The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that (...) the methods offered for specification and balancing of principles are inadequate. (shrink)

Within the latter half of the 30-year history of bioethics there has been an increasing pressure to address bioethical issues globally. Bioethics is not traditionally a theory-based enterprise, rather the focus has been problem related. With the introduction of the global perspective, theory has, however, become more important. One of the best known, probably the best known, theory of bioethics is the one presented by Tom L. Beauchamp and James F. Childress in their PrinciplesofBiomedicalEthics in 1979. This theory is known (...) as the or the approach or It is the attempt to create a global framework for bioethics on the four principlesthat I will scrutinize in this paper. (shrink)

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

The Maccabean Lecture by the most outspoken prestigious opponent of the Wolfenden reform proposal. Answered by Stuart Hampshire, A.J. Ayer, et al.--Jim Kepner.

In der 1785 veröffentlichten Grundlegung zur Metaphysik der Sitten formuliert Kant erstmals die Prinzipien einer universalistischen Ethik der Autonomie, deren Einfluß bis heute ungebrochen ist. Schon beim Übergang von der gemeinen zur philosophischen Vernunfterkenntnis findet man die Hauptgedanken: In der Ethik geht es nicht primär um das gute Leben und das Glück, und es geht auch zunächst nicht darum, welche Handlungserfolge erzielt werden; Gegenstand moralischer Hochschätzung sind vielmehr Intentionen und Maximen. Gut ist, was für alle vernünftigen Wesen gilt, weil es (...) von ihnen als autonomen und vernünftigen Wesen gewollt wird. Die Schrift ist kurz, einfach gegliedert und verständlich geschrieben. Sie eignet sich daher als Einführung in Kants Ethik, enthält aber zugleich als Grundlegung alle wesentlichen Gedanken seiner praktischen Philosophie. Auf der Grundlage der Originalausgabe von 1785/86 wurde der Text völlig neu erstellt. Eines der wichtigsten Bücher der Philosophiegeschichte liegt damit in einer zuverlässigen und preisgünstigen Neuausgabe vor. (shrink)

Unlike the principles of Kant, Mill, and Rawls, those of principlism are not action guides that stem from an underlying, integrated moral theory. Hence problems arise in reconciling the principles with each other and, indeed, in interpreting them as action guides at all, since they have no content in and of themselves. Another approach to "theory and method in bioethics" is presented as an alternative to principlism, though actually the "alternative" predates principlism by about 10 years. The alternative's account of (...) morality stays close to ordinary, common morality with its rules and ideals, which in turn are grounded in aspects of human nature. As such, morality must be understood to be a rational, impartial, and public system that is incumbent on everyone. Morality is a unified and integrated system. The moral rules and ideals are also "culture-" and "profession-sensitive" in that they are interpreted more specifically within these various contexts. (shrink)

Virtue is the most perdurable concept in the history of ethics, which is understandable given the ineradicability of the moral agent in the events of the moral life. Historically, virtue enjoyed normative force as long as the philosophical anthropology and the metaphysics of the good that grounded virtue were viable. That grounding has eroded in both general and medical ethics. If virtue is to be restored to a normative status, its philosophical underpinnings must be reconstructed. Such reconstruction seems unlikely in (...) general ethics, where the possibility of agreement on the good for humans is remote. However, it is a realistic possibility in the professional ethics of the health professions where agreement on the telos of the healing relationship is more likely to arise. Nevertheless, virtue-based ethics must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. (shrink)

Casuistry is a traditional method of interpreting and resolving moral problems. It focuses on the circumstances of particular cases rather than on the application of ethical theories and principles. After a brief history of casuistry, the method is explained and its relation to theory and principles is discussed.

Health care services are constantly assessed by their ability to accommodate values popular in contemporary societies. Autonomy, justice, and human dignity have for some time been among such values in the affluent West. Relative newcomers in the field are the notions of and which seem to attract, in particular, Continental European ethicists. a.

