Michael Lamb’s recent book A Commonwealth of Hope presents an opportunity for bioethicists to engage in critical self-evaluation in order to consider anew why and how to engage difficult bioethical problems and questions with those who maintain diverse moral and metaphysical perspectives. Drawing on an account of the virtue of hope from Augustine of Hippo, Lamb develops a political theory in which hope provides common ground for political cooperation between diverse citizens of a commonwealth. The purpose of this introduction is (...) to sketch out a framework by which to assess and evaluate whether bioethics demonstrates hope. This article provides a summary description of Lamb’s presentation of Augustine’s virtue of hope and his concept of politics. Then it considers implications of Lamb’s politics of hope for bioethics, identifying three features of hopeful bioethics, with which bioethicists can engage in self-reflection and evaluation. (shrink)

This special issue commemorates the 40th anniversary of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics with a collection of original essays addressing some of the major themes in the book. It opens with intellectual autobiographies by Beauchamp and Childress themselves. Subsequent articles explore the topics of common morality, specification and balancing of moral principles, virtue, moral status, autonomy, and lists of bioethical principles. The issue closes with a reply by Beauchamp and Childress to the other authors.

Beauchamp and Childress’ biomedical principlism is nearly synonymous with medical ethics for most clinicians. Their four principles are theoretically derived from the “common morality”, a universal cache of moral beliefs and claims shared by all morally serious humans. Others have challenged the viability of the common morality, but none have attempted to explain why the common morality makes intuitive sense to Western ethicists. Here I use the work of Charles Taylor to trace how events in the Western history of ideas (...) made the common morality seem plausible and yet, ironically, underscore the cultural particularity of the so-called common morality. I conclude that the supposedly universal common morality is actually quite culturally contained. Importantly, this should give us pause about the global authority of principlism and Beauchamp and Childress’ claim to a global bioethics project. (shrink)

Tom Beauchamp and James Childress‘s revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle’s eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics —autonomy, beneficence, nonmaleficence, justice—in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend (...) that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake—conflating common areas regulated by moral norms with common norms regulating moral conduct—that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change—moral progress, regress, reform, evolution, devolution, or revolution—no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences. (shrink)

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

“Outsiders” addressing ethical issues in medicine—Strangers at the Bedside —became “bioethicists.” Bioethicists providing research ethics consultation have been described as “stranger...

Bioethicists often remind health care professionals to pay close attention to issues of diversity and inclusion. Approaches to ethics consultation, where the perspective of the bioethicist is taken to be more morally correct or necessarily authoritative, have been critiqued as inappropriately authoritarian. Despite such apparent recognition of the importance of respecting moral diversity and the inclusion of different viewpoints, authoritarianism is all too often the approach adopted, especially as bioethics has shifted evermore into concerns for public policy. Yet, secular values (...) and philosophical principles are not morally neutral; nor are the private moral convictions of bioethicists. Such analysis is always grounded in particular understandings of the right and the good, the virtuous and the just. Critical examination of common treatments and new alternatives is essential for the careful scientific practice of medicine. The same is true with regard to bioethics. Stagnating in customary or accepted claims of a common secular morality or a standard set of bioethical principles out of an unwillingness to explore the real diversity of moral thought, including traditional religious and cultural worldviews, fails to tap the human capacity to find innovative solutions to the complex challenges facing medicine. (shrink)

Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions (...) about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment. (shrink)

Power tends to corrupt and absolute power corrupts absolutely. To be clear, I do not think that blood transfusions necessarily...