U.S. Complicity in Japan’s Wartime Atrocities
Harris, S. H. 2002. Factories of death: Japanese biological warfare, 1932– 1945, and the American cover-up. New York, NY: Routledge. Lafleur, W. R., G. B€ ohme, and S. Shimazono, eds. 2007. Dark medicine: Rationalizing unethical medical research. Bloomington, IN: Indiana University Press.
Nie, J. B. 2006. The United States cover-up of Japanese wartime medical atrocities: Complicity committed in the national interest and two proposals for contemporary action. American Journal of Bioethics 6(3): W21–W33.
Looking to the Future From the Past: Take Home Lessons From Japanese World War II Medical Atrocities Rael D. Strous, Beer Yaakov Mental Health Center and Tel Aviv University Ari Z. Zivotofsky, Bar Ilan University The injustices and atrocities of Nazi medicine were of catastrophic proportions. It is now well known that Nazi physicians during the Nazi era not only participated willingly in many of the inhumanities perpetrated on both the ill and non-ill, but they provided legitimacy to the Nazi regime, so sorely needed especially in its initial years of power. The physician and what he stood for were crucial to the success of Nazi policy, plans, and principles and on many occasions doctors enabled many of the regime’s ideological strategies (Chelouche 2008; Strous 2006). However, while there is much known about the practice of Nazi medicine during this time period, there is relatively little awareness about what happened contemporaneously several thousand miles away by Japanese physicians and medical researchers. Devolder (2015) is to be commended for raising awareness and addressing this poorly explored, recent historical episode characterized by a calamitous medical ethics failure. More specifically, as part of a wide scale setup termed the “Ishii Network,” named after its leader, Chief Medical Officer Shiro Ishii, Japanese doctors and researchers participated in and facilitated numerous human experiments in areas of biological warfare, military medicine, and infectious diseases. These studies were carried out in Manchukuo and areas of China occupied by Japan during World War II and were characterized by immense cruelty, wanton suffering, and profound disregard for human dignity and autonomy. It has been estimated that tens of thousands died, many after being exposed to extreme conditions of pain and suffering. Collaboration and participation by Japanese medical and research personnel were widespread, and it has been estimated that at its peak, the Ishii Network had more than 10,000 doctors and medical researchers conducting various biological and
other military related trials (Harris 2002). Much of the work of the network was carried out by Unit 731, established in 1936, in a huge 150-building site covering six square kilometers in the vicinity of the city of Harbin in China. Although it may be argued that the wanton cruelty and ethical violations committed by the Nazi physicians may have been matched or even exceeded by the Japanese medical professionals, it is at the end of the war that similarities between the two cases diverge. It became clear very soon after the war what atrocities in the name of medicine and medical science many of the German physicians had carried out. Many stood trial and were punished, both by the court of law and by losing their licenses to practice in their field. Perhaps even more significantly, the evils of medicine that occurred during the Nazi era, principally in Germany, Austria, and Poland, set into motion a process that fostered the development of ethical codes and declarations that slowly, over a period of decades, produced the welldefined codes of medical ethics that many around the world hold to be “sacred” to the practice of clinical and research medicine today. The first of these codes to be developed was the Nuremberg Code, in 1949, which demarcated 10 principles of medical experimentation, including voluntary consent, seeking societal good, minimizing harm, and permitting premature exit from study participation. This was followed by the more far-reaching 1960s Helsinki Declaration developed by the World Health Organization. The Helsinki declaration differentiated between therapeutic and nontherapeutic research, ensured the monitoring of studies, and clarified the means of surrogate decision making. Much discussion and academic work surrounded the ongoing development of these and other codes and
Address correspondence to Ari Z. Zivotofsky, Gonda Brain Research Center, Bar Ilan University, Ramat Gan 52900, Israel. E-mail: ari. [email protected]
June, Volume 15, Number 6, 2015
ajob 59
The American Journal of Bioethics
