Dr Tom Kerns
North Seattle Community College

 

Jenner On Trial

Tom Kerns

 

 

 

 

Chapter 6

 

Dr Jenner and the Nazi doctors

Even though Dr Jenner's smallpox vaccine experiments with human subjects would probably have been considered for the most part ethically proper, the typhus vaccine experiments of the Nazi doctors at Buchenwald and Natzweiler concentration camps were definitely not considered ethically acceptable. Those vaccine experiments were strongly condemned by the Nuremberg Tribunals, even though the experiments were in some respects quite similar to Jenner's experiments. Why were the Nazi vaccine experiments condemned (even though they were in so many ways similar to Jenner's), and Jenner's experiments would likely have been approved? In order to respond to this question, we will need to look at some of the similarities and differences between the two sets of experiments.

Similarities

These two sets of vaccination experiments were actually similar in several respects. They were alike in that both sets of experiments were trying to find a preventive vaccine for a deadly infectious human disease. Both sets of experiments saw that the only way to effectively test a candidate vaccine for safety and efficacy in human beings would be to actually test it on living human beings. Both used vulnerable subjects, Jenner using minor children and the Nazis using camp prisoners. Both knew that, since the candidate vaccine was itself of unproven safety and unproven efficacy, the human subjects who participated in the experiments would necessarily be at some degree of risk. Both also knew, however, that the potential benefits to innumerable present and future human beings and to society at large which might be gained from doing the experiment, risky as it was to the individual participants, would be very great. Both knew that some few present human beings would be undergoing greater risk now in hopes that numerous other present and future human beings might enjoy a very great benefit as a result of these present risks: viz., protection against a terrible and highly lethal infectious disease, in one case typhus and in the other smallpox. Finally, and most ethically suspect of all, both experiments chose to test the effectiveness of their candidate vaccines by the method of direct challenge: i.e., they tried to directly mechanically infect, by injection or inoculation, each of their subjects with virulent matter that caused a lethal disease, in Jenner's case, smallpox, in the Nazi's case, typhus.

Given these basic similarities between the two sets of experiments, why is it that we condemn the one and approve the other?

Differences

The reason is that, despite these basic similarities, the ethical differences between the two sets of experiments are significant. These differences become apparent when we examine each of the following five factors.

i. Preliminary evidence
Jenner did have quite strong preliminary evidence that his cowpox inoculation would protect his subjects against smallpox infection. He had substantial anecdotal evidence from the dairymen and milkmaids who had contracted cowpox and who had then been subsequently protected against smallpox. He had the swinepox experiment he had done on his son Edward, Jr, which had proven to be both safe and (probably) effective. He had the attempted challenges (by means of variolation) which he had performed on persons who reported that they had had natural cowpox infection. And, though it was proof for only part of his hypothesis (that artificial immunization against smallpox is possible), he also had all the evidence which showed that the practice of variolation did indeed protect people against smallpox.

There is no reason to believe that the Nazi doctors had any preliminary evidence at all that their candidate vaccines were either safe or effective. Even if they did have such data, it would not have been nearly as substantial as Jenner's. The Nazis, in other words, were putting human beings at great risk with little or no evidence that the vaccine would be either safe or effective for them.

ii. Vulnerable subjects

It is true that Jenner and the Nazis both used human subjects who would be considered vulnerable, Jenner using minor children and the Nazis using prisoners, and that both these classes of subjects are considered to be not entirely capable of giving free informed consent. In this respect the two sets of experiments were alike, but they differed in two significant ways.

a) Jenner's experiment had a high likelihood of actually benefiting the vulnerable subjects by protecting them against infection with smallpox, since smallpox was a disease that they would very likely be exposed to several times in their lives. There was, furthermore, a smallpox epidemic occurring in London right at the same time Jenner was proposing to do his experiments, and people in Gloucestershire were doubtless concerned about their own and their children's safety. The Nazi subjects, on the other hand, had little likelihood of personally benefiting from the typhus vaccine experiments because there was little (if any) evidence that the vaccine would be either safe or effective for anyone.

