Arguably one of the most important aspects of research in social science as well as empirical science is to consider the ethics of the research method. This has not always been the case; the sciences were created long before the ethical standards and guidelines that now accompany them were written into law or code. Many of the most fascinating experiments of the past – such as the Stanford Prison Experiment or the Milgram experiment on obedience – would today be considered grossly unethical. Thankfully, today researchers in all fields certainly have a specific set of ethical guidelines to aid in directing their research, and most even have a legal framework in which they can work accompanied by a commission, committee or other entity that enforces these codes.
One of the best examples of modern day ethical guidelines in scientific research comes from the Belmont Report, created almost forty years ago by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research as a fulfillment of a Congressional commission designed to protect human subjects in the long run. It was primarily created as a response to the Tuskegee Syphilis Study, which occurred from 1932 to 1972 and inherently violated the basic human rights of its human subjects. While the report was initially created in the 1970s, it certainly continues to bear relevance to the academic and scientific research projects, experiments, and behavioral studies of today.
At the very least, the three core principles of the report – respect for persons, beneficence, and justice – should continue to play a part in the research process as well as outcomes. This short discussion paper examines the Belmont Report in two different ways. First, the paper discusses the three core principles identified above more specifically, looking at both the language of the report and its suggested applications.
The paper then turns to a specific application of the core principles by looking to the experiment that sparked the creation of the Belmont Report in the first place, the Tuskegee syphilis experiment. The discussion examines how the three principles of the Belmont Report were specifically violated with this specific experiment and why. Overall, this discussion paper seeks to address not only the ethical principles of the Belmont Report, but also why the remain relevant in research today. This is accomplished by the detailed discussion and subsequent application of the principles, as outlined above.
The Belmont Report is primarily designed to act as a guideline for the creation of policy in regards to scientific and social research, particularly for the use of institutions, organizations, affiliations, and even law-making bodies – for instance, the Institutional Review Boards of various universities. While it has a grand task, the Report ostensibly conveys the most important ethical principles for research in a clear, applicable way. By way of example, the Report begins with the following statement: “Scientific research has produced substantial social benefits. It has also posed some troubling questions” (HHS, 1979, n.p.). This initial statement alone highlights the purpose of the Report: to both protect the interests of academic research as a precious resource of knowledge and to protect the human rights of anyone who may serve as human subjects through the course of this scientific or social research.
The report is the result of many years of research, consideration, and even soul searching. However, in pursuing the goal of protecting both research itself and human rights, the Report boils the protection of these interests to three ethical principles. As the Report states, these three principles are “comprehensive…and are stated at a level of generalization that should assist scientists, subjects, reviewers and interested citizens to understand the ethical issues inherent in research involving human subjects” (HSS, 1979, n.p.).
The ethical principles disussed here are “basic” in the sense that they refer to “those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of human actions” (HSS, 1979, n.p.). In other words, the principles are not simple; rather, they are fundamental to the continuation of ethical research. Other, more specific, principles may be relevant to specific cases of research, but these three principles should provide a framework by which both scientists and subjects can operate. The three ethical principles are: respect for persons, beneficence, and research. The specifics of these principles, as well as their application, will be discussed in more detail below.
The first ethical principle identified by the Belmont Report sounds basic enough: the respect for persons. According to the report, this principle incorporates “at least two ethical convictions” – namely, that “individuals should be treated as autonomous agents” and that “persons with diminished autonomy are entitled to protection” (HSS, 1979, n.p.). This is an important distinction, as it provides protection to any person who may ever possibly come under research conditions.
In other words, it protects both those who can consciously make their own choices and those that cannot necessarily enjoy the same luxury – either due to a handicap or else the lack of transparency of the researcher (as was the case with the Tuskegee syphilis experiments). In this way, the ethical principle for respect for persons has two distinct moral requirements: “the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy” (HSS, 1979, n.p.). These elements are discussed in more detail by the Report, as presented below.
According to the report, an autonomous person is one who can deliberate about their own personal goals and act on this specific deliberation. In this way, respecting and recognizing the autonomy of autonomous persons is to “give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others” (HSS, 1979, n.p.). Again, this appears basic enough as it also reflects the basic ethics behind the creation of most laws.
In contrast, other persons do not necessarily have the same autonomy, and should be further protected; more specifically, the protection should avoid risk of harm and evaluate the likelihood of benefit (HSS, 1979). Overall, the principle of respect for humans demands one particular course of action: that “subjects enter into the research voluntarily and with adequate information” (HSS, 1979, n.p.). This should serve as the foundation of any form of research.
The second basic ethical principle laid out by the Belmont Report traces back to the Hippocratic maxim to “do no harm”, which has been used by medical fields for generations but now also comes to embody the ethics of scientific and social research (HSS, 1979, n.p.). It applies to research, specifically, as it can make the claim that “one should not injure one person regardless of the benefits that might come to others” (HSS, 1979, n.p.). In this way, the Report extends beneficence to not simply protect against harm in the individual, but also to maximize benefit to the whole. It is understood in a “stronger sense, as an obligation” in research (HSS, 1979, n.p.).
More specifically, the Report forwards two specific rules in regard to beneficence: first, to do no harm, and second to both maximize possible benefit and minimize possible harms (HSS, 1979). It is important to note here that these obligations apply both to individual researchers and to society as a whole, since the principle applies not only to specific research projects but entire lines and fields of research. For instance, researching childhood diseases may not benefit individual research subjects, but it certainly benefits the whole of society and future generations. In this way, the field satisfies the principle of beneficence – as long as it does no harm.
The final basic ethical principle identified by the Belmont Report may, at first light, appear slightly more abstract than the other two – and rightly so (no pun intended). It asks the following question: “Who ought to receive the benefits of research and bear its burdens?” (HSS, 1979, n.p.). This aspect certainly takes more soul searching than the other two ethical principles combined. This principle requires both the equal treatment of people and the even distribution of the benefits gleaned through research.
What, exactly, is meant by equal is up to each individual formulation. The report gives a clear example of what justice can look like in research: “The selection of research subjects needed to be scrutinized in order to determine whether some classes are being systematically selected simply because of their easy availability, their compromised position, or their manipulability” (HSS, 1979, n.p.). Therefore, justice has to do with both the subjects and beneficiaries of research.
Now that the basic ethical principles of the Belmont Report have been established, the discussion can now turn to a specific application of the principles. One of the most infamous unethical experiments in United States history was actually carried out by the United States government – the Tuskegee syphilis experiment. The experiment was carried out from 1937 to 1972, and saw 600 African American men purposefully injected with syphilis under the guise of free medical care (CDC, 2016, n.p.).
In this experiment, all three of the ethical principles highlighted above were violated. First and foremost, the experimental study certain did not exhibit respect for persons, as the test subjects were not informed of what was being to their body and were actually injected under false pretenses and with false promises (Jones, 1981). Second, the experiment had little beneficence, as it did not actually result in any practicable results despite the length of the study.
Perhaps more importantly, the experiment certainly violated the maxim of ‘do no harm’. Finally, the study also violated the principle of justice in two primary ways: first, it is widely believed that only black men were selected primarily because of their need for free medical care and the fact that the test subjects would come under less scrutiny, and second nearly all of the 600 men died by the time an official apology was issued by the U.S. government (CDC, 2016). These two aspects translate into a clear lack of justice for the participants and their families. In this way, the Tuskegee syphilis experiment is perhaps the most prominent example of why the ethical principles laid out in the Belmont Report remain so important today.
