eBMJ -- Press Releases

BMJ Press Releases, Saturday 7 December 1996
Volume 313 No 7070

EMBARGO: Friday 6 November 00.01 Hrs

Nuremberg doctors' trial : 50 years on
The issues raised by the Nuremberg trials of doctors committing war crimes are as relevant in 1996 as in 1946, says BMJ editor
Nuremberg articles include:
[Editorial: Preventing Genocide by Sir Donald Acheson]
[Editorial: War crimes and medical science by Professor Jennifer Leaning]
[Education and Debate: Informed consent in human experimentation before the Nuremberg code by Prof Jochen Vollman and Prof Rolf Winau]
[Personal View: Nuremberg - Sex and Sin by David Berger]
[Personal View: Nuremberg - Can children be protected from the effects of war? by David Southall and Manuel Carballo]

Fifty years ago this week in Nuremberg the trial began of doctors who had committed war crimes during the second world war. The BMJ devotes around 40 pages of its 7 December issue to exploring the issues raised - issues which are still relevant in 1996.

"The issues thrown up by the trials - informed consent, the involvement of the doctors with the state, patient autonomy, genocide, and the behaviour of doctors when associated with abuses of human rights - are as relevant today as the day the trials began," says Richard Smith, editor of the BMJ.

Informed consent is the issue most closely associated with the Nuremberg trials, and the Nuremberg code produced in 1947 after the trials made informed consent an absolute requirement. The debate around whether informed consent should be an absolute requirement continues unabated. Twice in the past fortnight the BMJ has been debating whether to publish trials that did not include fully informed consent, and it did publish such a trial earlier this year. The Food and Drug Administration in the United States has just produced guidelines saying that research on patients needing immediate intensive care can be conducted without consent. And informed consent is at the centre of the case of Diane Blood, a British woman who has been denied the right to have her dead husband's sperm inseminated into her. She is denied because her husband never gave written consent.

Several of the articles in the Nuremberg issue revolve around doctors' involvement with the state. They describe how the Nazis developed the world's first and strongest anti smoking campaigns, how far from German doctors being corrupted by Hitler's regime they were ahead of the regime in advocating policies on eugenics, and how doctors have not fully considered the inherent conflict between caring for the individual as opposed to the health of the population. "Doctors today," says Dr Smith, "are very involved in action on public health and the rationing of health care, and they would do well to consider the relation of what they are doing to what German doctors were doing under National Socialism."

The killing by doctors of "less worthy" people was one of the main crimes addressed by the Nuremberg trials, and physician assisted suicide is perhaps the hottest issue in medical ethics today. The public in many countries are beginning to look favourably on the idea of physician assisted suicide, but most doctors' organisations continue to be strongly against it - partly because of memories of how the ethical code of medicine was debased during the second world war. But another issue thrown up by Nuremberg - that of the importance of patient autonomy - can conflict with the fundamental principle of "first, do no harm." "If patients clearly of sound mind want their doctors to hasten their ends, might the concepts of patient autonomy and serving the patients over-ride the deep professional instinct against euthanasia?" asks Dr Smith.

Genocide is also an issue that is as current in 1996 as it was in 1946. Donald Acheson, BMA President and Britain's former chief medical officer who grew up in Ireland and who led the World Health Organisation's relief efforts in Bosnia, describes in the BMJ what he thinks are the three stages of genocide. In the first stage there is systematic discrimination against a particular ethnic group. This stage is seen in most countries. In the second stage there is violence against the group. Again this is common. The third stage, argues Acheson, involves, the state becoming involved - openly or in secret. We have seen the terrible consequences of this in Bosnia and Rwanda, and we need trials of war criminals in both countries. Children suffer horribly in these conflicts, and David Southall and Manuel Carballo argue in the BMJ that the world needs to find mechanisms to protect children in these circumstances.

"I hope," concludes Dr Smith, "that this issue of the BMJ will help doctors and others think still more deeply about the many ethical issues that we faced in the second world war and continue to face."

Contact:
Dr Richard Smith, BMJ Editor

Tel: 0171 383 6102
Fax:0171 383 6418

Abortion and suicide risk
[Suicides after pregnancy in Finland, 1987-94: register linkage studies]

Women who have had an abortion have an increased risk of suicide, according to a paper from Finland in this week's BMJ.

Among women of childbearing age, suicide represented 15 per cent of all deaths. Information from death certificates was linked with national health records to find out the recent reproductive history of the women who committed suicide.

The suicide rate associated with miscarriage was higher than the average rate among women aged between 15 and 49 years (18.1 per 100,000 women cf a general rate of 11.3). Among women who had had an abortion, the suicide rate was three times higher than the general rate (34.7 cf 11.3 per 100,000 women). Women who had given birth had a lower suicide rate which was less than half the general rate (5.9 suicides per 100,000 women cf 11.3).

The Finnish data suggests that childbearing lowers the risk for suicide, although the risk was higher for teenage mothers. Relationships between abortion and suicide may be complicated by many factors such as depression and social class. The authors conclude the increased risk of suicide after an abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.

Contact:
Mr Mika Gissler
(not available on Friday 6.12.96)
Helsinki,
Finland

Tel: 003589 3967 2279
Fax: 003589 3967 2324

Road accident victims - is it good to talk?
[A randomised controlled trial of psychological debriefing for victims of road traffic accidents]

Psychiatric problems are common after road accidents and "psychological debriefing" is often used to minimise adverse reactions in victims. This week's BMJ publishes the results of a randomised controlled study to see if this intervention works . The study found no evidence that a single debriefing had helped, and some indication that it might have done more harm than good.

Contact:
Dr Michael Hobbs, consultant psychotherapist
Tel:01865 226 331
Fax: 01865 226 337

or Dr Richard Mayou
Tel:01865 226 469
Fax:01865 793101

Widow's fight for husband's sperm

Public debate over the rights and wrongs of the Diane Blood case continues in this week's BMJ. Ethical issues arising from Mrs Blood's fight for the right to use her late husband's sperm are raised in letters from:

Lord Winston, Professor of Fertility Studies at the Royal Postgraduate Medical School, Hammersmith Hospital, criticising the involvement of the BMA's medical ethics committee in writing to the Human Fertilisation and Embryology Authority;

Dr Stuart Horner, Chairman of the BMA Medical Ethics Committee , explaining the BMA's central concern to uphold the fundamental principle of the individual's rights over his or her own body; and John Hughes, Honorary Lecturer in medical law at the University of Wales, Aberystwyth, arguing that no one, not even a court, can give consent on behalf of an incompetent adult patient.