Drawing upon Confucian ethical insights extracted from the Analects, this essay argues that principlism suffers from fundamental theoretical flaws. Its four principles do not genuinely capture universal principles, because they distort the practice-embedded nature of authentic moral norms found within actual moral cultures, as elucidated by Confucian insights. Specifically, Confucianism highlights the importance of a reflective equilibrium between constitutive rules and regulative principles. Principlism, in reality, represents an abridged version of modern Western liberal ethical norms, as it retains (...) their significant regulative principles while excluding their specific constitutive rules. The essay also employs prominent examples to illustrate the practical ineffectiveness of principlism. Given that diverse cultures either adhere to different regulative principles that diverge from the four principles or are obligated to specify them with their distinct constitutive rules, relying on the four principles as a uniform starting point falls short in providing and justifying universal solutions to the bioethical dilemmas confronting contemporary societies. In addition, the essay delves into the underlying factors that have led to the seemingly widespread adoption of the four principles across different regions worldwide. Lastly, the essay introduces the concept of regioglobal bioethics as an alternative to principlism for global bioethics, outlining a general Confucian endorsement of this proposal and providing a brief response to potential objections, aiming to pave the way for further research. (shrink)

The decline in the interest in ethical theory is first outlined, as a background to the author’s discussion of principlism. The author’s own stance, that of a communitarian philosopher, is then described, before the subject of principlism itself is addressed. Two problems stand in the way of the author’s embracing principlism: its individualistic bias and its capacity to block substantive ethical inquiry. The more serious problem the author finds to be its blocking function. Discussing the four scenarios (...) the author finds that the utility of principlism is shown in the two scenarios about Jehovah’s Witnesses but that when it comes to selling kidneys for transplantation and germline enhancement, principlism is of little help. (shrink)

Clouser and Gert’s 'A Critique of Principlism’ (1990) has ignited debate over the adequacy of substituting principlism for moral theory as a means for dealing with biomedical dilemmas. Clouser and Gert argue that this sort of substitution is not adequate to the task. I examine their argument in light of recent defences of principlism on this score, those of B. Andrew Lustig (1992), David Degrazia (1992), and Beauchamp and Childress (1994). I argue that both sides in the (...) debate have assumed differing conceptions of a moral theory that virtually guarantee their respective conclusions. These differing conceptions are motivated by antecedent epistemological commitments. The present debate over principlism is therefore inconclusive. Future discussion should focus on the underlying epistemological issues. (shrink)

In November 2022 ChatGPT rang in the age of generative AI. Since then, conversational AI bots have been developing at an enormous pace. Unless specifically prompted otherwise, the models often default to principlism when analysing cases in medical ethics. We reflect on the journey of Beauchamp and Childress’ influential framework from an ‘analogue’ methodology into the era of artificial intelligence, discuss why the approach lends itself so well to automation, and provide an outlook on what the digital future of (...) principlism might look like. (shrink)

Moral conflicts occur in theories that involve more than one principle. I examine basic ways of dealing with moral dilemmas in medical ethics and in ethics generally, and propose a different approach based on a principle I call the "mutuality principle". It is offered as an addition to Tom Beauchamp and James Childress' principlism. The principle calls for the mutual enhancement of basic moral values. After explaining the principle and its strengths, I test it by way of an examination (...) of three responses—in the recent Festschrift for Dr Raanon Gillon—to a case involving parental refusal of a blood transfusion. The strongest response is the one that comes closest to the requirements of the mutuality principle but yet falls short. I argue that the mutuality principle provides an explicit future orientation in principlism and gives it greater moral coherence. (shrink)

