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The Secret of the Belmont Report: Why is it So Important to Biomedical Research?
In the field of ethics, principlism, as a method of applied ethics, focuses on solving moral dilemmas and discusses them around certain ethical principles. This approach is widely adopted in various professional fields because it avoids complex debates about moral philosophy at the theoretical level. Not only does principlism provide a practical approach to ethical decision-making, it is also increasingly becoming a guardian in biomedical research. It all started with the Belmont Report in the 1970s, which undoubtedly laid the foundation for principlism as we know it today.
Published in 1976, the Belmont Report focused on identifying three fundamental ethical principles in biomedical and behavioral research: autonomy, beneficence, and justice.
The Belmont Report was prompted by the National Research Act. The report upholds the protection of human subjects, and its core idea has a profound impact on medical ethics.
Core of the Principles
In Principles of Biomedical Ethics, Tom Biochamp and James Childress further elaborate on four fundamental principles of principlism that are considered central to ethical reasoning in health care:
- Respect for autonomy
- Kindness
- Do no harm
- Fair
Respect for autonomy
This principle emphasizes the individual's ability to make their own decisions and choices, a concept that contrasts with patriarchy. In a medical setting, a physician's role should not override the patient's wishes, even if the physician believes that the decision is in the patient's best interest.
Mercy
The principle of beneficence requires health care providers to act for the benefit of others, to prevent or eliminate harm, and to proactively promote health. Its main purpose is to choose the action that will achieve the greatest benefit among multiple possible options.
Do no harm
This principle requires us to avoid intentionally causing harm. In moral decision-making, although the requirement of the principle of beneficence exists, the requirement to refrain from doing harm is usually more stringent. When faced with unavoidable harm, a balance between benefits and harms needs to be made.
Justice
The principle of justice requires a fair distribution of costs and benefits. Even when the principles of non-maleficence and beneficence are followed, moral behavior is not necessarily guaranteed; therefore, consideration must be given to whether the distribution of benefits is fair.
Principlism makes ethical decision-making practical and effective by recognizing the moral principles of autonomy, beneficence, nonmaleficence, and justice as shared principles.
Practical Ethical Decision Making
Principlism evolved into an approach to ethical decision-making that focuses on consensus. Moreover, the approach is compatible with a variety of ethical, theological, and socio-moral approaches to decision making. This pluralistic approach is particularly important when making ethical decisions at the institutional and community levels, because people from different backgrounds may not agree on a particular moral theory, but they can agree on some shared values.
Challenges and Support
While principlism has broad support, the approach has faced a number of challenges since it was first proposed by Biochap and Childress in 1979. Critics argue that the existence of principlism lacks theoretical unity and point out the risk of conflict between different principles. Some supporters emphasize that these principles can provide explanations and defenses for many substantive moral claims in medical ethics.
Principlism is the most dominant analytical approach in medical ethics today and continues to influence the development of biomedical research.
The Belmont Report not only laid the foundation for biomedical ethics, but also made it possible for medical practices that emphasize people-centeredness. However, do the diversity of its applications and theoretical challenges make us think more deeply about the complexity of ethical decision-making?
