Human Dignity and Bioethics

Human Dignity and Respect for Persons | 25
sources of insight into the National Commission’s deliberations and
ethical reasoning are the first-person accounts penned by such participants
as Albert Jonsen, a commissioner, and by Tom Beauchamp,
a staff philosopher during the Commission’s waning days and the
principal authorial force behind the ultimate form of the Belmont
Report.
In his Birth of Bioethics and other writings, Jonsen hones in on
the process of ethical reasoning used by the Commission: he says that
the commissioners “believed as principlists” but “worked as casuists.”
They believed that broad norms exist; that these norms apply to human
behavior per se and enjoy widespread acceptance as such, but
have special relevance for such circumscribed areas of concern as human
subjects research; and that such norms hold in general, though
any one may admit of exceptions. 22 The commissioners did not,
however, begin their deliberations on specific topics with an agreement
about governing principles from which more directed guidance
could be deduced. Their process was a thoroughly inductive one.
In his recollections, Beauchamp offers a more precise picture of
how the National Commission’s deliberative process joined principlist
convictions with casuist methods:
Casuistical reasoning more so than moral theory or universal
abstraction often did function to forge agreement during
National Commission deliberations. The commissioners appealed
to particular cases and families of cases, and consensus
was reached through agreement on cases and generalization
from cases when agreement on an underlying theoretical rationale
would have been impossible. Commissioners would
never have been able to agree on a single ethical theory, nor
did they even attempt to buttress the Belmont principles with
a theory. 23
Widely esteemed as an authoritative statement of ethical precepts,
the Belmont Report is a landmark in the evolution of the ethics
of clinical research and of principlism, a theory of ethical justification
that has spread beyond the sphere of human subjects research and has,
for several decades now, been dominant as well in the clinical sphere,
i.e., in relations between physicians and patients. 24 One principle in