Principlism

Medical ethics is a field of expertise that has developed alongside increasingly powerful technologies that have changed medical practice significantly over the past decades. From artificial ventilation and the possibility of resuscitation after cardiac arrest in the 1960s to big data-driven genomic medicine of today, modern medicine is loaded with ethical dilemmas and complex decisions. Four principles, namely respect for autonomy, non-maleficence, beneficence and justice, were identified in the 1970s as guiding concepts of an ethics of biomedicine, the then emerging clinical practice that is informed by biological and physiological evidence from basic research. However, as cultural and historical context affects understanding of these principles, their implementation in clinical practice and healthcare is not trivial. Here, we highlight additional principles and values that back up these four core principles in the European context, particularly solidarity, human dignity, pluralism, tolerance, non-discrimination and gender equality. We further summarize how European Union law reflects such principles and values, and refer to existing instruments to support their implementation. Focusing on solidarity, we highlight its understanding in the European context as well as some challenges for its realization.

This paper examines the roles of culture in the principles of biomedical ethics. Drawing on examples from African, Navajo and Western cultures, the paper maintains that various elements of culture are indispensable to the application of the principles of biomedical ethics.

This open access book seeks to identify the ethical spirit of European Union (EU) law, a context in which we can observe a trend towards increasing references to the terms ‘ethics’ and ‘morality’. This aspect is all the more important because EU law is now affecting more and more areas of national law, including such sensitive ones as the patentability of human life. Especially when unethical behaviour produces legal consequences, the frequent lack of clearly defined concepts remains a challenge, particularly against the background of the principle of legal certainty. This raises the question to which extent the content of these references is determined and whether it is possible to identify an ethical spirit of EU law. Answering that question, in turn, entails addressing the following questions: In references to ethics concerning EU law, can we identify references to a particular theory of practical philosophy at all; and, if so, to one or more normative ethical theories (deontology, consequentialism, or virtue ethics)? Further, should these non-legal concepts be imported in an unaltered way (“absolute approach”), or be adapted to the legal context (“relative approach”)? This book explores the different layers of EU law (primary law, agreements, secondary law, and tertiary law), including the role of ethics in EU lawmaking and in EU case law, as well as the implementation of relevant EU directives in selected Member States. In addition to the above-mentioned normative philosophical lens, the book also analyzes the findings from the legal lens of EU integration, i.e., especially EU values, human rights and the cornerstone of human dignity.

Since 2019, media outlets including the New York Times, Business Insider, and Fortune began identifying a "gold rush" in psychedelic medicine as venture capital flocked to invest in psychedelic start-ups. Although most psychedelics remain Schedule 1 prohibited substances, venture capital firms were encouraged by the recent decriminalization of psilocybin in Denver, CO and Oakland, CA, and investors have been eager to establish an early foothold in the nascent psychedelic marketplace in light of the recent explosion of the adjacent cannabis industry. Meanwhile, the FDA granted "breakthrough therapy" designations to two psychedelic compounds across three clinical trials: MDMA for post-traumatic stress disorder (PTSD) in 2017, psilocybin for treatment-resistant depression in 2018, and psilocybin for major depressive disorder (MDD) in 2019. The Multidisciplinary Association for Psychedelic Studies (MAPS) projects that MDMA will gain FDA approval by 2023, and psychedelicassisted therapies are expected to extend widely to other clinical indications, including obsessive-compulsive disorder (OCD), substance use disorder (SUB), social anxiety in autistic adults, and end-of-life anxiety. In the global context of rising mental health burdens, the psychedelic drugs market has been projected to reach $6.85 billion by 2027. This course will examine the bioethical implications of this mainstreaming of psychedelic medicine, beginning with an introduction to some of the major methodologies and principles of bioethics as an interdisciplinary field. We will then develop a bioethical comprehension of key working concepts from psychedelic medicine, including "set and setting," suggestibility, and informed consent. Moving from the clinic to larger societal and structural dynamics, we will end by considering how market-based approaches to medicalization contrast with alternative models for new legal frameworks including decriminalization. On the basis of this groundwork, the course ends with conceptions for how the future of psychedelic medicine could be built to incorporate the bioethical themes of justice and equity towards the betterment of society.

