Outcome 1: Define Intellectual Disability

TASK 1

1.1 Give 2 definitions of intellectual disability in accordance with a recognized source. Follow prescribed APA format when citing sources.

Definition 1:

Intellectual disability causes limitations in intellectual functioning as well as in adaptive behaviors that include many skills which is needed every day. The onset age is under 18.

Source


:

FAQ on Intellectual Disability, American Association on Intellectual and Developmental Disabilities, retrieved from:

http://aaidd.org/intellectual-disability/definition/faqs-on-intellectual-disability

Definition 2:

Intellectual disability is a term used for when people has certain limitations in functioning mentally and in skills such as communicating, performing activities of daily living, and in his or her social behavior. Children with this ability may develop their skills (walking, talking, etc) at a delayed time as compared to normal. They may also have trouble with learning- it usually takes them a longer time to learn new skills.

Source:

National Center on Birth Defects and Developmental Disabilities.(2005) Intellectual disability, retrieved from:

http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/IntellectualDisability.pdf

1.2 Using a definition of intellectual disability give 2 explanations of how this impacts on the persons adaptive skills:

1. People with intellectual disability have experienced impairment in their ability to comprehend information. As a result, they have a hard time with reading comprehension, handling money, dealing with numbers as well as time.
2. Because of their impaired social functioning, they have tendency not to get along and socially deal with others. They are not able to recognize the laws of society or have a few limited abilities to follow rules.

Using a definition of intellectual disability give 2 explanations of how this impacts on the cognitive abilities:

1. Persons suffering from intellectual disability have lack of the ability to explain why they do certain things or why certain things happen. This is due to their impaired intelligence.
2. Learn and apply what is learnt- Intellectually disabled people have a hard time to gain new knowledge. It is difficult for them to process new information and understand new skills.

Age of onset of intellectual disability

There is no particular age to have start of the disability. But regarding to some research, it has been shown that it usually happen on the developmental period among 0-18 years old.

Outcome


2:


Describe the causes of intellectual disability

TASK 2

2.1


Give 2 examples of causes of intellectual disability that occur before birth and describe two (2) main characteristics of the effects.

Example 1


:

Genetic factors

Source:

sevencounties.org (2005-2014). Genetic Cause of Intellectual Disabilities, retrieved from:

http://www.sevencounties.org/poc/view_doc.php?type=doc&id=10335&cn=208

Main characteristics:

1. Fragile X syndrome: Physical features of FXS patients include: large ears, long face, macroorchidism, infections in the ears, flat feet, high arched palate, fingers with double joints and hyper-flexible joints
2. Prader-Willi Syndrome: People with Prader-Willi Syndrome have severe hypotonia. Therefore their sucking is poor in their early infancy.

Example 2:

Environmental hazards and toxins

Source:

sevencounties.org (2005-2014). The Many Causes of Intellectual Disabilities, Fetal Alcohol Syndrome and Environmental Exposure to Toxins, retrieved from:

http://sevencounties.org/poc/view_doc.php?type=doc&id=10333&cn=208

Main characteristics:

1. Fetal Alcohol Syndrome: During pregnancy people drink alcohol a lot which might cause fetal alcohol syndrome. People are born with a small head, flat face and nose bridge in the most common features. They tend to be hyperactive and have hard time in socializing.
2. Spinal bifida: It is caused lack of folic acid. People with Spinal Bifida usually have such problems as mental and social. In addition, they have hard time with walking, going somewhere and latex allergy, obesity, skin breakdown, depression.

2.2


Give 2 examples of causes of intellectual disability that occur during or immediately following birth and describe 2 main characteristics of the effects.

Example


1


:

Trauma

Source:

Merck Sharp and Dohme Corp. (2010-2013). The Merck Manual, Home Health Handbook, retrieved from:

http://www.merckmanuals.com/home/childrens_health_issues/problems_in_newborns/birth_injury.html

Main Characteristics:

1. Head and brain injury: Swelling of the scalp and bruising may occur due to birth trauma. Bleeding between the periosteum and skull causes hematoma, usually in the parietal region and sometimes the occipital region.
2. Nerve Injury: when forceps used to assist delivery puts much pressure on the facial nerve, weakness on one side of the face results. This injury becomes evident when the newborn baby cries and the face appears to be asymmetric.

