We contend that many of the criticisms of the American Psychological Association’s current Ethics Code are based on faulty assumptions and insufficient information. While the APA Ethics Committee values commentary on perceived shortcomings of the current Ethics Code as an important aspect of the current revision process, O’Donohue’s article contains inaccuracies that should be addressed. We clarify the functioning of the Ethics Code and the APA adjudication system, including explaining changes made to adjudication in light of the Commission on Ethics (...) Processes. We also explain the transparent, open process the APA has already undertaken to create a revised Ethics Code that is visionary and transformational. (shrink)

Specifying the moral demands of respect for the autonomy of people with dementia (PWD) in nursing homes (NHs) remains a challenging conceptual task. These challenges arise primarily because received notions of autonomous decision-making and informed consent do not straightforwardly apply to PWD in NHs. In this paper, I investigate whether, and to what extent, the influential account of autonomous decision-making and informed consent proposed by Beauchamp and Childress has applicability and relevance to PWD in NHs. Despite its otherwise practical (...) orientation and suitability for acute care settings, I identify three problems with this account when applied to PWD in NHs. These problems include (1) intentionality as an all-or-nothing condition of autonomous decision-making, (2) construing consent as one-off authorization, and (3) unresolved ambiguities around the primacy of precedent autonomy over best interest considerations. To address these problems, I propose and defend a number of revisions to Beauchamp and Childress’s account. First, I suggest that we consider intentionality as a non-binary criterion of autonomous decision-making. Second, I argue for a model of process consent to overcome the moral inadequacy of construing consent as one-off authorization in NHs. And, to overcome the third problem, I suggest accounting for both precedent and extant autonomy of PWD, considering mandates of precedent autonomy not as prescriptive but as informative, and drawing a less rigid distinction between autonomy considerations and best interest judgements. I conclude that this revised version of Beauchamp and Childress’s account fares better than the original version in capturing relevant autonomy considerations to care for PWD in NHs. (shrink)

The notion of common morality plays a prominent role in some of the most influential theories of biomedical ethics. Here, I focus on Beauchamp and Childress’s models in the fourth and fifth edition of Principles of Biomedical Ethics as well as on a revision that Beauchamp proposed in a recent article. Although there are significant differences in these works that require separate analysis, all include a role for common morality as starting point and normative framework for theory construction in (...) combination with a coherence theory of moral justification. I defend to some extent the existence and empirical significance of common morality, as delineated by Beauchamp and Childress in different versions, but criticize its normative role. It is neither convincing as a moral foundation nor well compatible with a standard coherentist justification. I suggest that the authors should give up the foundational account for a more modest account of common morality as resource of well-established moral insights and experiences, which have proved generally valid but neither sufficient nor infallible. Beauchamp’s latest proposal appears as a step in this direction; indeed, it may be the beginning of the end of his common-morality theory. (shrink)

For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be properly analysed and cogent philosophical solutions for the problems can be found. It seems that their ‘principlism’ gets updated, with better features being added during the course of the six editions of Principles of Biomedical Ethics. Nonetheless, Beauchamp and Childress seem to have been losing their way when it (...) comes to the common-morality justification, which is the epistemological (and perhaps metaphysical) backbone of their method, and this is shown more vividly in their most recent (2009) edition of Principles of Biomedical Ethics. The author points out what he calls the problem of ‘thick in status, thin in content’ in principlism. The problem exists because principlism cannot adequately explain how the prescriptive sense of common morality it supports is consistent with the existence of what Beauchamp and Childress call the ‘legitimate moral diversity in the world’. Because of this problem, first, the practical end that principlism allegedly accomplishes (ie, providing practical moral guidelines in a relatively ‘thick’ content, based on common morality) is frustrated, and, second, principlism makes itself the method of common morality de jure and of moral pluralism de facto. (shrink)

