So due to the ethical breaches associated
with the famous Tuskegee Syphilis Study, which
if you don't know, was a study conducted by
the US government on mostly black airmen and
in the study they infected these individuals
with syphilis without telling them. This is
considered to be quite a violation of these
individuals’ rights and today looked
upon as one of the most egregious examples
of bad ethical behavior by medical scientists.
Due to that particular circumstance, the Belmont
report was created to codify how best to protect
human subjects in American ethical research
or medical research. And the Belmont report
had some core principles that we will see
repeated several times as we talk about the
pillars of ethics. The first is, we have to
respect individuals. Respect is a problematic
word, what does that mean? It means you appreciate
their ability to make decisions for themselves.
Beneficence has to be a foundational idea
in medical ethics. Beneficence is when we
try to do good. And justice, what is justice?
Well justice is essentially treating people
the same no matter what their background,
whether it's race, whether it's gender, whether
it's age, whether it's social class, there
must be justice involved. Also, informed consent
was brought up again. Informed consent is
one of these themes that we will come back
to again and again, the individual must agree
to be experimented upon and that agreement
must be based upon a genuine appreciation
of the risks associated with the procedure.
Speaking of risks, another core principle
is the assessment of the risks. Is there an
attempt or was there an attempt by the researcher
to measure and to quantify and to qualify
the potential risks and benefits of their
experiment? And lastly how are the subjects
selected? This has to do with vulnerability.
Are you targeting a particular population
because you think they're more likely to consent
than others? That's a problem.
One of the key criticisms of the Belmont report
is that it offers a kind of one-size-fits-all
recommendation, it doesn't consider that there
could be differences in ethnic composition,
gender and culture in the populations that
you are looking at and that might help determine
which of the pillars you want to focus on
more. It also doesn't give any guidance on
how to wait or prioritize the core principles.
For example, is informed consent more important
than justice? Is beneficence more important
than assessing risks? We don't know.
It offers no guidance.