While much attention has been given to the use of principles in biomedical ethics and increasing attention is given to alternative theoretical approaches, relatively little attention has been devoted to the critical task of how one resolves conflicts among competing principles. After summarizing the system of principles and some problems in conceptualizing the principles, several strategies for reconciling conflicts among principles are examined including the use of single-principle theories (pure libertarianism, pure utilitarianism, and pure Hippocratism), balancing theories, conflicting appeals theories, (...) and lexical ordering. Then a mixed strategy is proposed in which consequentialist principles are balanced between themselves as are nonconsequentialist principles, after which the result of balancing the nonconsequentialist principles is lexically ranked over the result of balancing the consequentialist ones. Finally, strategies involving specifying and rule generation are discussed concluding that most current specification and rule-generating theories must involve some degree of lexical ordering of principles. (shrink)

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge (...) to us to show that our account of morality is more adequate than principlism. In particular we show that recognition of morality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label “Dartmouth Descriptivism.”. (shrink)

With the considerable attention given to UNESCO's Universal Declaration on the Human Genome and Human Rights, the time has come to take another look at the concept of dignity, on which this document is morally founded. The term “dignity” now appears in many national constitutions and international bioethical statements. It has also become popular among Continental European ethicists, many of whom wish to challenge the particularly American and overtly individualistic principles of “autonomy,” “justice,” “beneficence,” and “nonmaleficence.” a.

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, (...) these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

Taking precautions to prevent harm. Whether principe de précaution, Vorsorgeprinzip, føre-var prinsippet, or försiktighetsprincip, etc., the precautionary principle embodies the idea that public and private interests should act to prevent harm. Furthermore, the precautionary principle suggests that action should be taken to limit, regulate, or prevent potentially dangerous undertakings even in the absence of absolute scientific proof. Such measures also naturally entail taking economic costs into account. With the environmental disasters of the 1980s, the precautionary principle established itself as an (...) operational concept. On the eve of the 1997 Climate Summit in Kyoto, precaution, as the precautionary principle is often referred to, has now become a key legal principle in environmental law, in general, and in current international climate negotiations, in particular, attempts to understand why. It examines in turn the natural affinity between the precautionary principle and climate change, reviews a series of issues which the principle raises, and discusses avenues which it opens paper, climate change fulfills the theoretical requirements set for the application of the precautionary principle. It comes as no surprise that the actual application of the precautionary principle in the context of climate change raises high political stakes. As a result, climate change science, in particular, and science, in general, is under the fire of politically-motivated scientific skeptics. Thus, by way of the counter-measures which must be put into effect, the precautionary principle calls for a greater sense of responsibility on the part of scientists and the public at large. Specifically, from scientists, it demands perseverance in rigor, excellence in communication, and committment to education. However, even if special efforts are made to implement the precautionary principle in the context of climate change, the success of climate change mitigation will constitute no test of the validity, the usefulness, or the efficiency of the precautionary principle. Indeed, the degree to which climate change mitigation succeeds only provides a measure of our kind's ability to manage responsibly the global commons which we inherited from our ancestors and which our generation enjoys, the global commons which we will pass on to today's children and to generations to come. (shrink)