This paper makes three principal contributions to the literature. First, it advances the critique of principlism beyond familiar objections. Rather than arguing merely that Beauchamp's framework is culturally biased or insufficiently sensitive to context, it identifies a structural conceptual limit: principlism cannot register the legitimacy of relational authorization structures because its foundational account of agency is individualistic by design, not by accident. Second, it reframes the debate over consent waivers in embedded research. Existing literature — including Morain et (...) al.'s important contribution — treats waiver criteria as refinements of principlist norms. This paper argues that refinement within the principlist framework is insufficient when the framework's core assumptions are routinely violated by the research settings under consideration. The question is not how to calibrate existing criteria but how to reconceive the normative basis for authorization itself. Third, it synthesizes cross-cultural empirical evidence — drawn from Indigenous, South Asian, African, East Asian, and Asian-American contexts — not merely to illustrate diversity but to do philosophical work. That evidence is used to demonstrate that relational, collective, and spiritually mediated authorization structures represent legitimate expressions of respect for persons, not deviations from a universal norm. This moves the conversation from descriptive pluralism toward normative reconceptualization, offering a context-sensitive account of authorization grounded in communities' moral self-understandings. (shrink)

Tom Beauchamp’s contributions to the field of bioethics are as influential as they are numerous. Here we reflect on his intellectual legacy, specifically his role in establishing principlism as a method of bioethical analysis. Despite its prominence in medical ethics education, in our experience as clinical ethicists and researchers, we rarely analyze ethical issues the way principlism suggests, either in the clinic or our scholarship. In this paper, we consider the complex ways in which principlism may fruitfully (...) relate to other approaches to ethical analysis in clinical ethics (e.g., the four-box method) as well as its relative strengths and drawbacks pedagogically, explanatorily, and translationally. We conclude with some reflections about the intellectual flexibility of principlism and its role in fostering interdisciplinary bioethics. (shrink)

Tom Beauchamp’s contributions to the field of bioethics are as influential as they are numerous. Here we reflect on his intellectual legacy, specifically his role in establishing principlism as a method of bioethical analysis. Despite its prominence in medical ethics education, in our experience as clinical ethicists and researchers, we rarely analyze ethical issues the way principlism suggests, either in the clinic or our scholarship. In this paper, we consider the complex ways in which principlism may fruitfully (...) relate to other approaches to ethical analysis in clinical ethics (e.g., the four-box method) as well as its relative strengths and drawbacks pedagogically, explanatorily, and translationally. We conclude with some reflections about the intellectual flexibility of principlism and its role in fostering interdisciplinary bioethics. (shrink)

This paper is a response to particularist critics of the normative force of moral principles. The particularist critique, as I understand it, is a rejection not only of principle‐based accounts of moral deliberation and justification, but also of accounts of character in which principles play a central role. I focus on the latter challenge and counter it with a view I call character‐principlism. I begin by discussing in a general way what motivates the particularity objection to principles and then (...) contrast two views – both of which insist on the importance of attentiveness to particularity – about the relative normative status of principles and particular cases. I present some reasons for believing that we need a more normatively robust conception of the role of moral principles than the particularists provide. In the main portion of the paper, I discuss how character‐principlism sees principles functioning in our lives and the lives we lead with others. I contrast this with some other accounts of desirable character that particularists can embrace, and argue that these are seriously flawed because, unlike character‐principlism, they cannot satisfactorily explain how a person could possess the constancy of character that moral integrity requires. (shrink)

Tom Beauchamp and James Childress's Principles of Biomedical Ethics introduced principlism—or the “four principles approach”—which has since become one of the most influential frameworks in contemporary bioethics. However, its potential to serve as a foundation for shared transcultural bioethical norms has elicited both substantial support and considerable critique. In this article, I analyze two notable attempts that utilize, or appear to be modeled after, principlism as a basis for global bioethics: Beauchamp and Childress's original formulation and the recently (...) revised International Code of Medical Ethics by the World Medical Association. I argue that each model fails, but for different reasons. Beauchamp and Childress's account is rooted in particular moralities, making it suitable for guiding action in specific clinical contexts but ill‐equipped to handle global ethical pluralism. Conversely, the WMA's approach is deficient due to its undefined moral foundation and lack of political legitimacy. To address these shortcomings, I outline a third approach designed to make explicit the connection between principlism, global bioethics, and the problem of political legitimacy. (shrink)

