In “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Keisha Ray and Jane Fallis Cooper argue that one aspect of environmental health h...

Bioethical decision-making depends on presuppositions about the function and goal of bioethics. The authors in this issue of The Journal of Medicine and Philosophy share the assumption that bioethics is about resolving cases, not about moral theory, and that the best method of bioethical decision-making is that which produces useful answers. Because we have no universally agreed upon background moral theory which can serve as the basis for bioethical decision-making, they try to move bioethics away from theory. For them, a (...) good method of bioethical decision-making is one which resolves cases in ways that are justifiable to the parties involved, not necessarily in ways that bring us ‘close’ to the right and the true. The authors consider how the move away from theory and toward actual cases is best accomplished. In particular, the debate in this issue is about specification, specified principlism, and casuistry. (shrink)

Principlism, a most prominent approach in bioethics, has been criticized for lacking an underlying moral theory. We propose that the four principles of principlism can be related to the four traditional cardinal virtues. These virtues appear prominently in Plato's Republic and in Aristotle's Nicomachean Ethics. We show how this connection can be made. In this way principlism has its own compelling ethical basis.

Drawing upon Confucian ethical insights extracted from the Analects, this essay argues that principlism suffers from fundamental theoretical flaws. Its four principles do not genuinely capture universal principles, because they distort the practice-embedded nature of authentic moral norms found within actual moral cultures, as elucidated by Confucian insights. Specifically, Confucianism highlights the importance of a reflective equilibrium between constitutive rules and regulative principles. Principlism, in reality, represents an abridged version of modern Western liberal ethical norms, as it retains (...) their significant regulative principles while excluding their specific constitutive rules. The essay also employs prominent examples to illustrate the practical ineffectiveness of principlism. Given that diverse cultures either adhere to different regulative principles that diverge from the four principles or are obligated to specify them with their distinct constitutive rules, relying on the four principles as a uniform starting point falls short in providing and justifying universal solutions to the bioethical dilemmas confronting contemporary societies. In addition, the essay delves into the underlying factors that have led to the seemingly widespread adoption of the four principles across different regions worldwide. Lastly, the essay introduces the concept of regioglobal bioethics as an alternative to principlism for global bioethics, outlining a general Confucian endorsement of this proposal and providing a brief response to potential objections, aiming to pave the way for further research. (shrink)

The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics. Keywords: casuistry, deductivism, ethical theories, intuition principlism, (...) specified principlism, specification CiteULike Connotea Del.icio.us What's this? (shrink)

The Hippocratic ethic, or medical ethics, has guided medical practitioners for 2,500 years. More recently it has been displaced by bioethics. Traditional medicalethics is a covenant between a competent physician and a sick patient, the purpose of which is to effect healing. Bioethics is a civil consensual ethic regulating health-care delivery. It is not personal by nature.Medical ethics is a deontological, virtue-based ethic. Bioethics, particularly as expressed in principlism, its most prominent school in the United States, isa liberal utilitarian (...) ethic that emphasizes individual autonomy.Bioethics and principlism both play a role in guiding health-care delivery in a pluralistic society. However, traditional medical ethics, and not bioethics, bestaddresses the moral issues arising in the personal relationships between a treating physician and a suffering patient. (shrink)

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics (...) fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. (shrink)

The bioethics of four principles, named as principlism, began in 1979 with the work of Principles of Biomedical Ethics by Tom Beauchamp and James F. Childress and has been widely criticized since the 80s. In recent years four rival approaches towards principlism have been specified in this critique. These include: a) impartial rule theory, developed by K. Danner Clouser; b) casuistry, represented by Albert Jensen, and c) virtue ethics, developed by Edmund D. Pellegrino. The critique of principlism (...) presented by K. Danner Clouser, Bernard Gert was not only defended by T. Beauchamp and J.F. Childress themselves, but also by others, including B. Andrew Lustig, David DeGrazia, and Henry Richardson. The discussion has not weakened but continued till the present time. It was presented extensively in the June issue of The Journal of Medicine and Philosophy. We want to join the discussion from the position of personalistic bioethics. (shrink)

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification—adding specific content to general principles—and balancing—determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it (...) lacks a theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework. (shrink)

