Bioethics can be broken down into several primary components according to the Belmont Principles—components including beneficence, nonmaleficence, justice, and autonomy—however, there is merit in looking at some of the basic underpinnings of these ethical ideas. Although the Belmont Principles provide some guidance insofar as deciding what course of action is morally justified, there are certain areas where they are insufficient, and in these cases, it can be useful to look at the more basic reasons behind why these principles were established in the first place.
The Prescriptive Model
One of the more fundamental theories underlying the Belmont Principles is what can be colloquially called the “prescriptive model.” In other words, this is an instance in which an outside authority such as the government, has decided what is right and wrong. This can include governments deciding that they have the right to govern in the first place, or religious leaders determining what is a morally correct way of behaving, or the entire concept of ethics as a whole.
Yet another deep underpinning of the Belmont Principles can be found in what is known as “Rights Theory,” or the idea that you have to come to a clear moral picture of what is moral or immoral while also considering how culture may have influenced what you consider morally right. If one considers the morality involved in hurting a puppy, although doing so is not illegal, it is considered a highly immoral act in many societies because dogs are such cherished household pets. The immorality of hurting a puppy might be less pronounced in different societies in which dogs are considered less important, however, which demonstrates the variability of what we consider morally ethical.
There is room for a certain amount of ethical grey area, particularly because there has been an evolution in our thinking and morals concerning what is right and wrong. If we apply Rights Theory to Nazi prison experiments, for example, it could appear that the experiments being performed on prisoners did not violate moral standards because there were no explicit rules against that sort of testing. However, in retrospect, it appears clearly immoral that prisoners were being tested on because they had not given their informed consent, and also because they had clearly been forcibly coerced into participating.
The third underlying theory of the Belmont Principles is the utilitarian theory, which considers any course of action which would yield the greatest good for society to be the ethically moral course to take. In the case of the Nazi prison experiments, it seems that using the findings from these experiments to help further scientific findings would be the morally just course of action under the utilitarian theory because it would help the greatest amount of people. However, under opposing theories, this appears to be a morally unjust undertaking because it ignores the suffering that the Nazi prisoners underwent as a consequence of the experiments. The other major problem facing this theory is that it remains impossible to measure utility because it is such a variable concept. For instance, if one considers the utility that one thousand dollars would provide to a rich person such as Warren Buffett compared to the utility that would be provided to someone of a much lower economic class, it is obvious that the utility would be much higher for the person with less economic means. The fact that utility remains so difficult to quantify means that utilitarianism as a theory is hard to use when trying to determine the morally just course of action.
The nuances involved in bioethics are important to consider, particularly when it comes to scenarios that the Belmont Principles cannot fully address.