Lepicard, and Gerhard Baader lay the foundation, as they relate norms and discussions in the later decades of the nineteenth century and the opening decades of the twentieth, up to Nuremberg. An exploration of research ethics and practices in the first decades of the twentieth century is provided by Wolfgang Eckhart, Christoph Gradmann, and Boris Yudin. Essays by Christian Bonah, Phillipe Menut, and Daniel Nadav explore the Lubeck BCG vaccination episode and scandal.

The second half of the book considers Nazi medicine and the Nuremberg Code, as well as the post-Nuremberg debates about ethics. Andreas Frewer, Volker Roelcke, Paul Weindling, Jenny Hazelgrove, Susan Lederer, Paul Edelson, Giovanni Maio, Jiri Simek, and Takashi Nagashima focus our attention on discussions in Great Britain, the United States, France, the Czech Republic, and Japan. Maria Rentetzi, Nadav Davidovitch, Nurit Kirsh, Harriet Washington, and Pei Koay make contributions that revolve around the politics of defining experimentation, with a particular focus on contemporary debates, and extend the scope of the volume to Israel and Iceland.

Among the outstanding papers in this volume are the truly illuminating essays by Weindling and Davidovitch. Weindling's analysis of the Nuremberg trial and Nazi doctors' defense carefully disentangles the legal and ethical objectives of the trial, and ultimately locates the origins of the Nuremberg Code in a discourse that took place apart from and prior to the courtroom drama. Davidovitch, in a sweeping and ingenious essay that traces the placebo's progress from a "humble humbug" to one of the hallmarks of scientific medical research, locates the status of the placebo in the changing power relationship between orthodox and alternative medicine.

Susan Lederer, for her part, does an unparalleled job of illuminating the politics of the more than decade-long effort to craft the Declaration of Helsinki. She uncovers the distinct national visions of ethical research and the financial and commercial clout that ultimately lent American viewpoints priority. Editors Roelcke and Maio also contribute two compelling essays to this volume: on research during Germany's National Socialist Era, and on the influences and inconsistencies in French research after the war.

Although there are, to be sure, fascinating essays in all sections of this book—such as the discussion of the very different ways in which BCG vaccination was framed and understood in France and Germany, and of population research in Iceland—its great strength lies in the analysis of Nuremberg and its aftermath. This helps to lift it above its weaker elements, which include an unevenness in the quality and production of the essays. Poor copyediting and translation at times obscure particular points within, if not the overall argument of, many of the essays. Some are too narrowly focused, or insufficiently developed beyond what would certainly have made fine conference papers to meaningfully illuminate current ethical debates and make clear the value of history, which is the aim of the editors. And given the commanding role that ethics has taken in debates regarding how to weigh the needs of society against the rights of the individual, at times some of the essays fall short in treating ethics as a historical discourse and privileging prevailing understandings of ethical principles, thus giving them a kind of trans-historical...