The COVID-19 pandemic has coincided with the proliferation of ethical guidance documents to assist public health authorities, health care providers, practitioners and staff with responding to ethical challenges posed by the pandemic. Like ethical guidelines relating to infectious disease that have preceded them, what unites many COVID-19 guidance documents is their dependency on an under-developed approach to bioethical principlism, a normative framework that attempts to guide actions based on a list of prima facie, unranked ethical principles. By situating them (...) in relation to the key philosophical debates concerning bioethical principlism, we aim to explore the limits and limitations of pandemic ethical guidance documents as, specifically, ethics documents – documents that fulfil the functions of ethics as a fundamentally normative discipline. This means not only determining whether such ethical guidance documents can, in principle, provide adequate action guidance and action justification, but also, more importantly where pandemics are concerned, determining whether they support consistent decision making and transparent processes of justification. Having highlighted the problems with merely furnishing ethical guidelines with substantive ethical content in terms of principles and values, we argue that organizations that develop these documents should, instead, focus on the procedural dimensions of action guidance and action justification, which extend to questions regarding the make-up of the committees, panels and groups that develop such guidelines, the public transparency of justifications for specific pandemic-related advice or interventions and the development of explicit procedures for transparent and consistent decision making. (shrink)

This is a new edition of the manual published in 1974 and 1984. Compared with those earlier editions it is revised, enlarged and more precise in its argumentation. In its beginnings the manual aimed at meeting the didactic needs to present students of the Faculty of Christian Philosophy at the ATK a complete handling of Christian ethics. The author, who wrote his manual in difficult times of communist ideology, decided to include in one work, besides a positive exposition of Christian (...) ethics, a critical discussion with other ethical systems as well as his own explicit theory on Augustinian and Thomistic ethics, which he endeavoured to develop. Thus the work interlocked the didactic objectives and the process of growth and justification of the Author's views, Krakow 2001, p. 308). (shrink)

Principlism has been advocated as an approach to resolving concrete cases and issues in bioethics, but critics have pointed out that a main problem for principlism is its lack of a method for assigning priorities to conflicting ethical principles. A version of principlism referred to as 'specified principlism' has been put forward in an attempt to overcome this problem. However, none of the advocates of specified principlism have attempted to demonstrate that the method actually works (...) in resolving detailed clinical cases. This paper shows that when one tries to use it, specified principlism fails to provide practical assistance in deciding how to resolve concrete cases. Proponents of specified principlism have attempted to defend it by arguing that it is superior to casuistry, but it can be shown that their arguments are faulty. Because of these reasons, specified principlism should not be considered a leading contender in the search for methods of making justifiable decisions in clinical cases. (shrink)

Fertility treatments, which are part of "assisted reproductive technologies" (ART), mainly undertaken through in vitro fertilization (IVF), offer the opportunity to infertile couples to conceive. IVF treatments are undertaken in Israel in significantly higher numbers than in the rest of the world. As such, Israel provides an important case-in-point for examining the validity of the actual claims used to justify the more generous public funding of IVF treatments at the policy level. In this article, we utilize an analytical philosophy approach (...) to conduct this examination. First, we highlight two fundamental concepts that were used at the Israeli public policy level in order to justify the generous public funding of IVF treatments. These concepts are “emotional vulnerability” and the “worthlessness of the childless,” where the latter emphasizes the infinite value of children. Then, by applying the perspective of the European model of Bioethical Principlism, and focusing the attention to these two concepts we show that these justifications are invalid. Specifically, it is suggested that these concepts are on the one hand both relying on and expressing the principles of vulnerability, dignity, and integrity; yet on the other hand, these concepts are also undermining the very principles of bioethics they are supposed to express and rely on. Based on this suggested criticism, we offer two “take home” messages informed by our analysis of the Israeli case, but reaching beyond it. (shrink)

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross’s ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy (...) of abstract general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised. (shrink)

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize (...) the debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

The ethical issues raised by cybersecurity practices and technologies are of critical importance. However, there is disagreement about what is the best ethical framework for understanding those issues. In this paper we seek to address this shortcoming through the introduction of a principlist ethical framework for cybersecurity that builds on existing work in adjacent fields of applied ethics, bioethics, and AI ethics. By redeploying the AI4People framework, we develop a domain-relevant specification of five ethical principles in cybersecurity: beneficence, non-maleficence, autonomy, (...) justice, and explicability. We then illustrate the advantages of this principlist framework by examining the ethical issues raised by four common cybersecurity contexts: penetration testing, distributed denial of service attacks (DDoS), ransomware, and system administration. These case analyses demonstrate the utility of this principlist framework as a basis for understanding cybersecurity ethics and for cultivating the ethical expertise and ethical sensitivity of cybersecurity professionals and other stakeholders. (shrink)

Principlism, or principle based ethics, was one of the first approaches in an independent bioethics. After receiving some criticism towards the end of the 1980s, an adjusted version was put forward. This paper attempts to analyse the main theoretical problems associated with principlism and test them against the background of modern linguistic philosophy, the philosophy of Robert B. Brandom in particular.