It is widely acknowledged that high-level AI principles are difficult to translate into practices via explicit rules and design guidelines. Consequently, many AI research and development groups that claim to adopt ethics principles have been accused of unwarranted “ethics washing”. Accordingly, there remains a question as to if and how high-level principles should be expected to influence the development of safe and beneficial AI. In this short commentary I discuss two roles high-level principles might play in AI ethics and governance. (...) The first and most often discussed “start-point” function quickly succumbs to the complaints outlined above. I suggest, however, that a second “cultural influence” function is where the primary value of high-level principles lies. (shrink)

The theoretical and practical roles of moral principles in principlist theory is the subject of this chapter. I start by discussing the historical background of the emergence of basic universal principles in bioethics. I then analyze the nature of the moral commitments in the universal framework of principles that I have developed over the last 40 years with James Childress. I also discuss how universal principles are fashioned into particular moralities such as those found in professional medical ethics, and the (...) circumstances under which particular moralities are consistent with universal morality. Finally, I show the relevance of principles for global research ethics and for an understanding of the rights of minorities in multicultural societies. (shrink)

My purpose is to briefly interrogate and qualify common presumptions regarding autonomy’s place in the four-principle approach. I argue that treating normative considerations of autonomy as a token to trade off against bio- medical beneficence, nonmaleficence, and justice relies on an “indefensibly thin” notion of autonomy, which causes it to become a greater source of intractable disagreement, or deadlock, than the other three principles (Reis-Dennis 2020, 2). -/- Three features unique to bioethical autonomy drive deadlock. First, bioethical autonomy is infinitely (...) available as a justificatory resource, in contrast to the other principles, which are relatively domain restricted. Second, considerations of bioethical autonomy offer no clear valence toward one decision over another (except in extreme cases), unlike the other principles. Its normative force is often undifferentiated such that it can be cited for and against the same intervention with equal legitimacy. Third, the normative weight of bioethical autonomy is inscrutable, with no operationalizable way to negotiate how much autonomy should count against competing principles, in contrast with the other principles, whose force admits of various forms of metrology and “cooperative negotiation” (Hieronymi 2023, 151). -/- This piece motivates the need for a more substantive conception of autonomy within bioethical principlism, so respect for autonomy remains a guiding ideal, while avoiding its tendency to dominate, destabilize, or promote deadlock under the principlist method, and without becoming the “trump” card that Beauchamp and Childress explicitly feared (Beauchamp and Childress 2019, 173). (shrink)

Principlism is the approach promoted by Beauchamp and Childress for addressing the ethics of medical practice. Instead of evaluating clinical decisions by means of full-scale theories from moral philosophy, Beauchamp and Childress refer people to four principles—of autonomy, beneficence, nonmaleficence, and justice. Now it is one thing for principlism to be invoked in an academic literature dwelling on a stock topic of medical ethical writing: end-of-life decisions, for example. It is another when the topic lies further from the (...) mainstream. In such cases the cost of reaching for the familiar Beauchamp and Childress framework, with its formulaic set of concerns, may be to miss something morally important. After discussing an example of the sort of academic literature I have in mind, I propose to distinguish the uses of the formulaic from the uses of the more unapologetically theoretical in applied ethics, and to suggest that the latter can make up for some of the limitations of the former. This is not to say that the more theoretical literature has no limitations of its own, or that it should take the place of the formulaic. On the contrary, there is room in applied ethics and a use in applied ethics for both. But there is a sense in which there is a greater dependence of principlism on theory than the other way round, and at the end I try to spell out the significance of this fact. (shrink)