This special issue commemorates the 40th anniversary of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics with a collection of original essays addressing some of the major themes in the book. It opens with intellectual autobiographies by Beauchamp and Childress themselves. Subsequent articles explore the topics of common morality, specification and balancing of moral principles, virtue, moral status, autonomy, and lists of bioethical principles. The issue closes with a reply by Beauchamp and Childress to the other (...) authors. (shrink)

What do medicine and war have to do with each other? This question is explored through the writings of James Childress, whose early contributions to just war theory illuminate his work in bioethics. By considering the conceptual influences of just war theory on Childress’s bioethics, the contributions and limits of his approach can be set in relief through normative engagement with certain areas of medicine. In particular, Childress’s just-war-inspired bioethics befits the practice of surgery; but oncology, as (...) a medical analogue to total warfare, requires significant transformation in order to be disciplined by Childress’s approach. Childress offers a coherent schema for navigating moral conflict in a fallen world, but he does not provide a substantive account of the peaceable end toward which medicine as just war aims. (shrink)

In the latest edition of Principles of Biomedical Ethics, Tom Beauchamp and James Childress provide an expanded discussion of the ethical theory underlying their treatment of issues in medical ethics. Balancing judgements remain central to their method, as does the contention that such judgements are more than intuitive. This theory is developed precisely in response to the common skepticism directed at "principlism" in medical ethics. Such skepticism includes the claim that moral reasoning comes to a dead halt when confronted (...) by competing conflicts between moral norms in a given pluralistic situation. In this paper, I use examples from the text to show that despite the authors’s arguments to the contrary, balancing judgements are the product of unreasoned intuitions. Given the necessity of some such judgements in any principle-based system, my argument highlights the degree to which principled ethical reasoning rests upon an arational core. (shrink)

In season one of True Detective, people watch Rustin Cohle evolve from a man who is slowly suffocating under the weight of the world to one who can shoulder it. His metamorphosis is existential. By the end of the season, when he proclaims that the "light is winning", Cohle has arrived. Cohle has had enough of his life; he is trapped in his despair and choking on its poison. Throughout the first season of True Detective, Cohle is the shepherd who (...) is choking on all that is bitter and ugly in the world. He is struggling to find the strength to kill the snake. The snake represents the necessity of affirming all aspects of life and willing them eternally. This leads us to Errol Childress. He is the hyperbolic monster at the end of the dream; he is the specter of nihilism and suffering. Their encounter ends with a violent, crippling battle and Childress' death. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report on (...) the difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

In responding to my critics, James Childress, Tom Beauchamp, Soren Holm, and Ruth Macklin, I reprise my arguments for medical ethics being an uncommon morality. I also elaborate on points that required further clarification. I explain the role of trust and trustworthiness in the creation of a profession. I also describe my views on the relationship of the medical profession to the society in which medicine is practiced. Finally, I defend my claim that medical ethics “is constructed by medical (...) professionals for medical professionals” by describing the profession’s unique vantage point for regulating and policing the profession’s uncommon powers and privileges. (shrink)

The theoretical commitments of Rust Cohle, the philosopher detective of True Detective, tend toward nihilism. Cohle appears to be a tough‐minded naturalist. True Detective is a deep enough show that it offers some genuinely penetrating insights into evil and evil personhood. In True Detective evil is Errol William Childress: the "Lawnmower Man" of True Detective, with a yen for torturing, raping, murdering, and ritualistically posing young women. Childress is described as a "green‐eared spaghetti monster". Some philosophers suggest that (...) there is a link between evil people and monsters. Most philosophers agree that being an evil person is qualitatively worse than being a bad person or even a very, very bad person. Cohle does some bad stuff— and with impunity, by his own account— however he is not a pederast and he is not a child killer. That is a qualitative distinction. Childress seems to have killed more people than Cohle; that is a quantitative distinction. (shrink)

In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched (...) by the dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)