declarations over the years, including the valuable contribution of the 1979 Belmont Report, which demarcated three central principles governing ethical research: “respect for persons” (autonomy), beneficence, and justice. Thus, while much has been learned from the egregious behavior of German medicine, spurring the development of national and international medical ethical codes and declarations, no similar lessons were derived from the misdeeds of the Japanese medical community. It is generally accepted that the principal reason for this is that most, if not all, of the high-ranking Japanese physicians involved in the atrocities were never sent to trial and were never held responsible and publicly condemned to the extent that German physicians were following World War II. It is suggested (Devolder 2015) that what accounted for this oversight and omission was the complicity of the United States in ignoring or turning a blind eye to the Japanese physicians’ involvement in these programs in order to exploit their knowledge of biological warfare for U.S. national purposes. In addition, it allegedly was in order to thwart the possibility of Russian recruitment of these individuals for Soviet purposes after the war and during the initial stages of the “Cold War” between the United States and the USSR that the U.S. shielded the Japanese doctors. Devolder (2015) and others maintain that a focus should be made on the necessity for U.S. authorities to apologize for oversight in managing their alleged complicity in not uncovering and publicizing what took place during this time. This, it is argued, should be irrespective of the sociopolitical climate that appeared to have dictated much of the United States’ postwar decision making. However, we believe that it would be a pity if there was an overfocus on the necessity for U.S. authorities to apologize for their alleged complicity, as this would divert critical energy and creativity from once again learning from what transpired during this time period and building an even more ethical practice of medicine in general and an interface between medicine and government in particular. Instead of investing energy in demanding apologies and admission of guilt for this national wrongdoing, we think that a focus should be on what can be learned from this dark period. It would be misguided at best and irresponsible at worst if we failed to ensure that something can be learned from that period for the future of the medical field in general. A similar argument has been made regarding the role of German nurses and the lessons that can be learned from their misdeeds (Lagerwey 2009). Taking a page from the postwar period and how various medical and legal establishments addressed the Nazi medicine atrocities, a great deal can be achieved by moving forward and updating various codes of ethical practice in light of the Japanese medical atrocities and the alleged U.S. complicity. To name a few, these should include the following: 1. Reference to medical professionals’ boundary violations. Boundaries are critical to the practice of ethical
60 ajob
medicine. Perhaps there is no central governing principle more important than boundaries in the doctor– patient relationship. Thus, it would be unbecoming of a physician to transgress these boundaries and engage in a practice with patients with anything unrelated to the social contract that he or she received from the community—that is, the relief and treatment of illness and suffering (Strous 2013). While the principle of boundaries is one that is recognized as important in medicine, it is not one that has received much individual attention in international codes of ethical medical practice. The example of Japanese medical professionals engaging in experimenting with and practicing biological warfare is an example of a form of boundary violation and one from which future generations of medical professionals should learn a lesson. 2. Response to government interventions and/or interference in medical practice. Medical professionals should use their professional skills only to manage illness and suffering. Doctors have no mandate to engage in furthering the purposes of the political or governing establishment. Thus, for example, in a very contemporary subject (Iacopino and Xenakis, 2011), it is forbidden for physicians to aid in torture; even passive presence would be prohibited, even if it furthers the national interests of the government (O’Connor 2009). The necessity for physicians to desist from involvement in governmental interest outside of their contract with society needs to be made clear and emphasized in international medical codes of ethics. 3. Reference to complicity and/or silence in the face of medical ethical violations. It appears that after the war the United States was complicit in the cover-up and lack of prosecution of Japanese medical professionals due to the United States’ own political agenda. While sovereign states have a right to protect their own interests, nevertheless in cases of overt crimes to humanity they should not grant immunity and they should prosecute. However, what is of prime concern is that physicians should not remain complicit and silent in the face of such lack of attention to medical inhumanities since it directly affects the practice of medicine. They should speak out and condemn on both an individual and a societal level. Provisions in international codes of medical ethics should be made to encourage such behavior. 4. Discussion of optimal response to medical ethical violations by medical societies and international legal and political infrastructures. When it is clear that overt medical ethical violations have taken place, there should be some official response by national and international medical organizational bodies. This would in turn impress the value of ethical practice and the intolerance by medical structures for unethical behavior by its practitioners. Following both the Japanese and Nazi experience of unethical medical practice, international medical organizations were slow to respond. Things might have been very different had internal medical associations spoken out in a clear and vociferous manner beginning in the
