Abstract
The four principles approach to bioethics, an approach most associated with the work of Tom Beauchamp and James Childress, is supposed to provide a framework for reasoning through moral issues in medicine. One might wonder, if one were to guide one’s thinking by the method suggested by principlism, will one identify and perform the objectively morally right action? Will one’s decision making be justified, and consequently, will the action that flows from that decision itself be justified? In this paper, I show that principlism can, and has been, characterized in these two different ways. I also argue that when it is understood according to the first characterization, the view cannot be put into practice. However, when it is understood as an account of justification, there is reason to think that it is indeed action-guiding. Given the problems that confront the first version of the view, perhaps it is best to understand principlism, and biomedical ethical theories generally, not as action-guiding theories of right action, but rather, as procedures by which one’s decisions and actions in medicine can achieve a reasonable degree of moral justification.
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Notes
It could be claimed that principlism is concerned both with the rightness of action and the justification of action, in which case what appears to be a disagreement in the literature is, in fact, no disagreement at all. My project should still be of interest to those who accept this view, however. I suggest that they understand my project here as a defense of the view that principlism is totally implausible as an action-guiding criterion for the rightness of action.
I disagree that it is the “prima facie nature” of the principles that explains the thinness of the framework. That the principles express prima facie obligations implies that these obligations are not absolute, not that the principles are content-thin.
I do not want my criterion to imply that in every case there is one unique morally right action, and consequently, only one appropriate specification and balancing. Given this clarification, it is compatible with my statement of AGC, that more than one course of action is morally right.
Most utilitarians do not find this feature of their view problematic. One standard reply to this objection can be made by drawing a distinction between (1) a criterion for the rightness of action, and (2) a decision procedure. Utilitarians point out that utilitarianism attempts to provide (1), and that providing (1) does not commit one to any particular view about (2) [11].
My discussion here focused largely on Kantian ethics and utilitarianism. I believe the same point I have made here can be extended to other theories. Our lack of conceptual knowledge and our lack of knowledge about consequences prevent us from putting these theories into practice for determining the objectively morally right action.
I do not mean to commit myself to the view that the only way in which one’s moral beliefs can be justified is through the method of reflective equilibrium. Perhaps there are other ways. I am simply suggesting that going through this process is one way for one’s moral beliefs to attain a reasonable degree of justification, a degree that I suspect will make them immune from accusations of negligence.
References
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Hine, K. What is the outcome of applying principlism?. Theor Med Bioeth 32, 375–388 (2011). https://doi.org/10.1007/s11017-011-9185-x
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DOI: https://doi.org/10.1007/s11017-011-9185-x