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3. As McNaughton and Rawling, point out, most and perhaps even all of Ross’s duties are actually versions of thick moral concepts, and I believe that this is also true of most other forms of principlism. McNaughton, D, Rawling, P. Unprincipled ethics. In: Hooker, B, Little, M, eds. Moral Particularism. Oxford: Oxford University Press; 2000: 266 Google Scholar. On the topic of thick notions see as well Williams, B. Ethics and the Limits of Philosophy. Cambridge, MA: Harvard University Press; 1985:40–45 Google Scholar and Dancy, J. In defense of thick concepts. Midwest Studies in Philosophy 1995;20:263–79CrossRefGoogle Scholar. For a good collection of papers on the topic see Thick Concepts, ed. S. Kirchin (Oxford: Oxford University Press, 2013).

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7. See note 1, Dancy 1983, at 542. Although Ross does seem to be a particularist in his epistemology, he apparently feels the need for a generalist metaphysical viewpoint, likely due to assumptions about the nature of moral rationality. If Dancy is correct here, and I think it likely that he is, then one important difference between Ross and contemporary principlists is that they tend to support a generalist epistemology and metaphysics, whereas Ross only supports a generalist metaphysics.

8. Richardson HS. Specifying norms as a way to resolve concrete ethical problems. Philosophy and Public Affairs 1990;19:287. On the role and limits of intuitionism in the principlism of Beauchamp and Childress see Lustig, A. The method of Principlism: A critique of the critique. Journal of Medicine and Philosophy 1992;17(5):487–510 CrossRefGoogle ScholarPubMed.

9. Although the traditional reading of Ross is that such self-evident principles are used to justify case-decisions, there are some occasions in his later work where he appears to makes different claims. For example, at one point Ross states: “when I reflect on my own attitude towards particular acts, I seem to find that it is not by deduction but by direct insight that I see them to be right or wrong. I never seem to be in the position of not seeing directly the rightness or a particular act of kindness, for instance, and of having to read this off from a general principle—‘all acts of kindness are right, and therefore this must be, though I cannot see its rightness directly.’” See Ross, WD. The Foundations of Ethics. Oxford: Clarendon Press; 1939:171 Google Scholar. Ross does go on to suggest that in exceptional circumstances principles do play an epistemological role but his general viewpoint here belies the claim that principles are typically justificatory. Ross also makes the related claim that we apprehend self-evident principles from self-evident acts. See Ross, W.D. The Right and the Good. Oxford: Clarendon Press; 1930:33 Google Scholar. These suggestions that individual acts can be both self-evident and justified without the use or need of principles are contrary to his earlier, and arguably overall, emphasis on principles as being both foundational and justificatory. I raise this point to suggest that, although Ross is typically viewed as being opposed to particularism, there are possible readings of him that are essentially particularist in nature.

10. The seeds for this approach arguably arose out of their participation in the Belmont Commission which resulted in the Belmont Report in 1978. On the Belmont Report see The Belmont Revisited: Ethical Principles for Research with Human Subjects. eds. Childress, James F., Meslin, Eric M., and Shapiro, Harold T.. Washington DC: Georgetown University Press; 2005 Google Scholar; Beauchamp, TL. The origins and drafting of the Belmont report. Perspectives in Biology and Medicine 2020;63(2):240–50CrossRefGoogle ScholarPubMed; Nagai, H, Nakazawa, E, Akabayashi, A. The creation of the Belmont report and its effect on ethical principles: A historical study. Monash Bioethics Review 2022:40:157–70CrossRefGoogle ScholarPubMed. For a critique of the discipline of applied ethics as it emerged during this time see MacIntyre, A. Does applied ethics rest on a mistake? Monist 1984;67(4):498–513 CrossRefGoogle Scholar. On the development of principlism see Evans, JH. A sociological account of the growth of Principlism. Hastings Center Report 2000;30:31–38 CrossRefGoogle ScholarPubMed and Callahan, D. Universalism and particularism: Fighting to a draw. Hastings Center Report 2000;30:37–44 CrossRefGoogle ScholarPubMed. For a helpful history of the origins and development of the field see Pellegrino, E. The metamorphosis of medical ethics: A 30 year perspective. JAMA 1993;269:1158–62CrossRefGoogle Scholar; Jonsen, A. The Birth of Bioethics. New York: Oxford University Press; 2008 Google Scholar; and Callahan, D. In Search of the Good: A Life in Bioethics. Cambridge, MA: MIT Press; 2012 CrossRefGoogle Scholar.

