Research with human subjects has long been controversial because of the conflicts that often arise between promoting scientific knowledge and protecting the rights and welfare of subjects. Twenty-five years ago the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research addressed these conflicts. The result was the Belmont Report: Ethical Principles and Guidance for Research Involving Human Subjects, a report that identified foundational principles for ethical research with human subjects: respect for persons, beneficence, and justice. Since the publication of Belmont, these three principles have greatly influenced discussions of research with human subjects. While they are often regarded as the single-most influential set of guidelines for biomedical research and practice in the United States (and other parts of the world), not everyone agrees that they provide adequate guidance. Belmont Revisited brings together a stellar group of scholars in bioethics to revisit the findings of that original report. Their responses constitute a broad overview of the development of the Belmont Report and the extent of its influence, especially on governmental commissions, as well as an assessment of its virtues and shortcomings. Belmont Revisited looks back to reexamine the creation and influence of the Belmont Report, and also looks forward to the future of research - with a strong call to rethink how institutions and investigators can conduct research more ethically.

Madison Powers and Ruth Faden here develop an innovative theory of structural injustice that links human rights norms and fairness norms. Norms of both kinds are grounded in an account of well-being. Their well-being account provides the foundation for human rights, explains the depth of unfairness of systematic patterns of disadvantage, and locates the unfairness of power relations in forms of control some groups have over the well-being of other groups. They explain how human rights violations and structurally unfair patterns of power and advantage are so often interconnected. Unlike theories of structural injustice tailored for largely benign social processes, Powers and Faden's theory addresses typical patterns of structural injustice-those in which the wrongful conduct of identifiable agents creates or sustains mutually reinforcing forms of injustice. These patterns exist both within nation-states and across national boundaries. However, this theory rejects the claim that for a structural theory to be broadly applicable both within and across national boundaries its central claims must be universally endorsable. Instead, Powers and Faden find support for their theory in examples of structural injustice around the world, and in the insights and perspectives of related social movements. Their theory also differs from approaches that make enhanced democratic decision-making or the global extension of republican institutions the centerpiece of proposed remedies. Instead, the theory focuses on justifiable forms of resistance in circumstances in which institutions are unwilling or unable to address pressing problems of injustice. The insights developed in Structural Injustice will interest not only scholars and students in a range of disciplines from political philosophy to feminist theory and environmental justice, but also activists and journalists engaged with issues of social justice.

Madison Powers and Ruth Faden here develop an innovative theory of structural injustice that links human rights norms and fairness norms. Norms of both kinds are grounded in an account of well-being. Their well-being account provides the foundation for human rights, explains the depth of unfairness of systematic patterns of disadvantage, and locates the unfairness of power relations in forms of control some groups have over the well-being of other groups. They explain how human rights violations and structurally unfair patterns of power and advantage are so often interconnected. Unlike theories of structural injustice tailored for largely benign social processes, Powers and Faden's theory addresses typical patterns of structural injustice-those in which the wrongful conduct of identifiable agents creates or sustains mutually reinforcing forms of injustice. These patterns exist both within nation-states and across national boundaries. However, this theory rejects the claim that for a structural theory to be broadly applicable both within and across national boundaries its central claims must be universally endorsable. Instead, Powers and Faden find support for their theory in examples of structural injustice around the world, and in the insights and perspectives of related social movements. Their theory also differs from approaches that make enhanced democratic decision-making or the global extension of republican institutions the centerpiece of proposed remedies. Instead, the theory focuses on justifiable forms of resistance in circumstances in which institutions are unwilling or unable to address pressing problems of injustice. The insights developed in Structural Injustice will interest not only scholars and students in a range of disciplines from political philosophy to feminist theory and environmental justice, but also activists and journalists engaged with issues of social justice.

This book describes, in fascinating detail, a variety of experiments sponsored by the U.S. government in which people were exposed to radiation without their knowledge. After reviewing hundreds of thousands of documents from the Atomic Energy Commission and other agencies, the Advisory Committee appointed by President Clinton in January 1994 found that nearly 4,000 human radiation experiments--most involving very low doses of radioactive tracers--were sponsored by the federal government between 1944-1974. This book documents these findings to provide a fascinating if not disturbing reminder of both the shocking standards for human experimentation and the shrouded practice of government secrecy in recent history. Carried out at the height of the Cold War, experiments included feeding radioactive cereal to teenagers at a school for the mentally retarded, irradiating the testicles of prison inmates, injecting plutonium into hospital patients, and intentional releases of radiation into the environment. The book places these experiments within their historical context, and a review of the relevant government policies and ethics standards at the time is included. The analysis is then applied to contemporary research on human subjects. The book concludes with a discussion of the Committee's key findings and a set of recommendations for changes in in institutional review boards, the interpretation of ethics rules and policies, the conduct of research involving military personnel, the oversight and accountability for ethical violations, compensation for research injuries, and balancing national securities interests with the rights of the public. This compelling volume will prove to be a landmark in the development of standards for human experimentation. Ethicists, public health professionals and those interested in the history of medicine and Cold War history will be intrigued by the findings in this volume.

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy.