Medicine, Health Care and Philosophy

, Volume 15, Issue 4, pp 373–382

The principle of proportionality revisited: interpretations and applications

Scientific Contribution


The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized.


Appropriateness Excessiveness Means and ends Precautionary principle Principle of proportionality 


  1. Allis, C.D., T. Jenuwein, and D. Reinberg (eds.). 2007. Epigenetics. New York: CSHL Press.Google Scholar
  2. Bentham, J. 1960. An introduction to the principles of morals and legislation. Oxford: Basil Blackwell (first published 1789).Google Scholar
  3. Boenink, M. 2010. Molecular medicine and concepts of disease: The ethical value of a conceptual analysis of emerging biomedical technologies. Medicine, Health Care and Philosophy 13: 11–23.CrossRefGoogle Scholar
  4. Brownsword, R. 2007. Ethical pluralism and the regulation of modern biotechnology. In The impact of biotechnologies on human rights, ed. Francesco Francioni. Oxford: Hart Publishing.Google Scholar
  5. Cassell, E.J. 1991. The nature of suffering and the goals of medicine. New York: Oxford University Press.Google Scholar
  6. EGE. 2000. European group on ethics. Opinion 15. Ethical aspects of stem cell research and use. Brussels: European Commission.Google Scholar
  7. EGE. 2003. European group on ethics. Opinion 17. Opinion on the ethical aspects of clinical research in developing countries. Brussels: European Commission.Google Scholar
  8. EGE. 2009. European group on ethics. Opinion 25. Ethics of synthetic biology. Brussels: European Commission.Google Scholar
  9. Fleischhauer, K., and G. Hermerén. 2006. The goals of medicine in the course of history and today. Stockholm: Vitterhetsakademien/Royal Academy of Letters.Google Scholar
  10. Forge, J. 2009. Proportionality, just war theory and weapons innovation. Science and Engineering Ethics 15(1): 25–38.PubMedCrossRefGoogle Scholar
  11. Gärdenfors, P., and N.-E. Sahlin. 1988. Decision, probability, and utility: Selected readings. New York: Cambridge University Press.CrossRefGoogle Scholar
  12. Gerhards, J. H. 2011. Proportionality review in European Law. IVR Encyclopaedia of Jurisprudence, Legal Theory and Philosophy of Law. Accessed 23 May 2011.
  13. Hermerén, G. 2008. European values – and others. Europe’s shared values: Towards an ever-closer union? European Review 16(3): 373–385.Google Scholar
  14. Hofmann, B. 2010. The concept of disease—vague, complex, or just indefinable? Medicine, Health Care and Philosophy 13: 3–10.CrossRefGoogle Scholar
  15. Holm, S., and J. Harris. 1999. Precautionary principle stifles discovery. Nature 400: 398.PubMedCrossRefGoogle Scholar
  16. Jansen, L.A., and P.L. Sulmasy. 2002. Proportionality, terminal suffering and the restorative goals of medicine. Theoretical Medicine 23: 321–337.CrossRefGoogle Scholar
  17. Kirchengast, T. 2010. Proportionality in sentencing and the restorative justice paradigm: ‘Just Deserts’ for victims and defendants alike? Criminal Law and Philosophy 4: 197–213.CrossRefGoogle Scholar
  18. Latour, B. 1999. Pandora’s hope: Essays on the reality of science studies. Cambridge, MA: Harvard University Press.Google Scholar
  19. Machiavelli, N. 1988. The prince. Cambridge: Cambridge University Press.Google Scholar
  20. Moseley, A. 2009. Just war theory. Internet Encyclopedia of philosophy. Accessed 28 Dec 2010.
  21. Nordenfelt, L. 1995. On the nature of health. An action-theoretic approach. Dordrecht: Kluwer.Google Scholar
  22. Peterson, M. 2007. Should the precautionary principle guide our actions or our beliefs? Journal of Medical Ethics 33(1): 5–10.PubMedCrossRefGoogle Scholar
  23. Poto, M. 2007. The principle of proportionality in comparative perspective. German Law Journal 8(9): 835–870.Google Scholar
  24. Quill, T., B. Lo, D.W. Brock. 1997. Palliative care options of last resort. Journal of the American Medical Association, 278; 239:2009–2104.Google Scholar
  25. Rio declaration on environment and development. 1993. Statement of forest principles: the final text of agreements negotiated by governments at the United Nations Conference on Environment and Development (UNCED). New York: United Nations Department of Public Information.Google Scholar
  26. Rosenthal, J.S. 2006. Struck by lightning: The curious world of probabilities. Washington DC: Joseph Henry Press.Google Scholar
  27. Sahlin, N.-E. 2011. Unreliable probabilities, paradoxes, and epistemic risk. In Handbook of risk theory, ed. S. Roeser, R. Hillerbrand, M. Peterson, P. Sandin. New York: Springer (in press).Google Scholar
  28. Shapin, S. 1996. The scientific revolution. Chicago: University of Chicago Press.Google Scholar
  29. Singer, P. 1993. Practical ethics. Cambridge: Cambridge University Press.Google Scholar
  30. Ten, C.L. 1987. Crime, guilt and punishment. Oxford: Clarendon Press.Google Scholar
  31. Tost, J. 2008. Epigenetics. Norwich: Horizon Scientific Press.Google Scholar
  32. Treaty of Amsterdam. 1997. Luxembourg: Office for Official Publications of the European Communities.Google Scholar
  33. Weber, M. 1976. The protestant ethic and the spirit of capitalism. London: Allen & Unwin. (First published in German in 1934).Google Scholar
  34. WMA. 2008. Declaration of HelsinkiEthical principles for medical research involving human subjects. The latest version so far adopted at the 59th WMA General Assembly, Seoul, October 2008 (many earlier versions).Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Medical Ethics, Biomedical CentreLund UniversityLundSweden

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