The Nuremberg Code Applied to Mental Health Practices
A mental therapy which has never been clinically tested for safety and effectiveness is by definition experimental. Therefore, any mental health provider who uses untested techniques like so-called Memory Recovery Therapy is by definition engaging in an experiment on a human subject, and the principles of the Nuremberg Code should apply. This document applies the Nuremberg Code to mental health practices by substituting the words "therapy" for "experiment," "patient" for "subject," and "practitioner" for "scientist."
Permissible Mental Health PracticesThe great weight of the evidence before us is to the effect that certain types of mental therapy, when kept within reasonably well-defined bounds, conform to the ethics of the medical profession generally. The protagonists of the practice of mental therapy justify their views on the basis that such therapies yield results for the good of the individual and society that are unprocurable by other methods or means of treatment. All agree, however, that certain basic principles must be observed in order to satisfy moral, ethical and legal concepts:
1. The voluntary consent of the patient 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 patient there should be made known to him the nature, duration, and purpose of the therapy; 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 therapy.
The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the therapy. It is a personal duty and responsibility which may not be delegated to another with impunity.
2. The therapy should be such as to yield fruitful results for the individual, unprocurable by other methods or means of study, and not random and unnecessary in nature.
3. The therapy should be so designed and based on the results of clinical experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the therapy.
4. The therapy should be so conducted as to avoid all unnecessary physical and mental suffering and injury.
5. No therapy should be conducted where there is an a priori reason to believe that death, disabling injury, or disabling emotional disturbance will occur.
6. The degree of risk to be taken should never exceed that determined by the severity of the problem to be treated by the therapy.
7. Proper preparations should be made and adequate facilities provided to protect the patient against even remote possibilities of injury, disability, emotional disturbance, or death.
8. The therapy should be conducted only by qualified persons. The highest degree of skill and care should be required through all stages of the therapy of those who conduct or engage in the therapy.
9. During the course of the therapy the human subject should be at liberty to bring the therapy to an end if he has reached the physical or mental state where continuation of the therapy seems to him to be impossible.
10. During the course of the therapy the practitioner in charge must be prepared to terminate the therapy at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him that a continuation of the therapy is likely to result in injury, disability, emotional disturbance, or death to the patient.