Example2:

Premature birth and low birth weight.

Source:

UCSF Children’s Hospital at UCSF Medical Center. 2004. Intensive Care Nursery House Manual, retrieved from:

http://www.ucsfbenioffchildrens.org/pdf/manuals/20_VLBW_ELBW.pdf

Main Characteristics:

1. Hypothermia: Low birth weight infants have a greater body surface area. Thus, a decrease stores of brown fat and glycogen which results to an inability to conserve or generate body heat.
2. Respiratory Distress Syndrome (RDS): Respiratory problems due to a lack in surfactant and apnea of prematurity

2.3 Give 2 examples of causes of intellectual disability that occur during childhood years


and describe the impact on the day-to-day support needs of the person.

Example 1

: Brain Tumor

Source:

PMC: US National Library of Medicine, National Institute of Health. January 2008. “Caring for the Brain Tumor Patient: Family caregiver burden and unmet needs.”, retrieved from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600839/

Impact:

Patients with brain tumor need various supports in their day to day lives. Psychosocial support is one of them. It is important for them to learn how to handle the stress of a chronic illness, as family members realize that their lives will be forever changed by the uncertainty that surrounds this diagnosis. It is therefore important for the support provider to make sure the patient and family understands the impact of this illness to them and provide them of ways on how to cope and possibly live a close to normal life. Also, for the caregivers, it is important that they are always prepared for the possibility of disease progression. Even though a patient is stable for a certain period of time, the caregiver will always feel the wear and tear of caring for this patient. Thus, it is important to make sure that caregivers are also taken cared of to ensure quality care.

Example


2


:

Meningitis

Source:

Kelli de la Rocha (2014). Intellectual disability. NYU Langone medical center. retrieved from:

http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/intellectual-disability#

Impact:

Children with intellectual disability caused by meningitis can’t learn skills and any knowledge as fast as other children with same age. So supporters need to wait for their achievement with patient. And also they need to be aware of the risk that the children experience seizure, and then they should be trained for coping with them suffering seizure.

Outcome 3: Describe conditions frequently associated with intellectual disability.

TASK 3

Condition 1:

Cerebral Palsy

Causes


/s


:

Cerebral Palsy can be caused by having injury of brain before brain development is completed. Usually brain develops within 2 years after birth, so Cerebral Palsy can be occurred during prenatal or infant period. And birth complication can also cause this condition. But many cases get this condition from unknown causes before birth.

Main characteristic 1:

Cerebral Palsy is characterized by motor function impairment. It causes activity limitation.

Main characteristic 2:

People with Cerebral Palsy exhibit cognitive and sensory impairments.

Physical support:

People with Cerebral Palsy suffer from hypotonic and rigidity. So physical therapy is useful to support them physically. Effective physical therapy can help them to improve their muscle. Recent studies report that intensive exercise is effective. So support worker can make a schedule for resistive exercise four times per week.

Social support:

People with Cerebral Palsy can be easily isolated because of their handicaps. So support workers need to reduce barriers to participation in activities of school, work and society. To participate in activities, many devices are necessary. If the client can’t walk, using wheelchair could be helpful to go watching football games and cheer a team.

Cognitive support:

People with Cerebral Palsy can be normal intellectually, but they have difficulty in learning because of limitation of hearing, seeing, and movement. So for supporting them cognitively, support worker needs to help their study by give them enough time to understand and express or adjust knowledge. And support worker can provide some aids to improve their speech.