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12. It is important to note that there are different variations of principlism, with the most obvious difference between them being the number and understanding of principles that they support. For example, Pellegrino and Thomasma support a single-principle theory that emphasizes beneficence, although respect for autonomy and other goods are subsumed under beneficence. See Pellegrino, E, Thomasma, D. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press; 1988 Google Scholar. Tristam Engelhardt supports a two-principle theory emphasizing autonomy and beneficence with priority given to autonomy. See Engelhardt, TH. The Foundations of Bioethics. 2nd ed. New York: Oxford University Press; 1996 CrossRefGoogle Scholar at Chapter 2. More recently, David DeGrazia and Joseph Millum have also defended a two principle approach emphasizing well-being and respect. See DeGrazia, D, Millum, J. A Theory of Bioethics. Cambridge: Cambridge University Press; 2021 CrossRefGoogle Scholar. Baruch Brody’s pluralistic theory focuses on five right-making characteristics: consequences, rights, respect for persons, virtues, and a fifth appeal that includes not only justice but also cost-effectiveness. Brody, B. Life and Death Decision Making. New York: Oxford University Press; 1988:17–48 Google Scholar. Robert Veatch also supports a principlist viewpoint which has roughly 7 basic principles. See Veatch, R. Resolving conflicts among principles: Ranking, balancing, and specifying. Kennedy Institute of Ethics Journal 1995;5:199–218 CrossRefGoogle ScholarPubMed. Bernard Gert, R. M. Green, and Charles Clouser support a theory with 10 basic principles. See Gert, B, Green, RM, Clouser, KD. The method of public morality versus the method of Principlism. Journal of Medicine and Philosophy 1993;18:477–89Google Scholar. The new natural law theory of Germain Grisez, John Finnis, and Joseph Boyle also supports 10 basic goods. See Grisez, G, Finnis, J, and Boyle, J. Practical principles, moral truth, and ultimate ends. American Journal of Jurisprudence 1987;32(1):99–151 CrossRefGoogle Scholar and Finnis, J. Natural Law and Natural Rights. 2nd ed. Oxford: Oxford University Press; 2011 Google Scholar, and Tollefsen, C, Curlin, F. The Way of Medicine: Ethics and the Healing Profession. South Bend: University of Notre Dame Press; 2021 Google Scholar at Chapter 2. For a good overview see Veatch, R. Reconciling lists of principles in bioethics. Journal of Medicine and Philosophy 2020;45(5):540–59CrossRefGoogle ScholarPubMed.

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23. See note 21, Beauchamp, 1996, at 81.

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26. See note 21, Beauchamp, 1996, at 84.

27. See note 21, Beauchamp, 1996, at 84.

28. See note 21, Beauchamp, 1996, at 84.

29. See note 21, Beauchamp, 1996, at 84.

30. See note 21, Beauchamp, 1996, at 84.

31. See note 21, Beauchamp, 1996, at 84.

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33. As Margaret Little notes, “A set of features that in one context makes an action cruel can in another [context] carry no such import; the addition of another detail can change the meaning of the whole… Natural features do not always ground the same moral import, which then goes into the hopper to be weighed against whatever other independent factors happen to be present. The moral contribution they make on each occasion is holistically determined: it is itself dependent… on what other non-moral features are present or absent.” Little M. Wittgensteinian lessons on moral particularism. In: Elliot, C. ed. Slow Cures and Bad Philosophers: Essays on Wittgenstein, Medicine, and Bioethics. Durham, NC: Duke University Press; 2001:165.

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35. Jonsen AR. Strong on specification. Journal of Medicine and Philosophy 2000;25:353.

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40. See note 11, Beauchamp and Childress, 2019, at 17. Richardson gives the example of the norm that “one should not directly kill innocent persons” can, upon reflection, be specified into the norm that: it is generally wrong to directly kill innocent human beings who have attained self-consciousness, and generally wrong directly to kill human beings with the genetic potential to develop self-consciousness who would not be better-off dead, but it is not generally wrong directly to kill human beings who meet neither of these criteria. See note 8, Richardson, 1990, at 304.