The late Robert Veatch, one of the United States’ founders of bioethics, never tired of reminding us that the paradigm-shifting contribution that bioethics made to patient care was to liberate patients out of the hands of doctors, who were traditionally seen to know best, even when they decidedly did not know best. It seems to us that with the advent of COVID-19, health policy has come full-circle on this. COVID-19 gave rise to a large number of purportedly “ethical” guidance documents (...) aiming to assist health care providers and practitioners with responding to the ethical challenges that might arise in their response to the pandemic. Ethics has two primary functions: provide clear action guidance, and provide clear action justification. The documents in question arguably reflect the ultimate policy triumph of bioethical “principlism”, and, perhaps surprisingly, as a corollary, the ultimate triumph of “doctor-knows-best”. (shrink)

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics - principlism, put forward by Beauchamp and Childress in Principles of Bioethics , and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals - are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, (...) either the original version, or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated. (shrink)

Nathan Carlin revisits the role of religion in bioethics, an increasingly secular enterprise, and argues that pastoral theologians can enrich moral imagination in bioethics by cultivating an aesthetic sensibility that is theologically-informed, psychologically-sophisticated, therapeutically-oriented, and experientially-grounded. To achieve these ends, Carlin employs Paul Tillich's method of correlation by positioning four principles of bioethics with four images of pastoral care.

One’s understanding of compassionate care and one’s response to suffering depend on one’s bioethical framework. This paper contrasts the principlist bioethical model with the personalist bioethical model. These emphasize different principles, definitions, and understandings of concepts such as autonomy, compassion, suffering, harm, and help. The principlist model regards euthanasia and physician-assisted suicide as acts of autonomy and compassion that eradicate suffering. This perspective fails to keep in mind that autonomous patients do not always act for their own good. Conversely, the (...) personalist perspective emphasizes the integral good of the person, not just his or her autonomous choice, which is important but not unlimited. Since support for euthanasia and physician-assisted suicide often is motivated by a fear of suffering, being a burden, or depending on others, addressing the underlying factors that drive people to contemplate a hastened death is a more genuinely compassionate response than merely respecting people’s autonomous choice for a hastened death. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue (...) that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that principles should be understood as heuristics that can be “specified” as described by DeGrazia , and that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, (...) these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents (...) of casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. (shrink)

Principlism is an ethical framework that has dominated bioethical discourse for the past 50 years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism (...) to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics–a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education. (shrink)

Several scholars have recently criticized the dominant emphasis upon mid-level principles in bioethics best exemplified by Beauchamp and Childress's Principles of Biomedical Ethics . In Part I of this essay, I assess the fairness and cogency of three broad criticisms raised against ‘principlism’ as an approach: (1) that principlism, as an exercise in applied ethics, is insufficiently attentive to the dialectical relations between ethical theory and moral practice; (2) that principlism fails to offer a systematic account of (...) the principles of nonmaleficence, beneficence, respect for autonomy, and justice; and (3) that principlism, as a version of moral pluralism, is fatally flawed by its theoretical agnosticism. While acknowledging that Beauchamp and Childress's reliance upon Ross's version of intuitionism is problematic, I conclude that the critics of principlism have failed to make a compelling case against its theoretical or practical adequacy as an ethical approach. In Part II, I assess the moral theory developed by Bernard Gert in Morality: A New Justification of the Moral Rules , because Gert has recommended his approach as a systematic alternative to principlism. I judge Gert's theory to be seriously incomplete and, in contrast to principlism, unable to generate coherent conclusions about cases of active euthanasia and paternalism. Keywords: active euthanasia, applied ethics, Beauchamp and Childress, intuitionism, paternalism, principlism, W.D. Ross CiteULike Connotea Del.icio.us What's this? (shrink)

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. (...) That is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue (...) that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

Nanotechnology (NT)‐enabled disease‐free life is a form of reconstruction of the human body that promises a paradigm shift toward a new form of human existence in an imaginable life. However, as human reconstruction may be within the limits of the concept of “human enhancement,” it is not clear to what extent “enhanced humans” will be ethically acceptable or desired. This study discusses the ethical implications of NT‐embedded enhanced humans and this new imaginable life. First, ethical concerns arising from the existence (...) of a grey zone of certain dilemmas regarding benefits and possible/unpredicted risks are addressed in terms of the four main principles of bioethics. Then, we focus on the ethical problems in human nano‐enhancement. Finally, we study the methods of analyzing these ethical problems within the framework of principlism to conceive a comprehensive and coherent bioethical understanding. (shrink)

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. (shrink)