Several scholars have recently criticized the dominant emphasis upon mid-level principles in bioethics best exemplified by Beauchamp and Childress's Principles of Biomedical Ethics . In Part I of this essay, I assess the fairness and cogency of three broad criticisms raised against ‘principlism’ as an approach: (1) that principlism, as an exercise in applied ethics, is insufficiently attentive to the dialectical relations between ethical theory and moral practice; (2) that principlism fails to offer a systematic account of (...) the principles of nonmaleficence, beneficence, respect for autonomy, and justice; and (3) that principlism, as a version of moral pluralism, is fatally flawed by its theoretical agnosticism. While acknowledging that Beauchamp and Childress's reliance upon Ross's version of intuitionism is problematic, I conclude that the critics of principlism have failed to make a compelling case against its theoretical or practical adequacy as an ethical approach. In Part II, I assess the moral theory developed by Bernard Gert in Morality: A New Justification of the Moral Rules , because Gert has recommended his approach as a systematic alternative to principlism. I judge Gert's theory to be seriously incomplete and, in contrast to principlism, unable to generate coherent conclusions about cases of active euthanasia and paternalism. Keywords: active euthanasia, applied ethics, Beauchamp and Childress, intuitionism, paternalism, principlism, W.D. Ross CiteULike Connotea Del.icio.us What's this? (shrink)

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics - principlism, put forward by Beauchamp and Childress in Principles of Bioethics , and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals - are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, (...) either the original version, or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated. (shrink)

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. (...) That is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

In this essay, we explore the parts of ethical life that cannot be captured and may actually be foreclosed by the dominant principle-centered approach to AI ethics. We argue that principles maintain traces of the moral encounters they were abstracted from, including traces of the moral and metaphysical intuitions that guided people in those encounters. Principlism is thus haunted by an unacknowledged particularity and what we call a “spectral moral ontology.” While bioethics principlism remains connected to the animating (...) force of the encounter through a moral actor, who vivifies its spectral moral ontology, AI possibly removes this moral actor. To do so, programmers must further abstract from the moral encounter by reducing the principles to formal logics cutting “ethics” off from its animating force. This approach to AI ethics creates and deploys a reductive spectral moral ontology that is woefully inadequate to the complexity and irreducibility of the moral encounter. (shrink)

In his landmark article “How Medicine Saved the Life of Ethics” (1982), Stephen Toulmin persuasively argues that (serious) problems cannot be solved by mere rationalistic approaches in ethics and that ethics was eventually saved by dint of having to deal with vital questions and concrete problems in medicine. Whether one is a proponent of, for example, principlism or casuistry, one certainly has to admit that a convincing ethical theory or method must have practical application. Analogously, it is about time (...) to consider another vital and prominent issue in normative ethics—the universalism-relativism debate—that might profit from the bioethical approach of principlism (otherwise known as the four-principles .. (shrink)

In this open peer commentary, we respond to Omelianchuk et al.’s article (2026), entitled “Reflecting on Principlism: Explaining, but not Guiding, Clinical Ethics Analysis.” We agree that clinical...

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents (...) of casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue (...) that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

This paper discusses aspects of market farming in the Bünz Valley in Switzerland, where market farmers rely heavily on water from the Bünz River to irrigate their vegetable fields during the summer months undermining minimal water sources for fish survival. It proposes to analyze such conflict situations using a principlist ethical methodology. Principlism, well known from biomedical ethics, is an ethical approach that relies on key ethical principles relevant to a particular area of practice without claiming to be a (...) full-fledged ethical theory. Through a critique of the classical principlist approach, the paper shows why a principlist approach, with some improvements, can do two things in cases like the present one. On the one hand, it makes it possible to identify the various claims and entitlements in a given case. On the other hand, an extended principlism can help identify duty bearers, which are much less obvious in environmental contexts than in medical practice. The paper illustrates these claims with a likely resolution of the Bünz case as a result of the application of the principlist methodology. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue (...) that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that principles should be understood as heuristics that can be “specified” as described by DeGrazia , and that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

This is a response to Earp and colleagues' target article "If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical break-up". I argue that the authors may indulge in the vice of in-principlism when presenting their ethical framework for dealing with anti-love biotechnology, and that they mis-apply the concept of harm.

