Abstract
Principlism is the approach promoted by Beauchamp and Childress for addressing the ethics of medical practice. Instead of evaluating clinical decisions by means of full-scale theories from moral philosophy, Beauchamp and Childress refer people to four principles—of autonomy, beneficence, nonmaleficence, and justice. Now it is one thing for principlism to be invoked in an academic literature dwelling on a stock topic of medical ethical writing: end-of-life decisions, for example. It is another when the topic lies further from the mainstream. In such cases the cost of reaching for the familiar Beauchamp and Childress framework, with its formulaic set of concerns, may be to miss something morally important. After discussing an example of the sort of academic literature I have in mind, I propose to distinguish the uses of the formulaic from the uses of the more unapologetically theoretical in applied ethics, and to suggest that the latter can make up for some of the limitations of the former. This is not to say that the more theoretical literature has no limitations of its own, or that it should take the place of the formulaic. On the contrary, there is room in applied ethics and a use in applied ethics for both. But there is a sense in which there is a greater dependence of principlism on theory than the other way round, and at the end I try to spell out the significance of this fact.
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Notes
The term ‘principlism’ is sometimes associated with critics of Beauchamp and Childress, notably K Danner Clouser and Bernard Gert, in a series of articles and books from the 1990s. This paper is not associated with the point of view of Clouser and Gert. Beauchamp and Childress’s book has now gone through six editions, and its deployment of the four principles was already changing markedly in the fourth edition. (see Emmanuel 1995: 37–38). Whereas principlism was once associated with bringing hard cases under general principles and deriving the implications of principles in different situations of action, that does not seem to fit Beauchamp and Childress in its latest incarnation. The matter is discussed in chapter 10 of the Sixth Edition, op. cit. By ‘principlism’ I mean turning for diagnoses and solutions of problems of health care ethics to one or more of the four principles promoted by Beauchamp and Childress rather than any broader or more general moral theory, including a general moral theory formulated in academic philosophy. This approach may more properly associated with Raanon Gillon than Beauchamp and Childress. See the Festschrift issue for Gillon:2003).
For some of the ethical issues connected with wandering, and useful references to its clinical side, see McShane et al. 1994: 1274.
The book is a translation of J-D Bauby, Le scaphandre et le papillon (Paris; Editions Pocket, 1997).
For more information on this syndrome, see the US National Institutes of Health web-page: http://www.ninds.nih.gov/disorders/lockedinsyndrome/lockedinsyndrome.htm
See e.g., Cotrell and Shulz 1993: 205–211.
“For example, A[ssistive ]T[echnology] &T[elecare] might be used to facilitate skill teaching. Similarly, independence(and the increased opportunities for choice making which go hand in hand with it) can be one consequence of the use of smart home technology if the presence of staff is reduced”.p. 82
J Percival and J Hanson, ‘Big Brother or Brave New World? Telecare and its Implications for Older People’s Independence and Social Inclusion’ Critical Social Policy 26 (2006) 888–909, see esp. p. 898. L Robinson et al., (2007) ‘Balancing Rights and Risks: conflicting perspectives in the management of wandering in dementia’, Health, Risk and Society 9 (2007) pp. 389–406.
P. 83
P.84
P. 85
Ibid.
Ibid.
This conjecture is perhaps contradicted by very recently published evidence. See M-A Bruno et al., ‘A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority’ BMJ Open (Feb 2011) http://bmjopen.bmj.com/content/early/2011/02/16/bmjopen-2010-000039.full#
Percival and Hanson 2006: 888–909, see esp. p. 898.
Utilitarianism could give weight to the unpleasantness of loneliness, but it might imply that the associated disutility is more than compensated for by e.g. the pain relief afforded by the reduction in staff costs made possible by telecare.
See my ‘Citizen-Patient/Citizen-Doctor’ Health Care Analysis 9 (2001) pp. 25–39
For the importance of this in practice in the UK National Health service, see Ian Kennedy’s (2001) Report of the Bristol Royal Infirmary Inquiry (UK Dept. of Health CM5207 (I)) ch.22, §18.
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I am grateful to Prof. Heather Draper for discussion of some of the issues taken up here.
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Sorell, T. The Limits of Principlism and Recourse to Theory: The Example of Telecare. Ethic Theory Moral Prac 14, 369–382 (2011). https://doi.org/10.1007/s10677-011-9292-9
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DOI: https://doi.org/10.1007/s10677-011-9292-9