Which approach contains the principle of respect for persons

Corollary principle: Don't increase the risk of harm to others. Corollary principle: It is wrong to waste resources that could be used for good. Combining beneficence and nonaleficence: Each action must produce more good than harm.

The Principle of justice We have an obligation to provide others with whatever they are owed or deserve. In public life, we have an obligation to treat all people equally, fairly, and impartially. If you accept this as a basic principle as a reductive pluralist, you are committed to being able to derive all relevant concrete duties from it.

But if you accept it as a non-Wittgensteinian taxonomical pluralist, you are only committed to the idea that there is a set of more concrete duties or norms or values that are all united by this idea, but in the end are nothing more than different species belonging to a common genus. The principle of Beneficence, as well as possibly a distinct principle of Nonmaleficence, covers promotion and protection of health and human welfare, both of which should probably be seen as multi-dimensional and where it is quite possible that we need to identify different sub-principles regulating different aspects of health and welfare.

If we look at human rights in general, a wide range of rights especially social and economic rights can be seen as specifying the content of a principle like this. Footnote 8 To a large extent, Beneficence and Nonmaleficence are grounded in needs and interests that we have as individuals and while being part of a society will certainly enable a much greater satisfaction of those needs and interests, many of them are such that we would have them even if we were to live alone on some desert island.

Both Justice and Respect for Persons do however seem to be more deeply social or political concerns. Justice has to do with handling the relative scarcity of resources or goods and would also seem to be multi-dimensional cf.

Walzer , with different sub-principles regulating different areas, covering matters like equitable access to health care, fairness in prioritization, and non-discrimination. These are concerns which are certainly not irrelevant to the individual practitioner, but they have a strongly institutional character which suggests that they are primarily political rather than ethical in character. If we turn to Respect for Persons, we are looking at concerns that have to do with the standing we have as members of human societies and about how we relate to each other not just in terms of what we do more concretely, but also how we basically think about each other and what our underlying view of mankind is.

While both Beneficence and Nonmaleficence point to concerns which a utilitarian would readily embrace although one can certainly recognize these concerns without embracing a utilitarian calculus , Respect for Persons more distinctly raises concerns about how we cannot use individuals as means or ignore them even for the sake of the greater good. As already pointed out, it is also a principle that seems very closely connected to the kind of moral status that we share as human beings, but which is not applicable to other animals.

One can potentially identify some unifying features to it, albeit relatively abstract and thin. The taxonomical pluralist can see a point in identifying a relatively limited set of main families of values, norms, or rights.

Doing so provides structure to the normative terrain that we need to navigate. Something like the three-principle Belmont model or the four-principle model by Beauchamp and Childress would seem to be what one should then be aiming at. Such models might perhaps be criticized for relying on principles that are too broad, but for the taxonomical pluralists they are only the first step anyway.

With respect to human rights it is certainly possible to wholly eschew the level of more general, abstract principles and just focus on long lists of specific rights. But not only does it simply seem to be the case that one can identify existing such families of concerns, doing so also makes the terrain of human rights more navigable, especially for non-lawyers.

And in the context of bioethics, if human rights are to be integrated into existing discussions about medical decision making, this would arguably be facilitated if they can be understood as one way of bringing specificity to approaches like the four-principle model. This kind of work also clearly seems to be an area where philosophical ethics can make a contribution. Now, the argument up to this point has been that a human rights-based approach allows us to develop a conception of moral status involving human beings as having high and equal status, one that can be contrasted with hierarchical conceptions of what human societies should look like, but also with implicitly hierarchical normative theories.

The idea is that part of the reason why the approach advocated here can serve this role is precisely its rich pluralism. The notion of there being some kind of highly substantive normative core underneath all the everyday moral complexities or the long lists of human rights can certainly seem attractive from a strictly theoretical point of view; but it is difficult, if not impossible, to articulate that kind of core without at least implicitly placing many human beings in the margins of what is involved in personhood.