June, Volume 15, Number 6, 2015
U.S. Complicity in Japan’s Wartime Atrocities
early to mid-1930s and continuing into the later years of the war. The lessons that can be learned from where the medical profession has gone astray in terms of ethical practice in the past are profound. Many believe, in fact, that the focus on teaching ethics by principles without learning where we have transgressed in the past is a meaningless and futile exercise. We should not forget that many argue that the German medical ethics code of 1931 is more far-reaching than most medical ethical codes in existence today. Thus, focusing too much on pressuring the United States to apologize for political decisions that influenced its lack of acknowledgment of medical ethics violations more than 70 years ago is not nearly as helpful as learning about the violations from the past in order to refine contemporary medical ethics declarations. In turn, these lessons should be codified within addendums to already existing medical ethical codes. We have mentioned a few of the most important potential addendums, but there are others. It is the optimism of the medical profession that, together with the lessons from the past, can move humanity forward and be the example to the community and the hope that it believes us to be. &
REFERENCES Chelouche, T. 2008. Medicine and the Holocaust—Lessons for present and future physicians. Medical Law 27(4): 787–804. Devolder, K. 2015. U.S. complicity and Japan’s wartime medical atrocities: Time for a response. American Journal of Bioethics 15(6): 40–49. Harris, S. H. 2002. Factories of death: Japanese biological warfare, 1932– 1945, and the American cover-up, rev. ed. New York, NY: Routledge. Iacopino, V., and S. N. Xenakis. 2011. Neglect of medical evidence of torture in Guantanamo Bay: A case series. PLoS Medicine 8(4): e1001027. doi:10.1371/journal.pmed.1001027. Lagerwey, M. D. 2009. The Third Reich, nursing, and AJN. American Journal of Nursing 109(8): 44–49. O’Connor, M. 2009. Can we prevent doctors being complicit in torture? Breaking the serpent’s egg. Journal of Law and Medicine 17(3): 426–438. Strous, R. D. 2006. Hitler’s psychiatrists: Healers and researchers turned executioners and its relevance today. Harvard Review of Psychiatry 14: 30–37. Strous, R. D. 2013. Ethical considerations during times of conflict: challenges and pitfalls for the psychiatrist. Israel Journal of Psychiatry and Related Sciences 50(2): 122–128.
Rather Than Responding to the Past, Shape the Future Instead Sharon Kaur, University of Malaya The atrocities conducted by the Japanese during World War II are undeniably shocking, and the U.S. government’s complicity in failing to bring any of them to justice, indefensible. However, while there is value in the author’s argument that the United States should be held to account, it is submitted that there is far more value in examining why the Japanese felt justified in carrying out such atrocities and addressing such concerns in ethics guidelines, with a view to ensuring better protection in the future. The idea that some human lives are worth more than others lay at the heart of research misconduct during World War II. In fact, the undervaluation of human life can be traced back to the earliest forms of systematic medical research. The emergence of hospital medicine in Paris, France, between 1794 and 1848 transformed not only the practice of medicine but medical research as well. Hospital medicine made it possible to run clinical experiments on large numbers of people. This in turn provided physicians with rich data upon which to
design treatment modalities. Using hospital patients as research subjects was considered appropriate because for most of the 18th century, hospitals were administered to care for the poor and infirm, who were considered the most suitable subjects for experiments because of their illnesses, their perceived resulting obligation to society, and the power structure within hospitals that created a regulated research environment. (Ackerknecht 1967, 15) Bernard de Gordon advised that medicines should be tested “first on birds, next on mammals, then [on patients] in hospitals, then on lesser brethren, and then on others in [ascending] order, because if it should be poisonous it would kill” (Demaitre, 1980, 28). Because they were poor and unable to pay for their own treatment, hospital patients were considered to be of less value and thus legitimate subjects of medical research. Over time, observational hospital medicine evolved into laboratory and evidence based medicine, and observational clinical research developed into formally run
Address correspondence to Sharon Kaur, Faculty of Law, University of Malaya, Kuala Lumpur, 50603 Malaysia. E-mail: kaursh@um. edu.my
June, Volume 15, Number 6, 2015
ajob 61
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Harris, S. H. 2002. Factories of death: Japanese biological warfare, 1932– 1945, and the American cover-up. New York, NY: Routledge. Lafleur, W. R., G. B€ ohme, and S. Shimazono, eds. 2007. Dark medicine: Rationalizing unethical medical research. Bloomington, IN: Indiana University Press.