Source


/s


:

Karen W. Krigger, M.D., M.ED., university of Louisville school of Medicine, Cerebral Palsy: An Overview, Kentucky Am Fam Physician. 2006 Jan 1; 73(1): 91-100, retrieved from

http://www.aafp.org/afp/2006/0101/p91.html

Condition 2: Prader-Willi Syndrome

Causes


/s


:

Prader-Willi Syndrome is caused by genetic abnormality. They have the chromosome number 15 without genetic information that normally people have from the father. It is thought to occur entirely by chance.

Main characteristic 1:

People with Prader-Willi Syndrome have severe hypotonia. So their sucking is poor in their early infancy.

Main characteristic 2:

Obesity is commonly caused. This is a result of an excessive appetite, a permanent feeling of hunger, and hyperphagia or overeating, and a low calorific requirement which is due to low energy expenditure levels.

Physical support:

People with Prader-Willi Syndrome can’t control their eating because they always feel hunger. Furthermore, they can easily become obesity that causes many complications. To prevent them from being obesity, support workers need to give exercise outside where they can’t find food easily. They need regular and continual exercise, so it is important to make a schedule with various and interesting exercise to them.

Social support:

They should take daily food intake under supervision. Once people between 2 and 4 years old start to overeat, supervision will assist them to minimize food and prevent them from being obesity. Parents make sure that they can easily open refrigerators and cabinets containing food to eat. It is extremely necessary for them to have a well-balanced, low-calorie diet and regular exercise and should be maintained for all of the individual’s life.

Cognitive support:

People who have PWS usually suffer from controlling their emotions. It is helpful to use behavioral therapy which helps them with their emotions. Losing temple, stubbornness and obsessive compulsive behavior as well as obsession with food have to be coped with behavioral management programs using firm limit-setting strategies.

Source:

Andres Martin, M.D, 1998, Prader-Willi Syndrome, Am J Psychiatry 1998; 155:1265-1273, retrieved from

http://ajp.psychiatryonline.org/article.aspx?articleID=173004

Condition


3

: Autism

Cause


/


s

:

Autism, a kind of neurodevelopmental disorder is defined by their behavior. But it is caused from various kind of brain dysfunction that affects the ability to handle information. In many cases, there is a genetic component.

Main characteristic 1:

People who have autism have impairment in many areas of development. They have difficulty in reciprocal interaction and have learning disability.

Main characteristic 2:

People with autism have lack of social and communication skill. Their behavior is not typical, but many babies with autism have tendency to overly focus on certain object. They also have poor eye contact and lose interest in others easily.

Physical support:

They have difficulty with making balance, gait and delicate motor skill. To improve their muscle tone, support workers need to provide regular physical fitness besides it is also important to be provided properly when they exercise.

Social support:

Children with autism may have the high risk of peer rejection and social isolation. To improve social skill, it is necessary to establish the relationship with support worker. Support workers need to provide practice proper and positive answer as much more as possible in social group. That is why they can learn facial express and eye contact.

Cognitive support:

People with autism have cognitive impairment, so they can’t be aware of their needs and cope with their mood. It can cause anxiety. It needs for them to recognize their mood. For this reason, support workers can give enough opportunities to express and verbalize their mood and feeling for recognizing their mood.

Source:

National Institute of Mental Health, 2011, A Parent’s Guide to Autism Spectrum Disorder, retrieved from:

http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-spectrum-disorder/parent-guide-to-autism.pdf

Abstract

This paper discusses the awareness of endometriosis. The importance of symptoms and diagnoses of endometriosis is vital for women suffering with the disorder. The outcome all women want is a cure. There has only been one proven cure, which is laparoscopic  surgery.

