Human Dignity and Bioethics

Human Dignity and Respect for Persons | 23
Freedom of Information Act (1977), Research Involving Those Institutionalized
as Mentally Infirm (1978). Only at the very end—one is
tempted to say as the culmination—of its work did the Commission
issue its famed Belmont Report. 12
In the Belmont Report, the National Commission began by citing
the “troubling ethical questions” raised, not by the Tuskegee Syphilis
Study, but rather by the 1946 Nuremberg War Crime Trials, and the
prosecution, there and then, of Nazi physicians for their conduct of
often horrific experiments involving inmates from the concentration
camps. The Nuremberg tribunal ended its written judgment of these
physicians and their “crimes against humanity” with the declaration
of a ten-point code of ethics for the conduct of research with human
subjects, the first element of which reads “the voluntary consent of
the human subject is absolutely essential.” 13 In the Belmont Report,
the National Commission acknowledges the Nuremberg Code as
the progenitor of “many later codes,” but it contends that the general
as well as specific rules set forth in these codes often prove to
be inadequate in the complicated circumstances of human subjects
research—for example, when subjects are incapable of providing voluntary
consent. With the conviction that “broader ethical principles
will provide a basis on which specific rules may be formulated, criticized,
and interpreted,” 14 the National Commission asserts that three
such principles are “relevant” to human subjects research: respect for
persons, beneficence, and justice. 15
In the Belmont Report, the National Commission describes these
principles as “comprehensive”: they are “stated at a level of generalization”
that should prove helpful to investigators, human subjects,
and interested citizens, and together they “provide an analytical
framework that will guide the resolution of ethical problems.” 16 Principles,
in the National Commission’s view, are “general prescriptive
judgments” that offer “a basic justification for the many particular
ethical prescriptions and evaluations of human actions.” 17 In brief,
these principles illuminate the focus for ethical evaluation, directing
how we are to think about, and how we are to act to resolve, ethical
problems in human subjects research. As for the source of these principles,
they are neither the products of pure reason nor the dictates
of natural law; nor are they the constructs of philosophers or of professional
ethicists. Instead, according to the National Commission,