The maximin rule can be used as a formal version of the precautionary principle. This paper evaluates the feasibility and the intuitive plausibility of this decision rule. The major conclusions are: (1) Precaution has to be applied symmetrically. (2) Precaution is only possible when outcomes are comparable in terms of value, so that it can be determined which outcome is worst. (3) Precaution is sensitive to standards of possibility. Far-away scenarios have to be excluded, and it is difficult to find (...) a principled way to draw the line. (4) Precaution is sensitive to the framing of decision problems. Local cautiousness may add up to global incautiousness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Mettle of Moral Fundamentalism: A Reply to Robert Baker*Tom L. Beauchamp (bio)AbstractThis article is a reply to Robert Baker’s attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally (...) bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.Robert baker’s imaginative and incisive articles on international bioethics (Baker 1998a & b) are rich in history and philosophy, but they are as profoundly misguided as they are misdirected. In this comment, I will concentrate both on a pivotal interpretation and criticism that he offers of the Report of the Advisory Committee on Human Radiation Experiments (ACHRE 1996) and on his philosophical thesis that a moral fundamentalism of principles and rights is bankrupt. Baker seriously misinterprets the ACHRE report, distorts and fails to refute moral fundamentalism, and ultimately embraces a form of the very fundamentalism that he declares bankrupt. These three topics are connected in that Baker’s misconceptions of the ACHRE report launch his critique of moral fundamentalism and his mistaken understanding of moral fundamentalism drives his critique of the ACHRE report. 1 [End Page 389]Some Misunderstandings of the Human Radiation CommitteeBaker proclaims a conflict between ACHRE’s moral fundamentalism and multiculturalism. He presents this conflict as primarily a factual issue regarding whether different cultures and eras accept different moral principles—“the difference claim,” in his vernacular (Baker 1998a, pp. 208–9). This interpretation eventuates in a critique of the work of both ACHRE and Ruth Macklin:[W]hen Macklin and the Radiation Committee consider the challenge of multiculturalism, they construe this challenge, not as dispute about anthropological fact, but as a dispute about philosophical theory. More specifically, they treat any assertion of the difference claim as a form of “ethical relativism.”... They thus respond to the multiculturalist’s factual observations—even to factual observations by anthropologists—as if they were philosophical analyses.(Baker 1998a, p. 209)Baker thinks that a factual question has been fallaciously transformed into a philosophical one. However, this false dilemma is a figment of his fancy. He provides no citation to ACHRE to show that it holds this view, and for an understandable reason: This position is neither stated nor presumed in the Report. ACHRE is quite clear that relativism involves both an anthropological (I would prefer to say historical) dispute about fact and a philosophical dispute about value—and that they are not the same.The Committee and its staff proceeded as follows: They first collected a large body of historical documents and facts about the practices, policies, and values that prevailed during the period they were studying. Chapters 1 through 3 and 5 through 13, 12 of the Report’s 18 chapters, display the results of this empirical work. The Committee concluded, on this basis, that research investigators and government officials were aware of the obligations generated by universal principles. The ACHRE report specifically lists six “basic” moral principles and maintains that these principles were pervasively recognized at the time of the radiation experiments (ACHRE 1996, pp. 114ff, 124). ACHRE received testimony, conducted interviews, and compiled documents that indicated how deeply these principles were woven into the fabric of American culture at the time, so deeply that no responsible research investigator could have been unaware of them. ACHRE did not move beyond its list of six principles to a broader thesis about the (factual) universality of other principles and did not examine other cultures or periods of history; such work would [End Page 390] have exceeded ACHRE’s mandate and would have done more to obscure than to further its arguments.ACHRE also found that some government officials had attempted to hide their wrongdoing—a clear indication that these officials were aware of the relevant moral principles and knew that they should not have been treating persons as they did (ACHRE 1996, pp. 152–53; Chapman 1946). These factual findings were not armchair philosophy or empirical guesswork... (shrink)

Metaphysische Anfangsgrunde der Rechtslehre ist ein unveranderter, hochwertiger Nachdruck der Originalausgabe aus dem Jahr 1797. Hansebooks ist Herausgeber von Literatur zu unterschiedlichen Themengebieten wie Forschung und Wissenschaft, Reisen und Expeditionen, Kochen und Ernahrung, Medizin und weiteren Genres.Der Schwerpunkt des Verlages liegt auf dem Erhalt historischer Literatur.Viele Werke historischer Schriftsteller und Wissenschaftler sind heute nur noch als Antiquitaten erhaltlich. Hansebooks verlegt diese Bucher neu und tragt damit zum Erhalt selten gewordener Literatur und historischem Wissen auch fur die Zukunft bei.".

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in the (...) context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)