Introduction

Many women around the world are affected by a disorder called endometriosis. According to Endometriosis Foundation of America, “Endometriosis is a disease of menstruation. It occurs when tissue similar to the lining of the uterus, or endometrium, migrates outside of the womb where the tissue would not be (What is Endometriosis? 2019). The article goes on to explain that at least 200 million women have been diagnosed with the disorder, but many are unaware they even have it. Endometriosis pain can hinder the lives of many women. The article explains, “Endometriosis can impact all aspects of life- school, careers, finances, relationships, and overall well being (What is Endometriosis? 2019). Mayo Clinic offers a great description on signs and symptoms of the disorder. Mayo Clinic reports, “The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual. Pain may also increase over time” (Mayo Clinic, 2019).  There are several other signs and symptoms that Mayo Clinic addresses. Endometriosis can cause painful intercourse, dysmenorrhea, painful periods, diarrhea, excessive bleeding, and infertility. Unfortunately, whenever a couple is trying to conceive are unable to, endometriosis can sometimes be the cause.

While the cause of endometriosis is unknown, there is a theorist who tried to determine what does cause endometriosis and his theory is still used in today’s teachings. Dr. John Sampson became interested with endometriosis when he came into contact with so many of his patients that were diagnosed with it. Dr. Sampson came up with the theory that this cause of endometriosis was retrograde menstruation. Retrograde menstruation is where there is a backflow of the menstruation blood. The endometrium is the lining that sheds of the uterus monthly, and Sampson proposed that if all the debris goes back up into the fallopian tubes, back up to the ovaries and all around the pelvic area causing it to implant. Surprisingly, retrograde menstruation is normal for most women but there is not a way to be certain it happens because women can’t feel it when back flow does happen. There is no known cause as to why retrograde menstruation happens. Many other doctors believe that retrograde menstruation is a myth and tend to believe that endometriosis is a genetic disorder along with the retrograde menstruation.

Endometriosis is known to cause infertility and painful intercourse. Both conditions can not only take a toll on the woman but also her partner. According to Endometriosis.org, “Because endo can cause pain on intercourse, women with the disease may have to cope with the lack of sex or sexual pleasure. This may have significant effects on a woman’s feelings or sexuality or femininity” (Endometriosis.org, n.d.). Endometriosis.org goes on to explain that most women go years without being diagnosed with it and it is often known as the silent illness. Early diagnosis is very important when it comes to this disorder. Women can suffer for years and be mis-diagnosed with different disorders other than endometriosis.  Jena Hailes describes in her article the importance of being aware of the symptoms and the importance of early diagnosis. Within her article, she has charts for references. In the “Early Diagnosis is Important” column. It states, “Women face a 7-8-year delay for surgical diagnosis and up to 13 years for deep infiltrative diseases (DIE)” (Jean Hailes, 2016). Hailes also points out what should be included in the patient’s assessment. When assessing the patient, one would want to ask about the patient’s menstrual history. After the subjective data is collected, the nurse may want to use objective data by palpating the abdomen and watch the patient’s face for grimacing from pain. If the woman is sexually active, the nurse will want to perform a vaginal exam for nodules and ovarian cysts. Hailes describes that the way to diagnose endometriosis is by combining laparoscopic exploratory surgery and verifying with the patient that they have a family history of endometriosis.

Case Studies of Endometriosis

National Center for Biotechnology Center is a government-based website that provides information on medical testing and is provided by Cochrane Library. There was a randomized controlled trial and the treatment process for endometriosis. The background of this study states, “Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and is associated with pain and subfertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy” (Laparoscopic Surgery for Endometriosis, 2014). The point of this study was to prove that the only cure to endometriosis is laparoscopic surgery. There were 973 women chosen to participate in the study. There were several comparable RCT studies done during this time. They compared groups of women who underwent laparoscopic excisions compared to women who underwent ablations. There were other RCT of women who were given hormone therapy such as birth control or gonadotropin- releasing hormone analogue or also known as GnRHa. The women who took the hormone therapy were laparoscopically diagnosed with endometriosis. The main results reported, “When laparoscopic ablation was compared with diagnostic laparoscopy plus medical therapy (GnHRa plus add-back therapy), more women in the ablation group reported they were pain free at 12 months. The difference between laparoscopic ablation and laparoscopic excision in the proportion of women reporting overall pain relief at 12 months on a VAS 0 to 10 pain scale was a 0” (Laparoscopic Surgery for Endometriosis, 2014).

