This article questions the commonly held view that professional ethics is grounded in general ethical principles, in particular, respect for client (or patient) autonomy and beneficence in the treatment of clients (or patients). Although these are admirable as general ethical principles, we argue that there is considerable logical difficulty in applying them to the professional-client relationship. The transition from general principles to professional ethics cannot be made because the intended conclusion applies differently to each of the parties involved, whereas the (...) premise is a general principle that applies equally to both parties. It is widely accepted that professionals are required to recognize that clients or patients possess rights to autonomy that are more than the general rights to personal autonomy accepted in ordinary social life, and that professionals are expected to display beneficence toward their clients that is more than the beneficence expected of anyone in ordinary social life. The comparative component of professional ethics is an intrinsic feature of the professional situation, and thus it cannot be bypassed in working out a proper professional ethics. Thus, we contend, the proper professional treatment of clients or patients has not been explained by appeal to general ethical principles. (shrink)

The aim of this article is to review the recent popularity of casuistry as a model of moral inquiry. I argue that proponents of casuistry do not endorse the particularist epistemology that seems to be implied by their position, and that this is why casuistry does not seem to present something really new in comparison to 'top-down' generalist approaches. I contend that casuistry should develop itself as a (moderately) particularist position and that the challenge for the defender of casuistry is (...) to come up with ideas that strengthen the ('intuitionist') model of rationality that underlies most forms of particularism. (shrink)

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross’s ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract (...) general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised. (shrink)

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance.The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research (...) evidence which points towards patients wanting more information and a greater degree of openness.Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. (shrink)

BackgroundThis study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.MethodThis study is based on 12 semi-structured interviews with (...) three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.ResultsIn this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice.ConclusionThis study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress – respect for autonomy, beneficence, nonmaleficence and justice – are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting. (shrink)

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming (...) neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. (shrink)

Principlism appears to be the prevailing applied ethical framework in bioethics. Despite the view’s various strengths, critics point out that since the principles are ad hoc, conflicts indubitably emerge leading to inconsistency. There is debate around whether principlism can provide definitive action-guiding moral prescriptions or only help structure intelligent analyses and justifications of moral choices. In this paper, I contend that applying concepts of moral symmetry and moral asymmetry allows us to modify one of principlism’s principles—the principle of beneficence—into what (...) I will call the principle of compassion. I argue that the principle of compassion can function as an arbitrating or primary principle within the principlist framework. The result is a view we might call compassionate principlism. Arguably, compassionate principlism leads to fewer inconsistencies and provides more acceptable action-guiding moral prescriptions than traditional principlism. (shrink)

Background: The pharmaceutical industry has been responsible for major medical advances, but the industry has also been heavily criticized. Such criticisms, and associated regulatory responses, are no doubt often warranted, but do not provide a framework for those who wish to reason systematically about the moral dimensions of drug development. We set out to develop such a framework using Beauchamp and Childress's “four principles” as organizing categories. Methods: We conducted a qualitative interview study of people working in the “medical affairs” (...) departments of pharmaceutical companies to determine: (1) whether our data could meaningfully be organized under the headings of “autonomy,” “beneficence,” “nonmaleficence,” and “justice”; (2) how principles might be expressed in this particular commercial setting; and (3) if these principles are expressed, whether and how competing principles are balanced. We then critiqued these findings using existing normative theory. Results: Our interviews demonstrated that three of Beauchamp and Childress's four principles were salient to our participants: beneficence, nonmaleficence, and justice. Within each of these principles, participants had two broad ethical orientations: an altruistic public focus (“other-ness”) and a commitment to their companies (“firm-ness”). Our participants also demonstrated efforts to balance these principles and highlighted the importance of phronesis (or practical wisdom) in balancing and enacting principles. Notably, however, our participants did not spontaneously emphasize the importance of autonomy. Conclusions: It is possible to use qualitative empirical research, together with normative analysis, to derive a framework for pharmaceutical ethics. We suggest that our framework would be useful for those who wish to reason ethically within, or in collaboration with, the pharmaceutical industry. (shrink)

This paper discusses the importance of Richard M. Zaners work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is (...) bound up with the normative commitments of medicine as a therapeutic enterprise. (shrink)

This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use (...) of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent. (shrink)

In professional settings, people often have diverse and competing conceptions of responsibility and of when it is fair to hold someone responsible. This may lead to undesirable gaps in the distribution of responsibilities. In this paper, a procedural model is developed for alleviating the tension between diverging responsibility conceptions. The model is based on the Rawlsian approach of wide reflective equilibrium and overlapping consensus. The model is applied to a technological project, which concerned the development of an in-house monitoring system (...) based on ambient technology. The development of this innovative technology raised questions among the technological researchers about its social acceptance and the way issues related to privacy and security should be addressed. The case is analyzed in terms of two procedural norms (reflective learning and inclusiveness), which are based on literature on policy and innovation networks. Analysis of the case shows that, in a pluralist setting, a procedural approach can be useful for encouraging discussion on the legitimacy of different responsibility conceptions and the question what a fair responsibility distribution amounts to. (shrink)

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance. The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of (...) research evidence which points towards patients wanting more information and a greater degree of openness. (shrink)

MA Thesis. Biomedical ethics does not lend itself to easy categorisation as either a 'theoretical' or a 'practical' enterprise because inquiry into the quandaries of morality requires both situational and 'translocal' perspectives. These types of investigation bring into question the legitimacy of the theory/practice divide that has dominated intellectual thought since antiquity. This division hinders the development of bioethics by fostering internal dispute within the discipline regarding appropriate methodology and the practice of clinical ethics. In this thesis, I argue that (...) much of these disciplinary disjunctions are due to an undue labeling of bioethics as either 'applied ethics' or 'practical ethics', and a failure to recognise the intricate way in which theory and practice inform each other and are integral and interrelated parts of moral deliberation. I argue for an integration of the theory and practice of bioethics. (shrink)

Questions concerning the role (or lack thereof) of God in morality are implicitly or explicitly important in Western philosophical ethics. I describe some of the different ways philosophers treat (or ignore) God and the foundations of morality more generally, and I highlight some of the implications of these approaches for bioethics. I demonstrate that the starting points we choose for morality set the course for fundamentally different accounts of what is permissible and impermissible, good and bad, and right and wrong.