Since the times of the Enlightenment, traditional control of religion in vital spheres of the social order began to crumble under the secular challenge of politics, culture, science, economy, judiciary, philosophy, and education.  Ethics and theology were probably the last strongholds until they eventually succumbed as well under the influence of the now secularized academia.  This happened at a time when society was restless with exciting medical discoveries which brought with them the age-old questions of just distribution, legitimate use of technology and justified manipulation of nature.  The debate on contraception was among the test cases of novel technology with ethical substance, and dissent against church teaching caused an exodus of scholar to join the burgeoning field of bioethics.  Even though theologians made important seminal contributions in the early days of bioethics, it was philosophy that bioethics eventually fell back on because of the troubles facing theology.  Principlism soon became the dominant philosophical model to be applied in policymaking and at the bedside.  However, the consensus achieved by this ethic looked contrived and open to manipulation of the potent.  As discontents brewed, a plethora of competing models surged on the horizon, many of them sought to relocate ethics in the context of the situation or the character of the moral agent.  Unwittingly, this puts secular bioethics on the path toward ethical relativism, liberalism and nihilism.  Bioethics has become a secular creature which not only rejects religion but now questions the very possibility of reason itself.  Different speculations sought to provide the causes of the secularization of bioethics.  At root is an uncertainty about the place of religion in democracy, and of situating religious ethics in public ethics.  Secular bioethics’ inadequacy also calls for a reexamination of the possible contribution of religion and theology in terms of distinctively religious content, communities and methodologies.  Hence, a ray of hope appears on the horizon for religion to reinsert itself into the bioethical debate, which has become impoverished from its absence.

Zwei Fragen werden in diesem Artiekl mit Bezug auf die Prinzipienethik (principlism) von Tom L. Beauchamp und James F. Childress erörtert: (A) Aus welchem systematischen Bedürfnis heraus haben Beauchamp und Childress ihren Ansatz entwickelt? (B) Warum verzichten die Autoren der Prinzipienethik darauf, die Prinzipien, die in ihrem Ansatz eine zentrale Rolle spielen, als »Prinzipien der mittleren Reichweite« zu bezeichnen? Eine Erörterung dieser Fragen hat eine über den diskutierten Ansatz hinausweisende Bedeutung für die philosophische Ethik insgesamt. Die Schlussthese wird in vier Schritten angestrebt: (1) Im ersten Teil werden epistemologische Fragen der Bioethik behandelt. Die These ist hier: Die anwendungsbezogene Bioethik zeigt der allgemeinen philosophischen Ethik, dass Intuitionen wichtige Erkenntnisprinzipien in Fragen nach der praktischen Orientierung im Handeln bereitstellen. (2) Im zweiten Teil soll daher zunächst erläutert werden, was im Sinne einer Prinzipienethik Intuitionen sind und es soll zudem gezeigt werden, dass Intuitionen ihre eigene kritische Instanz sind. (3) Der dritte Teil dagegen wendet sich einer begründungstheoretischen Grundsatzfrage zu. Die These ist hier: Die Bioethik zeigt der philosophischen Ethik, dass fundamentistische Begründungsprogramme in der Ethik einerseits nicht alternativlos und andererseits bei Fragen nach der praktischen Orientierung von Personen eher hinderlich sind. (4) Abschließend ist im vierten Teil zumindest skizzenhaft zu zeigen, wie die Prinzipienethik einen epistemologischen mit einem begründungstheoretischen Pluralismus vereinbaren kann, ohne auf die Anforderung an Handelnde, sich für ihre Handlungen zu rechtfertigen, zu verzichten. Also bleibt die These: Philosophen haben in der Ethik die Aufgabe sich mit epistemischen Fragen im Bereich der Moral auseinanderzusetzen und nicht eine Moral zu begründen.

Respect for Autonomy (RFA) has been a mainstay
of medical ethics since its enshrinement as one of the
four principles of biomedical ethics by Beauchamp and
Childress’ in the late 1970s. This paper traces the development
of this modern concept from Antiquity to the
present day, paying attention to its Enlightenment origins
in Kant and Rousseau. The rapid C20th developments of
bioethics and RFA are then considered in the context of
the post-war period and American socio-political thought.
The validity and utility of the RFA are discussed in light
of this philosophical-historical account. It is concluded
that it is not necessary to embrace an ethic of autonomy in
order to guard patients from coercion or paternalism, and
that, on the contrary, the dominance of autonomy threatens
to undermine those very things which have helped doctors
come to view and respect their patients as persons.

En la actualidad emergen con gran fuerza varias teorias que en general son denominadas jurisprudencia de valores y discurso principialistico. Estas teorias son muy variadas, sin embargo presentan algunos elementos comunes, dos de los cuales son su enfrentamientoal formalismo juridico latinoamericano y la aplicacion de postulados tenidos como superiores por encima de los contenidos de la norma escrita. En este escenario se nos ha hecho creer que solo hay dos opciones: el formalismo juridico o la jurisprudencia de valores y/o de principios, pero esta dicotomia, ademas de falsa, remite a laidea inconveniente de que de un extremo solo podemos pasar al otro, sin considerar puntos intermedios.Este trabajo analiza la jurisprudencia de valores y el discurso principialistico, para plantearsus peligros en la sociedad colombiana contemporanea (e incluso la latinoamericana),asi como los riesgos derivados de pasar de un extremo al otro, todo con el fin de sentar las bases para otras propuestas j...

This article critically examines appeals to common morality within Beauchamp and Childress's Principles of Biomedical Ethics. I examine how this aspect of their account relates to Kant's account of morality. I consider criticisms against principlism on the basis that medical ethics cannot be grounded on a common morality because of the responsibilities and duties specific to medical practice. I suggest these arguments do not deny the possibility of universal moral principles; rather they demonstrate how the actions and duties that best instantiate these principles are context-specific and can differ between organizations.