An older case study was chosen to establish evidence of how endometriosis should be assessed and treated. This case was performed in 1993, and doctors were still faced with the same evidence they are in today’s medicine.  The objective of the study was, “To undertake quantitative overviews of the following commonly used treatments for endometriosis-associated infertility: ovulation suppression, laparoscopic ablation, and conservative laparotomy” (Department of Obstetrics and Gynecology, McMaster University, 1993). The participants were chosen were women who had been visually diagnosed with endometriosis and had complaints of infertility. This study was also a randomized controlled trial. Hormone therapy also known as ovulation suppression was used and that treatment was deemed insignificant to treating the pain from endometriosis. The end of the results explains, “Laparoscopic data were similar to those from conservative laparotomy studies. Studies assessing conservative surgery plus danazol compared to danazol alone showed significant benefit from this adjunct” (


Department of Obstetrics and Gynecology, McMaster University, 1993). In other words, if one has the surgery done, they are then given hormone therapy to keep the endometriosis from growing back. The conclusion of this study reveals, “Ovulation suppression alone is an ineffective treatment for endometriosis- associated infertility. Well-designed trials of laparoscopic ablation deserve a high priority” (Department of Obstetrics and Gynecology, McMaster University, 1993).

Conclusion

Endometriosis is a very painful and can be debilitating for some women. Women can experience symptoms such a painful period, pelvic pain in between periods, painful coitus, and infertility. All of these can cause physical and psychological effects on a woman’s life and femininity. Theorists and doctors still aren’t 100% sure what the cause of the disease is. Clinical studies state that it is vital to diagnose endometriosis as early as possible to relieve the painful symptoms. Clinical studies have proven the only relief for endometriosis is laparoscopic surgery to have an excision or ablation performed.

References

• Hughes, E. G., Fedorkow, D. M., & Collins, J. A. (1993, May). A quantitative overview of controlled trials in endometriosis-associated infertility. Retrieved from
  
  https://www.ncbi.nlm.nih.gov/pubmed/8486196
  
• Duffy, J. M., Arambage, K., Correa, F. J., Olive, D., Farquhar, C., Garry, R., . . . Jacobson, T. Z. (2014, April 03). Laparoscopic surgery for endometriosis. Retrieved from
  
  https://www.ncbi.nlm.nih.gov/pubmed/24696265
  
• Jean Hailes for Women’s Health, 2016 (PDF)
• Endometriosis.org. (n.d.). Psychology and endometriosis « Endometriosis.org. Retrieved from
  

  Psychology and endometriosis

• Endometriosis. (2019, March 23). Retrieved from
  
  https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  

Laws of clinical trials-the Nuremberg phenomenon

Human research and war- German and the allied

German:

The Second World War (1939-45) is considered as the time when human research got a great attention along with all its flaws. The experiments conducted by the German government got all the attention, though the allied were also involved in such experiments.

The experiments that were done can be divided into three categories

1. Experiments aimed at facilitating the survival of Axis military personnel.- In Dachau, physicians from the German air force and from the German Experimental Institution for Aviation conducted high-altitude experiments, using a low-pressure chamber, to determine the maximum altitude from which crews of damaged aircraft could parachute to safety. Scientists there carried out so-called freezing experiments using prisoners to find an effective treatment for hypothermia. They also used prisoners to test various methods of making seawater potable.
2. Experimentation aimed at developing and testing pharmaceuticals and treatment methods for injuries and illnesses which German military and occupation personnel encountered in the field- At the German concentration camps of Sachsenhausen, Dachau, Natzweiler, Buchenwald, and Neuengamme, scientists tested immunization compounds and sera for the prevention and treatment of contagious diseases, including malaria, typhus, tuberculosis, typhoid fever, yellow fever, and infectious hepatitis. The Ravensbrueck camp was the site of bone-grafting experiments and experiments to test the efficacy of newly developed sulfa (sulfanilamide) drugs. At Natzweiler and Sachsenhausen, prisoners were subjected to phosgene and mustard gas in order to test possible antidotes.
3. Experimentation sought to advance the racial and ideological tenets of the Nazi worldview- The most infamous were the experiments of Josef Mengele at Auschwitz. Mengele conducted medical experiments on twins. He also directed serological experiments on Roma (Gypsies), as did Werner Fischer at Sachsenhausen, in order to determine how different “races” withstood various contagious diseases. The research of August Hirt at Strasbourg University also intended to establish “Jewish racial inferiority.”
4. Others- Other gruesome experiments meant to further Nazi racial goals were a series of sterilization experiments, undertaken primarily at Auschwitz and Ravensbrueck. There, scientists tested a number of methods in their effort to develop an efficient and inexpensive procedure for the mass sterilization of Jews, Roma, and other groups Nazi leaders considered to be racially or genetically undesirable.

