Research with human subjects has long been controversial because of the conflicts that often arise between promoting scientific knowledge and protecting the rights and welfare of subjects. Twenty-five years ago the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research addressed these conflicts. The result was the Belmont Report: Ethical Principles and Guidance for Research Involving Human Subjects, a report that identified foundational principles for ethical research with human subjects: respect for persons, beneficence, and justice.

Since the publication of Belmont, these three principles have greatly influenced discussions of research with human subjects. While they are often regarded as the single-most influential set of guidelines for biomedical research and practice in the United States (and other parts of the world), not everyone agrees that they provide adequate guidance. Belmont Revisited brings together a stellar group of scholars in bioethics to revisit the findings of that original report. Their responses constitute a broad overview of the development of the Belmont Report and the extent of its influence, especially on governmental commissions, as well as an assessment of its virtues and shortcomings.

Belmont Revisited looks back to reexamine the creation and influence of the Belmont Report, and also looks forward to the future of research—with a strong call to rethink how institutions and investigators can conduct research more ethically.

James F. Childress is the John Allen Hollingsworth Professor of Ethics at the University of Virginia.

Eric M. Meslin is director of the Indiana University Center for Bioethics.

Harold T. Shapiro is president emeritus, Princeton University and a professor of economics and public affairs in the Woodrow Wilson School of Public and International Affairs.

Introduction

PART I: BACKGROUND AND ORIGINS OF THE BELMONT REPORT

1. On the Origins and Future of the Belmont Report Albert R. Jonsen 2. The Origins and Evolution of the Belmont ReportTom L. Beauchamp

PART II: THE BELMONT PRINCIPLES: INFLUENCE & APPLICATION

3. The Dog in the Night-Time: Or the Curious Relationship of the Belmont Report and the President's Commission Alexander M. Capron 4. Beyond Belmont: Trust, Openness, and the Work of the Advisory Committee on Human Radiation ExperimentsRuth R. Faden, Anna Mastroianni, and Jeffrey P. Kahn

5. Relating to History: The Influence of the National Commission and Its Belmont Report on the National Bioethics Advisory CommissionHarold T. Shapiro and Eric M. Meslin

6. The Principles of the Belmont Report: How Have Respect for Persons, Beneficence, and Justice Been Applied in Clinical Medicine?Eric J. Cassell

Part III: THE BELMONT PRINCIPLES: POSSIBILITIES, LIMITATIONS, AND UNRESOLVED QUESTIONS

7. We Sure We Are Older But Are We Wiser?Karen Lebacqz

8. Toward a More Robust Autonomy: Revisiting the Belmont ReportLarry R. Churchill

9. The National Commission's Ethical Principles With Special Attention to BeneficenceRobert J. Levine

10. Justice beyond BelmontPatricia A. King

11. Belmont Revisited Through a Feminist LensSusan Sherwin

12. Protecting Communities in Research: From a New Principle to Rational ProtectionsEzekiel J. Emanuel and Charles Weijer

13. Ranking, Balancing, or Simultaneity: Resolving Conflicts Among the Belmont PrinciplesRobert M. Veatch

14. Specifying, Balancing, and Interpreting Bioethical PrinciplesHenry S. Richardson

15. Max Weber Meets the Belmont Report: Toward a Sociological Interpretation of PrinciplismJohn H. Evans

Epilogue: Looking Back to Look Forward
James F. Childress

Appendix: The Belmont Report

Contributors

Index