Nie, J. B. 2006. The United States cover-up of Japanese wartime medical atrocities: Complicity committed in the national interest and two proposals for contemporary action. American Journal of Bioethics 6(3): W21–W33.
Looking to the Future From the Past: Take Home Lessons From Japanese World War II Medical Atrocities Rael D. Strous, Beer Yaakov Mental Health Center and Tel Aviv University Ari Z. Zivotofsky, Bar Ilan University The injustices and atrocities of Nazi medicine were of catastrophic proportions. It is now well known that Nazi physicians during the Nazi era not only participated willingly in many of the inhumanities perpetrated on both the ill and non-ill, but they provided legitimacy to the Nazi regime, so sorely needed especially in its initial years of power. The physician and what he stood for were crucial to the success of Nazi policy, plans, and principles and on many occasions doctors enabled many of the regime’s ideological strategies (Chelouche 2008; Strous 2006). However, while there is much known about the practice of Nazi medicine during this time period, there is relatively little awareness about what happened contemporaneously several thousand miles away by Japanese physicians and medical researchers. Devolder (2015) is to be commended for raising awareness and addressing this poorly explored, recent historical episode characterized by a calamitous medical ethics failure. More specifically, as part of a wide scale setup termed the “Ishii Network,” named after its leader, Chief Medical Officer Shiro Ishii, Japanese doctors and researchers participated in and facilitated numerous human experiments in areas of biological warfare, military medicine, and infectious diseases. These studies were carried out in Manchukuo and areas of China occupied by Japan during World War II and were characterized by immense cruelty, wanton suffering, and profound disregard for human dignity and autonomy. It has been estimated that tens of thousands died, many after being exposed to extreme conditions of pain and suffering. Collaboration and participation by Japanese medical and research personnel were widespread, and it has been estimated that at its peak, the Ishii Network had more than 10,000 doctors and medical researchers conducting various biological and
other military related trials (Harris 2002). Much of the work of the network was carried out by Unit 731, established in 1936, in a huge 150-building site covering six square kilometers in the vicinity of the city of Harbin in China. Although it may be argued that the wanton cruelty and ethical violations committed by the Nazi physicians may have been matched or even exceeded by the Japanese medical professionals, it is at the end of the war that similarities between the two cases diverge. It became clear very soon after the war what atrocities in the name of medicine and medical science many of the German physicians had carried out. Many stood trial and were punished, both by the court of law and by losing their licenses to practice in their field. Perhaps even more significantly, the evils of medicine that occurred during the Nazi era, principally in Germany, Austria, and Poland, set into motion a process that fostered the development of ethical codes and declarations that slowly, over a period of decades, produced the welldefined codes of medical ethics that many around the world hold to be “sacred” to the practice of clinical and research medicine today. The first of these codes to be developed was the Nuremberg Code, in 1949, which demarcated 10 principles of medical experimentation, including voluntary consent, seeking societal good, minimizing harm, and permitting premature exit from study participation. This was followed by the more far-reaching 1960s Helsinki Declaration developed by the World Health Organization. The Helsinki declaration differentiated between therapeutic and nontherapeutic research, ensured the monitoring of studies, and clarified the means of surrogate decision making. Much discussion and academic work surrounded the ongoing development of these and other codes and
Address correspondence to Ari Z. Zivotofsky, Gonda Brain Research Center, Bar Ilan University, Ramat Gan 52900, Israel. E-mail: ari. [email protected]
June, Volume 15, Number 6, 2015
ajob 59
The American Journal of Bioethics
declarations over the years, including the valuable contribution of the 1979 Belmont Report, which demarcated three central principles governing ethical research: “respect for persons” (autonomy), beneficence, and justice. Thus, while much has been learned from the egregious behavior of German medicine, spurring the development of national and international medical ethical codes and declarations, no similar lessons were derived from the misdeeds of the Japanese medical community. It is generally accepted that the principal reason for this is that most, if not all, of the high-ranking Japanese physicians involved in the atrocities were never sent to trial and were never held responsible and publicly condemned to the extent that German physicians were following World War II. It is suggested (Devolder 