Apart from the German experiments the other axis nation Japan had formed the unit 731, which had supposedly carried out human experimentations including germ warfare, weapon testing and vivisection. However the Japanese work was never tested on an accredited legal trial. Hal Gold, Unit 731 Testimony, 2003, p. 109 claims that this was mainly because MacArthur secretly granted immunity to the physicians of Unit 731, including their leader, in exchange for providing America, but not the other wartime allies, with their research on biological warfare.

[1]
Under leadership of Lev Smirnov, one of the top Soviet prosecutors at the Nuremberg Trials, The Japanese doctors and army commanders who had perpetrated the Unit 731 experiments received sentences from the Khabarovsk court ranging from two to 25 years in a Siberian labour camp. The Americans refused to acknowledge the trials, branding them communist propaganda.

The allied experiments

[2]
–

The office of scientific research and Development (OSRD) was formed in the summer of 1941, by the executive order of the president of USA, to look over two committees –one related to weapons research and other the Committee on Medical Research (CMR)—to combat the health problems that threatened the combat efficiency of American soldiers. During the years the OSRD funded 600 research proposals valued at $25 million with 135 institutes.

[3]
The CMR not only provided the organisational basis but also the intellectual justification of post-world war NIH (national Institute of Health, USA). The CMR’s major concerns were dysentery, influenza, malaria, wounds, venereal diseases, and physical hardships (including sleep deprivation and exposure to frigid temperatures).

The dysentery trials of CMR residents of the Ohio Soldiers and Sailors Orphanage in Xenia, Ohio; the Dixon, Illinois, institution for the retarded; and the New Jersey State Colony for the Feeble- Minded. The residents were injected with experimental vaccines or potentially therapeutic agents, some of which produced a degree of protection against the bacteria but, as evidenced by fever and soreness, were too toxic for common use. In the malaria trial researchers chose to infect residents of state mental hospitals and prisons. A sixty bed clinical unit was established at the Manteno, Illinois, State Hospital; the subjects were psychotic, backward patients who were purposefully infected with malaria through blood transfusions and then given antimalarial therapies. Similarly, residents of state facilities for the retarded (Pennhurst, Pennsylvania) and the mentally ill (Michigan’s Ypsilanti State Hospital) were used for the anti- influenza trials.

Thus the wartime experiments both in the Nazi Germany and the Allied countries were promoting teleological as opposed to deontological ethics; “the greatest good for the greatest number” was the most compelling precept to justify sending some men to be killed so that others might live.

Post war changes – the Nuremberg Trial-

The epic shift in universal regulations of human experimentations as it is hailed by some came after the Second World War. The basis was the German Exploitation of the Jews in various camps and the subsequent war crimes trial that are combined to be known as Nuremberg trial. The trial comprised of one International Military Tribunal (IMT) and twelve trials of other accused war criminals before the United States Nuremberg Military Tribunals (NMT)

[4]
.

The NMT case 1- U.S.A. vs. Karl Brandt, et al, or the doctors’ trial as it is popularly known in public domain formed the basis of this regulation. Four counts of charges were brought against 23 doctors and researchers.

