- Putting Consent in Context:Military Research Subjects in Chemical Warfare Tests at Porton Down, UK
In 1945, the British researcher Kenneth Mellanby reflected on the use of soldiers and conscientious objectors in experiments he had conducted during World War II. Military subjects "nearly always," he claimed, took part in experiments "either because the sergeant-major says, 'I want three volunteers ... Jones, Smith and Robinson report, etc.,' or else because he thinks that by being a volunteer he will get a cushy job for a time, and perhaps some extra leave as well."1
Similar pressures continued after the war as military researchers sought human subjects for various trials, including the now-notorious chemical warfare experiments at the Chemical Defence Experimental Establishment at Porton Down. The program of nerve-gas testing at Porton that commenced after World War II remains controversial, in large part because of the 1953 death of leading aircraftman Ronald Maddison from exposure to liquid sarin, a nerve agent. Under increasing pressure by former Porton volunteers, the original coroner's verdict of "misadventure" was quashed and an inquest into the death of Maddison was reopened in May 2004. Having reviewed evidence from experts, witnesses, and documents produced by Porton scientists and officials, the jury returned its verdict of unlawful killing in November.
Critics of Porton are correct to argue that Maddison and other "volunteers" there did not give the free, informed consent defined in medical ethics codes as the prerequisite to participation in experiments. But judging the ethics of human experiments against norms of medical-ethics guidelines and [End Page 53] codes disregards the differences between ethics in theory and ethics in practice. We need to understand better how researchers at specific sites defined volunteers in human experiments. At Porton, consent was not a simple yes/ no question, but a tangled set of concerns that evolved over time.
Research Ethics in the United Kingdom
The history of ethics in human experiments in the United States has attracted extensive scholarship. Academics and ethicists, notably George Annas and Michael Grodin, Ruth Faden and Tom Beauchamp, Jay Katz, Susan Lederer, Alan Hornblum, and Jonathan Moreno, have pronounced institutions guilty of unethical experiments.2 Furthermore, the investigation commissioned by President Bill Clinton, published as the Final Report of the Advisory Committee on Radiation Experiments in 1996, provided an insightful account of the U.S. history of ethics of human experimentation.3 In comparison, scholars in the United Kingdom have been somewhat slow to engage with this subject in the context of both research policies and practices and institutional histories of facilities engaged in the use of human subjects.4
Literature that examines the British context tends to replicate the approaches of U.S. academics by emphasizing the Nuremberg Code of 1947. Constructed by Allied medical experts during the trial of Nazi doctors at Nuremberg, the Nuremberg Code consisted of ten points that the experts asserted were the medical-ethics standards of the day. The first point set out the principle of "voluntary consent" as the prerequisite of any human experiment. Only those with "legal capacity to give consent" could do so and it clearly stated that consent was valid only if it was obtained without pressure after the subject had been given "sufficient knowledge" of the procedure to be able to make an "enlightened decision."5 Paul Weindling has examined the role of informed consent prior to and during the Nuremberg Doctors' Trial.6 He has also highlighted the involvement of the British medical profession in the Nuremberg Trials, which had been viewed as particularly U.S. dominated, and has drawn attention to the fears of the British medical profession that the Nuremberg proceedings threatened their autonomy.7 Following Weindling's work, Ulf Schmidt has produced a detailed biography of one of the medical experts at Nuremberg, Leo Alexander, and his involvement in the construction of the Code.8
Others, however, have downplayed the importance of the code for postwar research. Jenny Hazelgrove's article "The Old Faith and the New Science" [End Page 54] was the first concerted attempt to examine the impact and meaning of the Nuremberg Code, in particular its principle of informed consent, for British...