2015) that what accounted for this oversight and omission was the complicity of the United States in ignoring or turning a blind eye to the Japanese physicians’ involvement in these programs in order to exploit their knowledge of biological warfare for U.S. national purposes. In addition, it allegedly was in order to thwart the possibility of Russian recruitment of these individuals for Soviet purposes after the war and during the initial stages of the “Cold War” between the United States and the USSR that the U.S. shielded the Japanese doctors. Devolder (2015) and others maintain that a focus should be made on the necessity for U.S. authorities to apologize for oversight in managing their alleged complicity in not uncovering and publicizing what took place during this time. This, it is argued, should be irrespective of the sociopolitical climate that appeared to have dictated much of the United States’ postwar decision making. However, we believe that it would be a pity if there was an overfocus on the necessity for U.S. authorities to apologize for their alleged complicity, as this would divert critical energy and creativity from once again learning from what transpired during this time period and building an even more ethical practice of medicine in general and an interface between medicine and government in particular. Instead of investing energy in demanding apologies and admission of guilt for this national wrongdoing, we think that a focus should be on what can be learned from this dark period. It would be misguided at best and irresponsible at worst if we failed to ensure that something can be learned from that period for the future of the medical field in general. A similar argument has been made regarding the role of German nurses and the lessons that can be learned from their misdeeds (Lagerwey 2009). Taking a page from the postwar period and how various medical and legal establishments addressed the Nazi medicine atrocities, a great deal can be achieved by moving forward and updating various codes of ethical practice in light of the Japanese medical atrocities and the alleged U.S. complicity. To name a few, these should include the following: 1. Reference to medical professionals’ boundary violations. Boundaries are critical to the practice of ethical
60 ajob
medicine. Perhaps there is no central governing principle more important than boundaries in the doctor– patient relationship. Thus, it would be unbecoming of a physician to transgress these boundaries and engage in a practice with patients with anything unrelated to the social contract that he or she received from the community—that is, the relief and treatment of illness and suffering (Strous 2013). While the principle of boundaries is one that is recognized as important in medicine, it is not one that has received much individual attention in international codes of ethical medical practice. The example of Japanese medical professionals engaging in experimenting with and practicing biological warfare is an example of a form of boundary violation and one from which future generations of medical professionals should learn a lesson. 2. Response to government interventions and/or interference in medical practice. Medical professionals should use their professional skills only to manage illness and suffering. Doctors have no mandate to engage in furthering the purposes of the political or governing establishment. Thus, for example, in a very contemporary subject (Iacopino and Xenakis, 2011), it is forbidden for physicians to aid in torture; even passive presence would be prohibited, even if it furthers the national interests of the government (O’Connor 2009). The necessity for physicians to desist from involvement in governmental interest outside of their contract with society needs to be made clear and emphasized in international medical codes of ethics. 3. Reference to complicity and/or silence in the face of medical ethical violations. It appears that after the war the United States was complicit in the cover-up and lack of prosecution of Japanese medical professionals due to the United States’ own political agenda. While sovereign states have a right to protect their own interests, nevertheless in cases of overt crimes to humanity they should not grant immunity and they should prosecute. However, what is of prime concern is that physicians should not remain complicit and silent in the face of such lack of attention to medical inhumanities since it directly affects the practice of medicine. They should speak out and condemn on both an individual and a societal level. Provisions in international codes of medical ethics should be made to encourage such behavior. 4. Discussion of optimal response to medical ethical violations by medical societies and international legal and political infrastructures. When it is clear that overt medical ethical violations have taken place, there should be some official response by national and international medical organizational bodies. This would in turn impress the value of ethical practice and the intolerance by medical structures for unethical behavior by its practitioners. Following both the Japanese and Nazi experience of unethical medical practice, international medical organizations were slow to respond. Things might have been very different had internal medical associations spoken out in a clear and vociferous manner beginning in the