This is simply part of the logic involved in the very idea of that kind of core. In contrast, while the taxonomical approach still recognizes the need for some systematization, it keeps even the basic principles open-ended, allowing us to complete them through exploration of the actual moral and political terrain rather than by derivation from the general to the particular.

We will now look at how a more richly pluralistic account can enable us to understand a principle like Respect for Persons as more broadly applicable than if centered on Respect for Autonomy. There is not enough space here for a full analysis of the content of existing human rights treaties on bioethics, but it is quite clear that they identify several concerns that seem connected to personhood and which are respect-oriented values.

The CoE Convention on Human Rights and Biomedicine identifies dignity, identity, and integrity Article 1 , consent Article 5 , and private life and right to information Article Even if one works from a taxonomical approach there might still be certain concerns among these that can be fully reduced to some other. For instance, the way integrity will be understood here potentially allows us to reduce concerns about identity to being about integrity. Concerns like confidentiality and the right to information are arguably reducible to being about the implications of privacy and consent about an aspect of exercising autonomy.

This would still leave us with a five-member family making up the concerns involved in Respect for Persons: autonomy, dignity, integrity, privacy, and vulnerability. Of course from a moral and political perspective it is perfectly possible that there are further aspects to Respect for Persons that are not captured by current human rights treatises and one thing that characterizes a taxonomical approach is its openness for discovering new species of an already recognized genus.

Still, for an approach that seeks to take existing institutions as a starting-point, which is something that characterizes a political approach to human rights, these treatises do provide the natural place to begin an investigation into what is involved in Respect for Persons in bioethics. Footnote 9 Let us now look briefly at the five members of this family of concerns and at how not framing them in terms of simply being about autonomous decision making makes a difference to how we can come to understand their applicability, but also to how we can understand autonomy itself.

In contrast, if autonomy is used as an overarching concept for understanding personhood we will tend to be pushed towards a relatively thin account of it in order for it to be able to serve that very general role. If we look at a document like the CRPD it actually involves a quite ambitious idea of autonomous decision making as something to be achieved rather than something that normally just happens unless there is undue interference Craigie and the discourse surrounding the CRPD also tends to focus on supported decision making rather than substituted decision making for persons with cognitive disabilities Gooding This does not necessarily invalidate the idea that respect for autonomy is often well-expressed through informed consent procedures, but it does broaden the applicability of a principle like Respect for Persons and cautions against universally having the strategy that whenever a choice is to be made, the focus should lie on finding someone, sometimes a substitute, that can sign a consent form.

This would potentially also mean that autonomy in one sense at least is something that can come in degrees and that a reasonable goal is to enable patients to exercise control of their life situation, including their health situation. Among the values identified here as falling under what is involved in Respect for Persons, dignity is special in that while it is sometimes used to designate a certain status or rank Waldron , one of having a worth beyond price to borrow a phrase from Kant and of being protected from degradation and instrumentalization, it is sometimes also used to designate a property supposed to be had by all human beings and which justifies why a principle like Respect for Persons applies to human beings.

For instance, Andorno , p. Footnote 10 Now, for a taxonomical pluralist, it is quite possible that what respect for dignity forbids is simply an interconnected family of bad things. Dignity can still be a meaningful category. To some extent what people find degrading will vary and it might therefore be thought that such matters should simply be left to autonomous choice. There is however a phenomenon of adaptive preferences, which means that people who have gotten used to degrading circumstances will lower their expectations and adjust their preferences.

Footnote 11 What one will expect in terms of how one is treated will partly be about the standing one already has as a member of society. Autonomous choices can certainly play a role in some circumstances, but there should accordingly also be a level of protection against degradation and humiliation that is non-negotiable and sets the basis for what we should come to expect.