b) The other significant way in which Jenner's vulnerable subjects were treated differently than the Nazi's vulnerable subjects is that Jenner's subjects were free to participate in the experiment or not. The Nazi subjects, on the other hand, were simply forced to participate, even though everyone knew they would probably suffer great harm, or death.

iii. Risks to subjects, benefits to others

In applying the utilitarian calculus of potential harms weighed against potential benefits, Jenner's subjects expected to take certain risks, but they also could expect that the risks might pay off for them individually, that they might personally benefit from the risks they took in the research. There was an appropriate risk-to-benefit ratio for the individual subjects. In the case of the Nazi typhus vaccine experiments, on the other hand, the individual subjects were absorbing all the risk, and the potential benefits, should there be any, would accrue almost exclusively to other persons. "A few would be hurt that many might be saved."

Furthermore, only 50% of the twins in the typhus vaccine experiments had even the smallest miniscule chance of enjoying any benefits at all from the experiments, viz., the subjects who actually received the candidate vaccine. The other 50% of subjects, i.e., the other twins, the controls, had no chance at all of benefiting, and virtually full certainty of being intentionally infected with a heavy (and probably fatal) dose of typhus.

iv. Informed consent

Jenner's subjects were informed of the purposes of the research, were told of the possible harms and possible benefits to subjects in the study, and were given the opportunity to freely choose whether to participate or not. They were also told (I am assuming) that they could freely quit their participation in the experiment at any time. Subjects in the Nazi vaccine experiments, however, were not informed about the purposes, the risks, or the benefits of the medical experiments done in the camps, and they were certainly not given the freedom to make an uncoerced choice about whether to participate or not. They were simply forced to participate.

v. Character of the investigators

There is almost never any conscious consideration given to questions about the character of the investigators. Officially, when considering the ethics of a proposed research protocol, the protocol is weighed entirely on its own merits, and all protocols are to be measured against the same strict set of ethical guidelines.

Nevertheless, I wonder if considerations about the investigators' character do not sometimes enter into our judgments about the protocols, even if only unconsciously. Considerations of character certainly do enter into our ethical judgments about actions in other spheres of life, even in the highly codified statutory structures of a courtroom. It would not be surprising to discover, therefore, that considerations of character also affected our judgments about medical experiments performed with human subjects. If we see that the principal investigators are persons of admirable character, or persons of questionable character, that fact may (and perhaps should) have some effect on our judgments about the worthiness of the experiments. All the other principles outlined in the ethical codes discussed in this book should of course play the major part in our judgments about the proposed protocol. Nonetheless, considerations of character will probably also enter into our judgments, if only under the quiet guise of an inclination to approve of, or an inclination to disapprove of, the protocol.

In comparing Jenner's experiments with the Nazi experiments, considerations of character probably also play a role, and perhaps should. We can recognize Dr Jenner's compassionate character, his deep concern for the well-being of his patients and subjects, and his hope of discovering a way to successfully prevent one of humanity's worst scourges. In the Nazis, on the other hand, we see in some cases the harsh, heartless cruelty of a Josef Mengele who can use his subjects and then send them off to the gas chambers to be destroyed, or we see in many other cases the apparent complete absence of normal human sympathy of any sort. We see, in other words, the seeming emptiness of character that leads to, in Hannah Arendt's phrase, "the banality of evil." It is little wonder, then, that we are at least inclined to approve of the one and despise the other. Nevertheless, good will alone or good character alone, does not make an act ethical. As Immanuel Kant has so clearly reminded us, in order for an action to be morally considered good, rectitude of character and motive is important, but the act itself must also be in accord with moral imperatives.

Thus, despite the superficial similarities between Jenner's experiments with vaccines and the Nazi experiments with vaccines, we can see that the significant ethical differences are enormous. It is no wonder that we feel so differently, and make such diametrically opposite moral judgments, about the two sets of experiments.

 

Jenner homepage and Table of Contents
preface | Introduction | chp 1 | chp 2 | chp 3 | chp 4
cchp 5 | chp 6 | chp 7 | chp 8 | App I | App II
Ethical Issues in HIV Vaccine Trials