[5]
The counts included

1. common design or conspiracy
2. war crimes
3. crimes against humanity
4. Membership in a criminal organisation.

The specific crimes charged included more than twelve series of medical experiments concerning the effects of and treatments for high altitude conditions, freezing, malaria, poison gas, sulfanilamide, bone, muscle, and nerve regeneration, bone transplantation, saltwater consumption, epidemic jaundice, sterilization, typhus, poisons, and incendiary bombs. These experiments were conducted on concentration camp inmates. Other crimes involved the killing of Jews for anatomical research, the killing of tubercular Poles, and the euthanasia of sick and disabled civilians in Germany and occupied territories. The defendants were charged with ordering, supervising, or coordinating criminal activities, as well as participating in them directly.

The trial began on Dec 9, 1946 and ended on Aug 20, 1947. The trial saw 85 witnesses and 1500 documents. Out of 23 defendants, 7 were acquitted of all charges, 16 were found to be guilty and 7 of them were executed. The argument for the defendants that were placed before the tribunal were-

1. The defendants had obeyed the laws of the Nazi regime. In fact, their experiments were the result of legally valid orders given by government authorities
2. They were not guilty of any crime, and certainly not of a crime against humanity, because they were licensed physicians, engaged in research. And the research pattrn was not different from that in other places of the world.
3. They had not violated any law or stature by which they were governed in place during the time of the crime.

The NMT was not keen on trying the 1931 German guidelines, which was actually in force at the times of committing the crime, even after representation by defendants.

[6]
A document was hastily put in place on the advice of medical experts Harold Sebring, Leo Alexander, and Andrew Ivy, which later became famous as Nuremberg Code. It comprised of ten sets of guidelines as follows

[7]
–

1. The voluntary consent of the human subject is absolutely essential.

This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment.

The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.

2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

3. The experiment should be so designed and based on the results of animal experimentation and knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.

5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.

6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.

7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.

10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probably cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subjects.

However the Nuremberg Code was not a law into itself. It was merely a loose collection of ideas drafted hastily to provide a trial. Apart from article 4, 5, 9 & 10, the Nuremberg code literally draws from the 1931 German Directive, though there are no acknowledgements of such and thus makes itself guilty of Plagiarism.

[8]
While article 4 & 9 are non-controversial, the article 5 & 10 are poorly worded and actually provided loopholes by virtue of being poorly structured. Article 5 seems to suggest that studies that are endangering the life of subjects are permissible, if the investigator also is a subject. This runs against natural justice, just because the investigator is ready to risk his own life, he has no right to endanger another person’s life. By this token, a drunken pilot should be allowed to fly, since his own life is at jeopardy along with that of his passengers. Similarly in article 10, investigator is not required to terminate the trial, but should be merely prepared to do so, if he/she thinks there is risk of death or serious injury to the subject. The difference between being required to stop and ready to stop has been lost on the authors of the document.

[9]

---

[1]
Takashi Tsuchiya, “The Imperial Japanese Experiments in China,” in

The Oxford Textbook of Clinical Research Ethics

(Oxford University Press, 2008), 35–42.

[2]

Enclyclopedia of Bioethics

.

[3]
Ibid.

[4]
“Nuremberg Trials Project — Introduction,” accessed April 12, 2014, http://nuremberg.law.harvard.edu/php/docs_swi.php?DI=1&text=overview.

[5]
“Nuremberg Trials Project — Medical Case Overview,” accessed April 12, 2014, http://nuremberg.law.harvard.edu/php/docs_swi.php?DI=1&text=medical.

[6]
Sass HM, “Ambiguities In Judging Cruel Human Experimentation: Arbitrary American Responses to German and Japanese Experiments” 13, no. 3 (May 2003): 102–4.

[7]
“The Nuremberg Code (1947).”

[8]
RavindraB Ghooi, “The Nuremberg Code-A Critique,”

Perspectives in Clinical Research

2, no. 2 (2011): 72, doi:10.4103/2229-3485.80371.

[9]
Ibid.