The Belmont Report states that “respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy.” The Belmont Report goes on to describe an autonomous person as “an individual capable of deliberation about personal goals and of acting under the direction of such deliberation.” To respect an individual’s autonomy is to allow an individual to develop opinions, make choices, and act as they please, unless their actions are clearly detrimental to others. Investigators may not touch or examine subjects or interfere in their lives in any way unless they agree or consent to the examination or interference. Investigators’ actions must recognize and affirm subjects’ autonomy. Lack of respect is shown when individuals’ considered judgments are rejected, their ability to act on their judgments is denied, or information is withheld that is necessary to make a thoughtful, considered judgment when there is no compelling reason to do so.
Not all human beings are capable of acting autonomously. The ability to set personal goals, develop opinions, and make choices may be compromised at times in a person’s life and, in the case of children, only develops over time. In other instances, individuals (such as the severely or terminally ill, mentally handicapped, and imprisoned) may lose the capacity for acting autonomously partially or completely, or for a period of time. Respect for these persons, as defined by the Belmont Report, requires that these vulnerable individuals be offered special protections during that period when they cannot act autonomously. Offering special protections for vulnerable individuals is also a major emphasis of the principle of justice which is discussed later in this module. The principle of justice requires that the vulnerable be extended special protections with regard to the distribution of the benefits and burdens of research. The vulnerable should be assured of receiving their fair share of the benefits and protected from having imposed upon them more than their fair share of the burdens of research.
Respect for Persons – Philosophical Foundation
A philosophical basis for treating individuals as autonomous agents can be found in the writings of Immanuel Kant. Kant argued that respect for persons is required due to our inherent dignity, which in turn is due to our being rational creatures. Rational beings have the capacity to use reason in forming decisions, and act not only in accordance with reason, but also for the sake of reasons we believe are right (thus becoming a moral agent). According to Kant, it is the capacity to choose right from wrong, and the responsibility that follows from possession of such a capacity, that accords persons the Kantian sense of dignity that deserves respect. As free and autonomous beings, we become responsible for our actions in ways that nonrational creatures cannot be.
To treat persons with respect is to treat them as beings who are morally self-determining. People must never be used simply as a means to the ends of others, but always as ends in themselves. Respect for persons, in Kantian terms, implies that what is crucial is that a person be free to act for the sake of reasons they believe are right. Thus, a person’s moral agency or autonomy is violated if that decisional process is denied or subverted, even if the person would have acted in the same way had they been given the opportunity to decide. In such a case, a person who is denied decisional involvement is thus denied the status of moral agent. And this, in turn, denies something essential to having moral dignity. This philosophical basis for treating individuals as autonomous agents and always as ends in themselves is consistent with the Judeo-Christian doctrine, which asserts that each human has infinite value.
An investigator’s ethical obligation to treat persons with respect is primarily carried out in the informed consent process, which is discussed in Module 2. However, ethical norms derived from this principle are discussed in each of the modules.