In his landmark article “How Medicine Saved the Life of Ethics” (1982), Stephen Toulmin persuasively argues that (serious) problems cannot be solved by mere rationalistic approaches in ethics and that ethics was eventually saved by dint of having to deal with vital questions and concrete problems in medicine. Whether one is a proponent of, for example, principlism or casuistry, one certainly has to admit that a convincing ethical theory or method must have practical application. Analogously, it is about time (...) to consider another vital and prominent issue in normative ethics—the universalism-relativism debate—that might profit from the bioethical approach of principlism (otherwise known as the four-principles .. (shrink)

Bioethicists’ attraction to principlism is rooted in a Western view of how matters that affect the public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from the circumstances of the problem. That view of deliberation, itself fostered by the Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of (...) bioethics discourse. (shrink)

The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics (...) as practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation. (shrink)

The ethics of physical restraint in the Emergency Department has always been an emotive and controversial issue. Recently a vanguard of advocacy groups and regulatory agencies have...

Bioethics today has become a subject of wide public concern. Almost every one of its tenets is being seriously questioned and likely to be reformulated. Moreover, the pressure on bioethics continues to mount as the number of moral conflicts that buffet our society increases. What, then, will bioethics look like a decade from now? In the variety of approaches that have been employed in the practice of bioethics, one has dominated in the United States in the last decade and a (...) half. That approach is "principlism", the use of moral principles to address theoretical issues and to resolve conflicts at the bedside. Recently, however, bioethicists and others increasingly have realized the limitations of principlism and are calling for the development of alternative approaches such as phenomenology, hermeneutics, narrative ethics, casuistry, and virtue ethics. This book maps the debate over principlism and the future direction of U.S. bioethics. Part One consists of a sociological description of U.S. bioethics at the beginning of the 1990s, along with a defense of principlism by one of its major proponents. Part Two maps cross-cultural critiques of principlism, while Part Three covers five alternatives to it. Three essays in Part Four - by a bioethicist, a physician, and a theologian - reflect on the future of U.S. bioethics, principlism, and its alternatives. The Afterword emphasizes the place of religion and theological discourse in the alternative approaches and in the future of bioethics. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue (...) that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

A trend called ‘African bioethics’ is growing on the continent due to perceptions of existing bioethics, especially guidelines for international collaborative research, as ‘ethical imperialism’. As a potential alternative to ‘Western Principlism,’ ‘African bioethics’ is supposed to be indigenous to Africa and reflective of African identity. However, despite many positive insights in the on-going discussions, it is feared that the growth of bioethics in Africa lacks a clear direction. Some of the views threaten to distort the essence of bioethics (...) and its development on the continent. This paper presents some of the dominant views on ‘African bioethics’, an examination of which reveals some valuable insights into the direction bioethics in Africa ought to take, but at the same time confirms some methodological challenges in some contributions to the discussion. On top of acknowledging critical insights in the discussion, the paper reveals that some views are characterized by arbitrariness and rhetorical discussions based on a strong negative and yet hard-to-accept assumption; doubtful designation; lack of a clearer problem being addressed and consequently obscure question and aim of the discourse. Finally, some methodological insights are proposed to guide bioethics research and scholarship in Africa. Specifically, the paper proposes that in search for the legitimacy of bioethics in Africa, we ought to protect the essence of bioethics by giving considerable attention to the utility of subsequent bioethics. To achieve this we need to specify the problem and proper designation for the discourse; focus on principles qua principles with impartiality and how to ensure their strict implementation; and encourage critical thinking as part of bioethics. In cultivating bioethics in Africa, the pursuit of identity is legitimate but must be conditional in light of other competing considerations. We should focus on an objective search for bioethical principles that can be effective in responding to African and global health challenges of moral significance, irrespective of the origin of the principles and at the same time focus more on strategies for ensuring compliance with resulting principles. (shrink)

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore the (...) existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes. (shrink)

Principlism : the Borg of bioethics -- A common morality for hedgehogs : Bernard Gert -- Getting down to cases : the revival of casuistry in bioethics -- Nice story but so what : narrative and justification in ethics -- Dewey and Rorty's pragmatism and bioethics -- Freestanding pragmatism in bioethics and law -- A method in search of a purpose : the internal morality of medicine -- Method to rule them all? Reflective equilibrium in bioethics -- Concluding reflections (...) : method in bioethics : the very idea. (shrink)

This is a response to Earp and colleagues' target article "If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical break-up". I argue that the authors may indulge in the vice of in-principlism when presenting their ethical framework for dealing with anti-love biotechnology, and that they mis-apply the concept of harm.