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.
BIOETHICS: A Systematic Approach is an extensive revision of Bioethics: A Return to Fundamentals. The subtitle has changed in order to emphasize that what distinguishes the authors’ approach to bioethics from almost all others is that it is systematic. It applies the account of morality and rationality presented in COMMON MORALITY: Deciding What To Do (2004) and MORALITY: Its Nature and Justification, Revised Edition (2005) to the moral problems that arise in the practice of medicine. The concept of rationality used to justify morality is the same concept that is used to define the concept of malady or disease. The book offers an account of the concept of death, and provides an account of euthanasia that fits within the systematic account of morality and rationality that have been provided. It also shows that this systematic account explains the controversy about the morality of abortion. There are new chapters on moral disagreements, abortion, and on “what doctors must know”, and significant improvements have been made in the treatment of the concepts of consent and malady. An entire chapter is devoted to the concept of mental maladies. Arguments are also developed against principlism and shows how principlism’s authors’ misunderstanding of this view undermines their criticisms.
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.
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