Justice, ethical principle

Bioethics, basing itself on the moral canon of the human being and on the necessity, as a rational being, to morally justify one s own acts, adopts the four ethical principles autonomy and beneficence which pertain to the private sphere of the individual and nonmaleficence and justice which pertain to the public sphere."" ... 

The Belmont report describes the basic ethical principles that underlie research involving human subjects respect for persons, beneficence, and justice. The report discusses application of informed consent, assessment of ri.sks and benefits, and selection of subjects. Its regulations require that IRBs have not fewer than five members who have the capability to judge research proposals in terms of community attitudes. Therefore, IRBs must include people whose primary concerns lie in the areas of legal, professional, and community acceptance rather than in the overall scientific design. 

The Belmont Report (1979) contains the ethical principles on which the federal regulations for protection of human subjects are based. The three basic principles are respect for persons, beneficence, and justice. Respect is reflected by the consent process. As a result the term autonomy is used in the research and healthcare context. A patient is normally regarded as autonomous if he or she can make his or her own judgments and decisions. In the absence of such ability, for example, as in the case of children, prisoners, and those with mental disorders, the person must be protected. In the Belmont Report and Beneficence, beneficence is the process of minimizing harm (risk) and maximizing possible benefits (usually for the community as a whole). Justice is the term used for the criterion that subjects must be fairly drawn from a variety of ethnic, social, and other groups. 

Ethical considerations must be applied from the design to the completion of a clinical trial. Clear scientific hypotheses and objectives are critical. It is difficult to justify a clinical study if it is not clinically important or relevant. There are added ethical considerations for cancer patients, many of whom have been heavily pretreated with other chemotherapy agents and many of whom are terminally ill and may not derive any direct benefit from the agent being studied, particularly in phase 0 and I trials [23]. Clinical trials are conducted under guidelines issued in the Belmont Report of 1978 that protects human subjects and follows principles of respect for persons, beneficence, and justice. Scientific conduct is also guided by ethical principles in that competent and rigorous analysis is required to prevent compromise of the results [24]. 

In the United States it was as a direct result of the revelation of the Tuskegee Syphilis Study that the next U.S. medical ethics initiative emerged. The National Research Act of 1974 was passed (Public Law 93348), which required regulatory protection for human subjects and created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In 1979 this commission produced the Belmont Report, named after the Smithsonian Institution s Conference Center, where the discussions were first held in 1976. The report established three ethical principles to allow problems to be solved in the area of ethics in clinical research (1) respect for persons, (2) beneficence, and (3) justice. In general terms, these categories were equivalent to informed consent, risk-benefit assessment, and an appropriate choice of subjects for the research. 

Several fundamental ethical principles guide clinical trials, including clinical equipoise, respect for study participants, beneficence, and justice. These are summarized here in turn. 

The principles of autonomy, beneficence, nonmaleficence, and justice form a foundation for analysis of ethical quandaries. In addition, a comprehensive ethical analysis will include considerations of cultural and reh-gious diversity of patient-subjects, health care providers and interpersonal relationships an assessment of the profession-based duties and obligations of the health care professionals, including an examination of relevant professional oaths and codes and an analysis of relevantly similar previous bioethical dilemmas. 

Despite the fact that the new codes of pharmaceutical ethics include the basic principles upon which bioethics is based (i.e., beneficence, autonomy, and justice), they are not complete enough to serve as a framework for making decisions in concrete situations where the basic principles come into conflict. In this case, an ethical foundation and a method are necessary. 

In reality, negative descrimination does not produce any ethical conflict. It is not ethical in itself, as it does not respect the principles of nonmaleficence and justice. 

Rationing of a clearly suitable therapy that does not have an alternative that is equally efficient and safe. The principles in conflict here would be those of nonmaleficence and justice. The rationing should be equitable and not infringe upon the decent minimum. This is ethically acceptable when the rationing criteria are explicit and known to those potentially affected. This is understood within a framework of scarce resources in which all of the measures have been adopted for the rationalization of these. 

As corrupt business and construction practices are the norm in some environments, students must learn not only that there are differences in what is considered acceptable practice they must also learn how to intellectually critique dubious ethical norms. We expect that exploration for and demonstration of universal and/or ubiquitous moral values will be an important component in international ethics education. One of the examples is the concept of Corporate Social Responsibility (CSR) (Baker 2004). CSR focuses on accountability of organizations to a broad group of stakeholders including employees, customers, suppliers, community organizations, subsidiaries and affiliates, joint venture partners, investors and shareholders. CSR policies are based on social justice principles, human rights, and environmental standards. CSR can make our science, engineering and management students better understand that we do not inherit the earth from our ancestors we borrow it from our children - a Native American proverb. Balanced evaluations are necessary. 

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