41. Not all interpreters of principlism agree that it is an anti-deductivist theory. Van der Steen and Borden, for example, argue that principlism is deductive in that, although principles arise from cases, they can be deductively (even if post hoc) applied back to cases, either the original cases, or to new ones. See van der Steen WJ. 1995. Facts, Values, and Methodology: A New Approach to Ethics, 63. Amsterdam-Atlanta, GA, Borden, SL. Character as a safeguard for journalists using case-based ethical reasoning. International Journal of Applied Philosophy 1999;13:93–104.Google Scholar

42. Richardson does not totally avoid balancing, but he severely limits its role, allowing it only minor leeway to function at more theoretical levels. However, even this limited reliance upon balancing is not entirely uncontroversial. For example, Veatch claims that “if principles are to be balanced, no norm can successfully be specified.” See note 12, Veatch, 1995, at 216. Here he appears to be suggesting that even theoretical balancing will be impacted as a result of context-changes, and this ever-changing balance prevents any concrete specification.

43. See note 8, Richardson, 1990, at 294.

44. See note 11, Beauchamp and Childress, 2019, at 19.

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52. In the same chapter, Hart argues that the uncertainly arising from the open texture of rules can also push one towards rule skepticism. Particularism would be seen by many as the perfect example of this result. However, I think that Hart’s stance is ultimately very similar to a more moderate form of particularism. Hart argues that neither rule-formalism nor rule-skepticism is correct, but rather some position between the two, with both case-experience and rules needed for concrete action guidance.

53. Strong makes a similar point in his article on specified principlism. See note 47, Strong, 2000.

54. See note 12, Veatch, 1995, at 216.

55. Beauchamp and Childress attempt to address this problem by linking specification to Rawls’s method of reflective equilibrium. See note 11, Beauchamp and Childress, 2019, at 456–57. As Arras argues, a serious problem here is that appeals to reflective equilibrium as a form of justification in bioethics often “devolve into the truism that the best method requires the careful rational assessment of all the relevant philosophical arguments bearing on a subject and assessing them on their merits…. Here wide reflective equilibrium appears to be more a rather massive effort of hand waiving than a precise road map to moral justification.” See Arras, JD. Methods in bioethics: The way we reason now. New York: Oxford University Press; 2019:188 Google Scholar.

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57. See note 36, Richardson, 2000, at 289.

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61. McDowell J. Virtue and reason. In: McDowell J. ed. Mind, Value, and Reality. Cambridge MA: Harvard University Press; 1998:58.

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71. I would argue that non-absolute or exceptionable principles can still account for moral holism. That is, generalists in this more moderate sense can accept the particularist viewpoint that the valence of a moral property is contextualized. Non-universal but still general ethical principles could be used as justificatory grounds for relevant decisions by either explaining how the valences of moral properties change in different contexts, or by excluding variant-causing contexts from their justificatory sphere.

72. See note 1, O’Neill, 2001, at 18 and note 1, Crisp, 2000, Particularizing Particularism at 32.

73. See note 1, Crisp, 2000, at 28–29.

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77. See note 1, Jackson, Petit, and Smith, 2000, at 88.

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80. See note 69, Kirchin, 2003, at 69.

81. For example, in clinical medicine many “principles” are actually guidelines that are known to have exceptions that must be evaluated on a case-by-case basis. Thus, the guideline “splint fractured bones” is a very useful generality, and one which is clear and easy to teach and follow. If a doctor universally followed this principle, he or she would be performing the right action most of the time. In fact, if a doctor followed this principle absolutely, they still would be fairly adequate, perhaps even average, at their craft. However, absolute and rigid obedience to this rule would not be helpful to some patients, and could even severely harm other patients. The mature practically wise physician who has a true understanding of his or her craft realizes the useful exceptions to this principle through prior experience and by evaluating its connection to other generalities, such as “preserve blood flow to extremities” and “lungs need adequate room for expansion to prevent collapse.” It is interesting to note how the concepts of virtue and practical wisdom become increasingly prevalent in successive editions of Beauchamp and Childress’s Principles of Biomedical Ethics. On this point see especially the section on discernment in Chapter 2, pp. 39–40.