Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud Principialismo, bioética personalista e princípios de ação em medicina e serviços de saúde Since there is a gap and differences between bioethical concepts and other principles of action arising from the practice of modern medicine, their comparison is reasonable. Modern medicine has created principles of action based on evidence and principles of quality in medicine, and bioethical argumentation frequently resorts to principlism or personalist bioethics. This article (...) intends to illustrate the characteristics of the relationships between these concepts and their potential mutual enrichment. A simple, practical comparison matrix is proposed to compare the relationship between principles. These concepts have a significant overlap; however, both in the history of ideas and in their formulation, they are very dissimilar. Emphasis is placed on the contextual value of this analysis given by global health trends and some implications for medicine from personalist bioethics. Para citar este artículo / To reference this article / Para citar este artigo Insua JT. Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud. pers. bioét. 2018; 22: 223-246. DOI: 10.5294/pebi.2018.22.2.3. (shrink)

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or (...) constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition. (shrink)