Although machine intelligence is increasingly employed in healthcare, the realm of decision-making in medical ethics remains largely unexplored from a technical perspective. We propose an approach based on fuzzy cognitive maps (FCMs), which builds on Beauchamp and Childress’ prima-facie principles. The FCM’s weights are optimized using a genetic algorithm to provide recommendations regarding the initiation, continuation, or withdrawal of medical treatment. The resulting model approximates the answers provided by our team of medical ethicists fairly well and offers a high (...) degree of interpretability. Possible applications of such a system include informal guidance on medical ethics dilemmas as well as educational purposes. (shrink)

The unfinished nature of Beauchamp and Childress’s account of the common morality after 34 years and seven editions raises questions about what is lacking, specifically in the way they carry out their project, more generally in the presuppositions of the classical liberal tradition on which they rely. Their wide-ranging review of ethical theories has not provided a method by which to move beyond a hypothetical approach to justification or, on a practical level regarding values conflict, beyond a questionable appeal (...) to consensus. My major purpose in this paper is to introduce the thought of Bernard Lonergan as offering a way toward such a methodological breakthrough. In the first section, I consider Beauchamp and Childress’s defense of their theory of the common morality. In the second, I relate a persisting vacillation in their argument regarding the relative importance of reason and experience to a similar tension in classical liberal theory. In the third, I consider aspects of Lonergan’s generalized empirical method as a way to address problems that surface in the first two sections of the paper: (1) the structural relation of reason and experience in human action; and (2) the importance of theory for practice in terms of what Lonergan calls “common sense” and “general bias.”. (shrink)

In their Target Article, Rahimzadeh et al. (2023) discuss the virtues and vices of employing ChatGPT in ethics education for healthcare professionals. To this end, they confront the chatbot with a moral dilemma and analyse its response. In interpreting the case, ChatGPT relies on Beauchamp and Childress’ four prima-facie principles: beneficence, non-maleficence, respect for patient autonomy, and justice. While the chatbot’s output appears admirable at first sight, it is worth taking a closer look: ChatGPT not only misses the point (...) when applying the principle of non-maleficence; its response also fails, in several places, to honour patient autonomy – a flaw that should be taken seriously if large language models are to be employed in ethics education. I therefore subject ChatGPT’s reply to detailed scrutiny and point out where it went astray. (shrink)

Childress and colleagues conclude that arguments from distributive justice do not justify discontinuing ECMO over a capacitated patient’s objections (Childress et al. 2023). However, this conclusio...

Childress et al. (2023) present the case of a patient with capacity who requests to stay on extracorporeal membrane oxygenation (ECMO) indefinitely and highlight the ethical challenges associated w...

Childress and colleagues (2023) review several arguments that would support the unilateral withdrawal of ECMO (extracorporeal membrane oxygenation) against the wishes of a capacitated patient (Mr....

Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...

Childress et al. (2023) critically examine claims used to support unilateral withdrawal of life-sustaining ECMO over the objections of capacitated patients. The authors raise important concerns abo...

Childress et al. (2023) describe a disagreement between the competent patient and the physician recommending withdrawal of life-sustaining therapy (WLST). While the scenario is specific to ECMO, th...

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience (...) itself needs a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.Sabine MNeuroScienceAndNorms: Ethical and Legal Aspects of Norms in Neuroimaging at Bonn University Hospital, Germany. Her main research interests are in neuroethics. She is coauthor of three German books about neuroethics and bioethics.Henrik Walter, M.D., Ph.D., is Full Professor of Medical Psychology at the University of Bonn, Germany, and vice-director of the Department of Psychiatry and Psychotherapy at the University Clinic of Bonn. He is author of Neurophilosophy of Free Will and editor of the book From Neuroethics to Neurolaw?. His research fields are biological psychiatry, cognitive neuroscience, neuroimaging, neurophilosophy, and neuroethics. (shrink)

Childress et al. (2023) argue in favor of “ECMO-DT,” the provision of ECMO indefinitely as “destination therapy” in the ICU for patients who are dependent on the technology to sustain their lives....