Principlism’s Balancing Act: Why the Principles of Biomedical Ethics Need a Theory of the Good

Abstract

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification—adding specific content to general principles—and balancing—determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it lacks a theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework.

District nurses’ experiences with involuntary treatment in dementia care at home: a qualitative descriptive study

“…leaving and returning later, changing the right moment of care, being firm, bringing in others, distracting or persuading them; or (3) creating new consonant cognitions by finding that providing safe care was more important than respecting the voice of the PLWD [ 20 , 31 ]. The finding that safety outweighed the autonomy of the PLWD showed that the normative arguments district nurses used to decide which care was needed were generally based on a biomedical ethical approach [ 32 ]. Since they mainly focused on the bodily needs of the PLWD like protecting against harm and less on their moral needs like involving them in decisions about their care, making the principles of non-maleficence (e.g.…”

Principlist approach to multiple heart valve replacements for patients with intravenous drug use-induced endocarditis

“…The best candidate for such an account is Beauchamp’s and Childress’s Principles of Biomedical Ethics , now in its eighth edition. Although principlism is not without its problems,17–19 it does provide viable a set of principles that are widely held by medical ethicists and which guide and inform the work of ethics committees at many secular medical facilities.…”

Exploring Modern Virtue Ethics in the Context of Oral Healthcare

“…[1][2][3] This interest in virtue ethics is further motivated by the realisation that character cannot be detached from ethical discourse in healthcare provision. [5][6][7] However, it seems that the features that make traditional virtue ethics valuable, have also created the impression that this theory is not as effective at providing action-guidance in resolving ethical dilemmas encountered in healthcare provision, as duty-based ethical theories. [5][6][7][8] Motivated by this misguided perception of the lack of action-guidance of traditional virtue ethics approaches, a variety of appealing modern forms of virtue approaches, have been put forward.…”

“…[5][6][7] However, it seems that the features that make traditional virtue ethics valuable, have also created the impression that this theory is not as effective at providing action-guidance in resolving ethical dilemmas encountered in healthcare provision, as duty-based ethical theories. [5][6][7][8] Motivated by this misguided perception of the lack of action-guidance of traditional virtue ethics approaches, a variety of appealing modern forms of virtue approaches, have been put forward. These modern virtue approaches aim to provide a correlation between considerations of virtue (and related virtuous behaviour), vice (and related vicious behaviour) and considerations of right or wrong actions.…”