La médecine expérimentale au tribunal: Implications éthiques de quelques procès médicaux du XXe siècle européen (review)
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Law is fundamental to the process of civilization, and in a way, there is nothing special in the fact that medicine comes to the bar. Yet unmistakably the great trials depicted in this collective work—Lübeck (1930–31), Nuremberg (1947), Thalidomide (1967–70), and Contaminated Blood Affairs—represent pathological events that shook societies by condemning errors and crimes and forcing goverments to change their research and health policies in an innovative manner.
It is often commonly received that bioethics is an invention of the late twentieth century, originating in the famous Nuremberg code, after a long period of medical “irresponsibility.” The book confirms that, fulfilling Claude Bernard’s agenda, medical experimentation in the nineteenth century enjoyed an unprecedented growth: it seemed accepted that academic freedom should not be restrained, and that the morality standards and code of behavior of the profession sufficed to avoid [End Page 787] any transgression. Yet these studies also reveal a more complex and contrasted history. First, the people concerned did not just submit silently to the schemes of the doctors. If governments were reluctant to interfere, judges wanted to limit medical autonomy and were ready to apply to doctors the common rules of law. Some affairs came to be openly discussed in journals, with debates on the legitimacy of introducing new drugs with uncharted effects, and on the patients’ rights to obtain information and to make decisions. Thus the famous Nuremberg trial represented by no means an absolute beginning. In fact, guidelines (Richtlinien) had been elaborated in Germany before the Lübeck drama. On the other side, Paul Weindling reveals some of the hidden agendas of the Nuremberg judges and an ethos more sympathetic to the doctors’ autonomy than is currently assumed.
The account of the BCG trial at Lübeck (1930–31), which marks a climax in the book, points to the chauvinism rampant on both sides of the French-German border, and unravels the far-reaching political implications of the scientific choices: The French were eager to see the Lübeck accident as a plot against their precious vaccine, which was expected to counter the disastrous effect of tuberculosis on a population decimated by the Great War. On the German side, the real charges were leveled at a man absent from the box, Albert Calmette, the initiator of the vaccine that had killed seventy-six children with tuberculosis. This parallel story of France and Germany suggests that trials are strongly affected by the historical and geographic context, and also that the practical consequences inferred by countries highly differ. This book pleads for the implementation of a still broader international comparison, exploring the whole range of theoretical issues and of local solutions devised to avoid the repetition of errors.
European countries have now harmonized their legislation as far as human experimentation is concerned, and have put the main emphasis on the formal aspects of consent—to the point that some think that medical research might be impeded in its development. Some patients, in the face of the increasing regulations, far from complaining that they are treated as human guinea pigs, claim free access to “compassionate” protocols and drugs, ahead of their official approval.
The book leaves pending the issue of to what extent legalist thinking is likely to solve most problems and what space has to be left for developing a critical mind among citizens. It illustrates forcefully the role of historical accounts in rousing attention to the errors and illusions of the past. Its contents are very...