June, Volume 15, Number 6, 2015
U.S. Complicity in Japan’s Wartime Atrocities
early to mid-1930s and continuing into the later years of the war. The lessons that can be learned from where the medical profession has gone astray in terms of ethical practice in the past are profound. Many believe, in fact, that the focus on teaching ethics by principles without learning where we have transgressed in the past is a meaningless and futile exercise. We should not forget that many argue that the German medical ethics code of 1931 is more far-reaching than most medical ethical codes in existence today. Thus, focusing too much on pressuring the United States to apologize for political decisions that influenced its lack of acknowledgment of medical ethics violations more than 70 years ago is not nearly as helpful as learning about the violations from the past in order to refine contemporary medical ethics declarations. In turn, these lessons should be codified within addendums to already existing medical ethical codes. We have mentioned a few of the most important potential addendums, but there are others. It is the optimism of the medical profession that, together with the lessons from the past, can move humanity forward and be the example to the community and the hope that it believes us to be. &
REFERENCES Chelouche, T. 2008. Medicine and the Holocaust—Lessons for present and future physicians. Medical Law 27(4): 787–804. Devolder, K. 2015. U.S. complicity and Japan’s wartime medical atrocities: Time for a response. American Journal of Bioethics 15(6): 40–49. Harris, S. H. 2002. Factories of death: Japanese biological warfare, 1932– 1945, and the American cover-up, rev. ed. New York, NY: Routledge. Iacopino, V., and S. N. Xenakis. 2011. Neglect of medical evidence of torture in Guantanamo Bay: A case series. PLoS Medicine 8(4): e1001027. doi:10.1371/journal.pmed.1001027. Lagerwey, M. D. 2009. The Third Reich, nursing, and AJN. American Journal of Nursing 109(8): 44–49. O’Connor, M. 2009. Can we prevent doctors being complicit in torture? Breaking the serpent’s egg. Journal of Law and Medicine 17(3): 426–438. Strous, R. D. 2006. Hitler’s psychiatrists: Healers and researchers turned executioners and its relevance today. Harvard Review of Psychiatry 14: 30–37. Strous, R. D. 2013. Ethical considerations during times of conflict: challenges and pitfalls for the psychiatrist. Israel Journal of Psychiatry and Related Sciences 50(2): 122–128.
Rather Than Responding to the Past, Shape the Future Instead Sharon Kaur, University of Malaya The atrocities conducted by the Japanese during World War II are undeniably shocking, and the U.S. government’s complicity in failing to bring any of them to justice, indefensible. However, while there is value in the author’s argument that the United States should be held to account, it is submitted that there is far more value in examining why the Japanese felt justified in carrying out such atrocities and addressing such concerns in ethics guidelines, with a view to ensuring better protection in the future. The idea that some human lives are worth more than others lay at the heart of research misconduct during World War II. In fact, the undervaluation of human life can be traced back to the earliest forms of systematic medical research. The emergence of hospital medicine in Paris, France, between 1794 and 1848 transformed not only the practice of medicine but medical research as well. Hospital medicine made it possible to run clinical experiments on large numbers of people. This in turn provided physicians with rich data upon which to
design treatment modalities. Using hospital patients as research subjects was considered appropriate because for most of the 18th century, hospitals were administered to care for the poor and infirm, who were considered the most suitable subjects for experiments because of their illnesses, their perceived resulting obligation to society, and the power structure within hospitals that created a regulated research environment. (Ackerknecht 1967, 15) Bernard de Gordon advised that medicines should be tested “first on birds, next on mammals, then [on patients] in hospitals, then on lesser brethren, and then on others in [ascending] order, because if it should be poisonous it would kill” (Demaitre, 1980, 28). Because they were poor and unable to pay for their own treatment, hospital patients were considered to be of less value and thus legitimate subjects of medical research. Over time, observational hospital medicine evolved into laboratory and evidence based medicine, and observational clinical research developed into formally run
Address correspondence to Sharon Kaur, Faculty of Law, University of Malaya, Kuala Lumpur, 50603 Malaysia. E-mail: kaursh@um. edu.my
June, Volume 15, Number 6, 2015
ajob 61
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