Dignity sometimes trumps autonomy, which is one reason why it cannot be reduced to matters of autonomy. This right can potentially be understood as consisting in at least two rights, the rights to mental and bodily integrity respectively. An idea of persons as having an untouchable core and there being important boundaries not to be crossed does however seem to be an important unifying theme Rendtorff , p.

A right to integrity can hardly be a right to be free from human contact, but must be about setting boundaries between acceptable and unacceptable contact. Finally, the right to integrity is clearly applicable to human beings that are not capable of autonomous decision making. Sometimes physical restraint is used in care, e. Respect for privacy is unique among the values that fall under Respect for Persons in that it to a large extent regulates behavior that happens without direct interactions with the persons in question.

People will often not know about whether their privacy has been breached or not. If privacy is understood in terms of restricted cognitive access, the difficult question is exactly which kinds of access that should be seen as undue cognitive access. In medicine we are dealing both with the fact that medical information is often highly sensitive as well as the fact that in order to treat patients, physicians and nurses must have relatively extensive cognitive access to facts about their patients.

Additionally, even if complete privacy is impossible it is still important and possible to look for ways of maintaining some privacy. Woogara points to how patients often can become habituated into accepting unnecessary infringements of privacy, so while there might be a temptation to understand the right to privacy in terms of autonomy or consent, it is important that our privacy is protected beyond what we might happen to accept, especially in situations where we are weakened and prone to just go along.

In fact, respect for privacy is similar to respect for dignity in that it does not just regulate the lives we lead anyway; instead, having it as a fundamental moral and political concern means having it play a constitutive role in defining our relations to each other and in building a specific kind of society.

While the notion of vulnerability was actually present already in the Belmont framework with respect to those groups where Respect for Persons could not be meaningfully formalized in terms of informed consent procedures , the UNESCO Declaration was the first major document that clearly articulated Respect for Vulnerability as a concern in its own right.

This right does not name anything that should be protected or promoted. Rather, we should be respectful or mindful of the fact that human beings are fundamentally vulnerable beings and that some humans might be in special circumstances of vulnerability. There are at least two main senses in which vulnerability is relevant in a biomedical context. First, there is a general existential sense in which we are all vulnerable and where our vulnerability is something that we are very much confronted with when we come face to face with the fact of illness Pellegrino But there are also concerns about especially vulnerable individuals or groups and the specific measures that should be taken with respect to them Macklin While our fundamental vulnerability is a universal feature of human existence that might be addressed by how we form societies, the exact ways in which we might be especially vulnerable will always depend on how our societies are organized, similar to how what becomes a disability depends on how society is organized.

Irrespective of exactly why certain concrete vulnerabilities exist, they tend to open us up for being coerced, deceived, or manipulated. The risk of exploitation is also why sensitivity to vulnerability is so important in research ethics as well Lange et al. This means that being sensitive to vulnerability can be an important reason for having informed consent procedures rather than mainly seeing them as a way of letting people exercise autonomous choice , but sensitivity to vulnerability clearly goes beyond matters of consent.

Precisely those groups that are not capable of consenting in meaningful ways will also tend to be especially vulnerable since they will often have difficulties making their voices heard and providing input into decision procedures that should still be respectful of them as persons.

A complete human rights-based approach to bioethics includes more than the concerns that have been considered here and to provide an overall assessment of such an approach lies well beyond the scope of this paper.

The focus has been on the principle of Respect for Persons and how it can be understood as being about a family of concerns which are interconnected, but not reducible to one another.

The main advantage of such a human rights-based approach is that it makes Respect for Persons into a principle that is clearly applicable to all human beings. Footnote 12 Exactly what this kind of respect then means more concretely will certainly vary from person to person and situation to situation and the kind of taxonomical pluralism advocated here cannot provide an algorithm for moral choice; indeed, its very rationale is that the moral landscape is too complex for such an algorithm to make sense.

