Assignment 2, Belmont Report

Trite sayings are often repeated because of the grains of truth they contain. In the case of biomedical research we might quote, “The road to hell is paved with good intentions”. Studies that start with high moral considerations and lofty goals of helping mankind can sometimes deteriorate into self-serving experiments which ultimately damage everyone associated with them. The Belmont Report was signed into law in 1979, defined ethical practices and guidelines for research using human subjects.
From the days of the Magna Carta through modern Geneva Conventions, society has recognized the need to protect human rights. Unfortunately, the Belmont Report’s existence was predicated on several horrific stories of gross malpractice in biomedical or behavioral research. The Nuremberg trials dramatized the medical ‘research’ inflicted by Nazi physicians in the concentration camps and P.O.W. camps. Prisoners are seldom able to give informed consent because by definition they have no free will to exercise.
Likewise the poor or uneducated are at the mercy of those they see as their superiors. They trust what they are told because there are no alternatives available to them. The ‘Tuskegee Study of Untreated Syphilis in the Negro Male’ continued for 40 years until 1972, destroying lives in the name of research when recognized cures were readily available.
In both cases “undesirable” people were considered expendable in the pursuit of risky treatments with little benefit. Even before these well documented cases hazardous procedures were inflicted on the poor while the wealthy benefited from any knowledge gained.
What are the “Basic Ethical Principles” cited in the Belmont Report? The first is respect for persons, specifically that individuals should be treated as autonomous agents, and that persons with diminished autonomy are entitled to protection. The second is beneficence (what a great word) exhorting clinicians to “do no harm” thereby maximizing possible benefits while minimizing possible harms. The third tenet is justice. How do we distribute burdens and benefits? “To each person an equal share, to each person according to individual need, to each person according to individual effort, to each person according to societal contribution, and to each person according to merit.” (The Belmont Report, Ethical Principles and Guidelines for the Protection of Human Subjects of Research, April 18, 1979)
These standards are applied through the use of informed consent, the assessment of risks and benefits, and a judicious selection of subjects, each standard carefully considered and examined to promote the ethical and humane treatment of all people.