I summarise a conception of morality as containing a set of rules which hold ceteris paribus and which impose pro-tanto obligations. I explain two ways in which moral rules are ceteris-paribus, according to whether an exception is duty-voiding or duty-overriding. I defend the claim that moral rules are ceteris-paribus against two qualms suggested by Luke Robinson’s discussion of moral rules and against the worry that such rules are uninformative. I show that Robinson’s argument that moral rules cannot ground pro-tanto obligations is unsound, because it confuses an absolute reason for an obligation with a reason for an absolute obligation, and because it overlooks the possibility that priority rules may be rules for ordering pro-tanto obligations rather than rules for eliminating contenders for the status of absolute obligation.

Good medical practice: a code of conduct for doctors in Australia provides uniform standards to be applied in relation to complaints about doctors to the new Medical Board of Australia. The draft Code was criticised for being prescriptive. The final Code employs apparently less authoritative wording than the draft Code, but the implicit obligations it contains are no less prescriptive. Although the draft Code was thought to potentially undermine trust in doctors, and stifle professional judgement in relation to individual patients, its general obligations always allowed for flexibility of application, depending on the circumstances of individual patients. Professional codes may contain some aspirational statements, but they always contain authoritative ones, and they share this feature with legal codes. In successfully diluting the apparent prescriptivity of the draft Code, the profession has lost an opportunity to demonstrate its commitment to the raison d'etre of self-regulati...

Obsession with moral principles is a modern phenomenon. Much of applied ethics and bioethics in particular is written on the assumption that there are general moral principles that can help us to determine which action is right in any particular situation. However, some philosophers have pointed out that the view is false and that it is impossible to codify morality and formulate general moral principles. The issue between generalism (the view that there are general moral principles) and particularism (the view, that there are no such principles) can be formulated in the following way. According to generalists there are patterned transitions from descriptive properties to moral properties. Particularists deny this. It has been objected by generalists, that particularist  position is untenable because if there are no patterned transitions between descriptive to moral, then descriptive differences of a situation will not make any difference from the moral point of view and as a consequence the connection between our moral judgments and reality turn out to be a mystery. In the paper I argue that this objection is not decisive for particularism. The objection assumes that if moral properties supervene on descriptive properties then the transition from descriptive to moral must be patterned in all cases. However, this assumption loses its force as soon as we switch from morality to arts. It is widely accepted that aesthetical properties supervene on descriptive properties. But only few would agree that in every case the transitions from descriptive to aesthetic are patterned. If the analogy between moral and aesthetic is correct (e.g., there are no metaphysical differences between those properties) then in some cases at least we should not expect the existence of patterns in morality as well. This, I think, justifies the acceptance of weak particularism – the view, that there are no patterned transitions from descriptive to moral in every case. And this in turn must change our attitude toward the way we treat moral rules in bioethics. Particularly, we should be more skeptical about the possibility of principles to solve important moral issues, and the role of principles in moral education.

Copyright © 2013 A. S. M. Anwarullah Bhuiyan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article is related to the ethical problem that is faced by a public servant in his organization. It focuses on relevant ideas, such as definition and components of administrative ethics. The attempt is to find out an answer to the question: What would be the responsibility of a public servant? In order to spell out the answer to this question, the article focuses on some ideas such as virtue ethics, principle of duty, problem solving model and some form of democratic model. As a case study, I have chosen a play of Henerik Ib-sen’s: An Enemy of the People. It also examines the concept of whistle blowing in the context of the play.

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental importance of understanding persons within the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging.

Islamic Perspectives on the Principles of Biomedical Ethics presents results from a pioneering seminar held in 2013 between Muslim religious scholars, biomedical scientists, and Western bioethicists at the research Center for Islamic Legislation & Ethics, Qatar Faculty of Islamic Studies. By examining principle-based bioethics, the contributors to this volume addressed a number of key issues related to the status quo and future of the field. Discussion is based around the role of religion in bioethical reasoning, specifically from an Islamic perspective. Also considered is a presentation of the concept of universal principles for bioethics, with a response looking at the possibility (or not) of involving religion. Finally, there is in-depth analysis of how far specific disciplines within the Islamic tradition — such as the higher objectives of Sharia (maqāṣid al-Sharī'ah) and legal maxims (qawā'id fiqhīyah) — can enrich principle-based bioethics.

This chapter describes and defends moral pluralist theories, that is, ethical theories that hold there is no one single principle to which all other principles may be reduced. It overviews Frankena's 'mixed deontological theory', Beauchamp and Childress' 'Principlism' and Gert's 'common morality', emphasizing the commonalities across these pluralist theories. It responds to the major philosophical challenges to moral pluralism, and - drawing especially on Beauchamp and Childress' work - develops a three-stage process of specification and conflict resolution to resolve clashes between principles in cases of conflict.