The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics (...) as practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters (...) for consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

The four principles approach to bioethics, an approach most associated with the work of Tom Beauchamp and James Childress, is supposed to provide a framework for reasoning through moral issues in medicine. One might wonder, if one were to guide one’s thinking by the method suggested by principlism, will one identify and perform the objectively morally right action? Will one’s decision making be justified, and consequently, will the action that flows from that decision itself be justified? In this paper, (...) I show that principlism can, and has been, characterized in these two different ways. I also argue that when it is understood according to the first characterization, the view cannot be put into practice. However, when it is understood as an account of justification, there is reason to think that it is indeed action-guiding. Given the problems that confront the first version of the view, perhaps it is best to understand principlism, and biomedical ethical theories generally, not as action-guiding theories of right action, but rather, as procedures by which one’s decisions and actions in medicine can achieve a reasonable degree of moral justification. (shrink)

Fertility treatments, which are part of "assisted reproductive technologies" (ART), mainly undertaken through in vitro fertilization (IVF), offer the opportunity to infertile couples to conceive. IVF treatments are undertaken in Israel in significantly higher numbers than in the rest of the world. As such, Israel provides an important case-in-point for examining the validity of the actual claims used to justify the more generous public funding of IVF treatments at the policy level. In this article, we utilize an analytical philosophy approach (...) to conduct this examination. First, we highlight two fundamental concepts that were used at the Israeli public policy level in order to justify the generous public funding of IVF treatments. These concepts are “emotional vulnerability” and the “worthlessness of the childless,” where the latter emphasizes the infinite value of children. Then, by applying the perspective of the European model of Bioethical Principlism, and focusing the attention to these two concepts we show that these justifications are invalid. Specifically, it is suggested that these concepts are on the one hand both relying on and expressing the principles of vulnerability, dignity, and integrity; yet on the other hand, these concepts are also undermining the very principles of bioethics they are supposed to express and rely on. Based on this suggested criticism, we offer two “take home” messages informed by our analysis of the Israeli case, but reaching beyond it. (shrink)

The bioethics of four principles, named as principlism, began in 1979 with the work of Principles of Biomedical Ethics by Tom Beauchamp and James F. Childress and has been widely criticized since the 80s. In recent years four rival approaches towards principlism have been specified in this critique. These include: a) impartial rule theory, developed by K. Danner Clouser; b) casuistry, represented by Albert Jensen, and c) virtue ethics, developed by Edmund D. Pellegrino. The critique of principlism (...) presented by K. Danner Clouser, Bernard Gert was not only defended by T. Beauchamp and J.F. Childress themselves, but also by others, including B. Andrew Lustig, David DeGrazia, and Henry Richardson. The discussion has not weakened but continued till the present time. It was presented extensively in the June issue of The Journal of Medicine and Philosophy. We want to join the discussion from the position of personalistic bioethics. (shrink)

Principlism is an ethical framework that has dominated bioethical discourse for the past 50 years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism (...) to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics–a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education. (shrink)

For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be properly analysed and cogent philosophical solutions for the problems can be found. It seems that their ‘principlism’ gets updated, with better features being added during the course of the six editions of Principles of Biomedical Ethics. Nonetheless, Beauchamp and Childress seem to have been losing their way when it comes (...) to the common-morality justification, which is the epistemological (and perhaps metaphysical) backbone of their method, and this is shown more vividly in their most recent (2009) edition of Principles of Biomedical Ethics. The author points out what he calls the problem of ‘thick in status, thin in content’ in principlism. The problem exists because principlism cannot adequately explain how the prescriptive sense of common morality it supports is consistent with the existence of what Beauchamp and Childress call the ‘legitimate moral diversity in the world’. Because of this problem, first, the practical end that principlism allegedly accomplishes (ie, providing practical moral guidelines in a relatively ‘thick’ content, based on common morality) is frustrated, and, second, principlism makes itself the method of common morality de jure and of moral pluralism de facto. (shrink)

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics (...) fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. (shrink)

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public health policies (...) and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented. (shrink)

Bioethicists’ attraction to principlism is rooted in a Western view of how matters that affect the public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from the circumstances of the problem. That view of deliberation, itself fostered by the Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of (...) bioethics discourse. (shrink)

In their article, Crutchfield and Redinger (2024) outline the conditions that they have identified as situations in which it is ethically permissible to use chemical restraints, defined as medicati...