Taxonomical pluralism points to a conception of philosophical ethics as a form of moral cartography, not moral mathematics. To some this might be disappointing, but when it comes to working within a strongly institutionalist approach, like a human rights-based one, where the focus is on the intersection between morality, law, and politics, it is at any rate difficult to see how the influence of philosophical ethics on the everyday workings of such institutions can realistically be about more than shifting the attention and ongoing conversations towards certain concerns rather than others.

The kind of open-ended moral cartography that taxonomical pluralism involves might not be philosophically sleek, but it can still matter for actual practice. One of the main sources of opposition to this kind of picture is feminist ethics in general and feminist bioethics in particular, for instance in developing relational approaches to autonomy that are often less ratiocentric in character e. It should be said that there are possible strategies for addressing this kind of problem.

One is to argue that potentiality for the relevant capacity is enough e. Another is to argue that what matters is membership in a species where members typically have certain relevant capacities e. A focus on membership will eventually characterize the approach articulated here, but to the extent that such an approach is built on ultimately anchoring full moral status in the value of sophisticated cognitive functioning, there will arguably still tend to be lingering questions about just why those who lack these capacities really matter.

It should be said that such accounts tend to be formulated to allow for a great plurality of ways of life, but any positive account of, say, human flourishing or central human capabilities will still be at risk of reifying ideas about what is normal, which is potentially problematic for instance in relation to persons with disabilities cf. Cochrane , p. The argument here ties in with a larger debate between what are often called naturalist vs.

There is another important sense of pluralism, namely the existence in our societies of many different moral outlooks. With respect to that kind of pluralism, human rights can hopefully be something around which an overlapping consensus can be formed cf. Taylor This is an issue that will be set aside, although the more open-ended character of the taxonomical approach to principles that will be defended here should be able to facilitate inclusivity in building such an overlapping consensus.

A certain kind of specification is also important in the four-principle model as presented by Beauchamp and Childress , pp. In the former case, we have a robust understanding of the principle that we then develop in more specific ways; in the latter, our understanding of the principle is rather like a common denominator for the species principles, which will be the ones doing the real work in our moral deliberations.

Rendtorff presents a similar list not surprisingly, since it is partly based in the same documents , although framed as a conceptualization of basic principles in European bioethics and biolaw. This should however not be taken to mean that we cannot think of dignity as a foundational value connected to our personhood or as a way of articulating the value inherent in personhood, it is just that the present account does not need that kind of notion of dignity.

It should be said that the standing of embryos is contested and they are not provided full moral standing in a document like the Oviedo Convention, where the handling of embryos is also quite clearly a product of compromise Andorno , p.

However, even then, the idea is that certain forms of respect will still be relevant for how we should deal with human embryos. Journal of International Biotechnology Law 2: — Article Google Scholar.

Journal of Medicine and Philosophy — Ashcroft RE Could human rights supersede bioethics? Human Rights Law Review — Beauchamp TL Informed consent: its history, meaning, and present challenges. Cambridge Quarterly of Healthcare Ethics — New York, Oxford University Press.

Google Scholar. The Lancet — Cochrane A Undignified Bioethics. Bioethics — This encompasses issues related to who benefits from research and who bears the risks of research. It provides the framework for thinking about these decisions in ways that are fair and equitable. People who are included in research should not be included merely because they are a population that is easy to access, available, or perhaps vulnerable and less able to decline participating.

An experimental strategy that is likely to be used by many types of people should be tested in the very populations of people who are likely to use it, to ensure that it is safe, effective, and acceptable for all of the potential users. For example, experimental treatments that are intended for use in the general population must be studied not only on men, but on enough women to ensure that they are also safe and effective for women. The principle of justice also indicates that questions being asked in trials should be of relevance to the communities participating in the study.

Research ethics are based on three fundamental principles: 1. Respect for Persons This principle incorporates two elements that deal with respecting people in regard to research: People should be treated as autonomous The term autonomous means that a person can make his or her own decisions about what to do and what to agree to.