Critical Overview of Principlist Theories

Mallia, Pierre

doi:10.1007/978-94-007-4939-9_2

Pierre Mallia²

Part of the book series: SpringerBriefs in Ethics ((BRIEFSETHIC,volume 2))

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Abstract

In this chapter three approaches to principles are reviewed. Firstly the Four-Principle approach as described by Tom Beauchamp and James Childress. Secondly Robert Veatch’s theory of medical ethics based on a contract relation and lexical ordering of principles giving priority to autonomy. Finally Engelhardt’s Principle of permission, amending his first edition which was based on a two-principle approach of beneficence and autonomy. Clearly the authors of these three models are ‘principlists’ themselves and the scope here is to go beyond simple principles.

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Notes

1.
Beauchamp. T.L., Childress J.F., Principles of Biomedical Ethics, 1989.
2.
Veatch R., A Theory of Biomedical Ethics, New York: Basic Books, 1981.
3.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, 1994.
4.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, 1986.
5.
McCullough L.B., “Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical Ethics”, in Kenn. Inst. of Ethics J., Vol. 6, No. 4, pp. 329–333.
6.
Ibid., p. 331.
7.
Beauchamp. T.L., “The ‘Four-principles’ Approach”, in Principles of Health Care Ethics, pp. 3–12.
8.
Ibid., p. 5.
9.
Idem.
10.
Childress J.F. “Principles-Oriented Bioethics, An Analysis and Assessment From Within”, in A Matter of Principles? p. 79.
11.
Beauchamp. T.L., op.cit., p. 4.
12.
Childress J.F., op. Cit., p. 79.
13.
Ibid., p. 78.
14.
Ibid., pp. 78–79.
15.
Idem.
16.
Clouser K.D., Gert B., “A Critique of Principlism”, pp. 216–236.
17.
Beauchamp. T.L., “The ‘Four-principles’ Approach”, p. 8.
18.
Clouser K.D., “Common Morality as an Alternative to Principlism”, in Kenn. Inst. of Ethics J. Vol. 5, No. 3, p. 223.
19.
Idem.
20.
Ibid., p. 224.
21.
Idem.
22.
Ibid., p. 225.
23.
Ibid., pp. 226–235.
24.
Gert B., Morality: A New Justification of the Moral Rules, New York: Oxford University Press, 1988.
25.
Clouser K.D., op. cit., p. 227.
26.
Idem.
27.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, in Kenn. Inst. of Ethics J. Vol. 5, No. 3, pp. 186–187.
28.
Beauchamp. T.L., “The ‘Four-principles’ Approach”, p. 9.
29.
Beauchamp. T.L. op. cit., pp. 187–188.
30.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, p. 190.
31.
Beauchamp. T.L., “The ‘Four-principles’ Approach”, p. 8.
32.
Childress J.F. “Principles-Oriented Bioethics, An Analysis and Assessment From Within”, in A Matter of Principles?, p. 81.
33.
Ibid., p. 82.
34.
DeGrazia D. “Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism.” In J. of Medicine and Philosophy 17(October); pp. 511–39.
35.
Childress J.F., op.cit., p. 82.
36.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, in Kenn. Inst. of Ethics J. Vol. 5, No. 3, p. 190.
37.
Childress J.F., op. cit., p. 75.
38.
Idem.
39.
Clouser K.D., Gert B., “Morality vs. Principlism”, p. 260
40.
Clouser K.D., Gert B., op.cit., p. 253.
41.
Rawls J. A Theory of Justice Harvard University Press, 1971, p. 115.
42.
Clouser K.D., Gert B., “Morality vs. Principlism” p. 254.
43.
Ibid., pp. 254–256.
44.
Ibid., pp. 256–257.
45.
Idem.
46.
Ibid., pp. 258–259.
47.
Ibid., p. 259.
48.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, p. 190.
49.
Ibid., p. 189.
50.
Beauchamp. T.L., “The ‘Four-principles’ Approach”, p. 10
51.
Ibid., p. 11.
52.
Beauchamp. T.L., op. cit., p. 11.
53.
Jonsen A.R., “Clinical Ethics and the Four Principles”, pp. 13–30.
54.
Ibid., p. 14
55.
Idem.
56.
Jonsen A.R., op.cit., p. 14.
57.
Clouser K.D., “Common Morality as an Alternative to Principlism”, p. 224.
58.
Jonsen A.R., “Casuistry: An Alternative or Compliment to Principles?”, in Kenn. Inst. of Ethics J. Vol. 5, No. 3, p. 239.
59.
italics mine
60.
Ibid., p. 239.
61.
Ibid., pp. 242–243.
62.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, p. 191.
63.
Idem.
64.
Jonsen A.R., “Casuistry: An Alternative or Compliment to Principles?”, p. 250.
65.
Jonsen A.R., “Clinical Ethics and the Four Principles”, p. 15.
66.
Ibid., p. 16.
67.
Jonsen A.R., Forward in A Matter of Principles? p. XVI.
68.
Jonsen A.R., “Casuistry: An Alternative or Compliment to Principles?”, p. 247.
69.
Jonsen A.R., “Clinical Ethics and the Four Principles”, p. 21.
70.
Ibid., p. 18.
71.
Jonsen A.R., Forward in A Matter of Principles?, p. XVI.
72.
Childress J.F., “Principles-Oriented Bioethics, An Analysis and Assessment From Within”, p. 87.
73.
Jonsen A.R., op. cit., p. XVII.
74.
Idem.
75.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship: the Need for a Better Linkage”, pp. 353–365.
76.
bid., p. 353.
77.
Ibid., p. 361.
78.
Ibid., p. 354.
79.
Ibid., p. 355.
80.
Ibid., p. 356.
81.
Idem.
82.
Beauchamp. T.L. and McCullough L.B. Medical Ethics: the moral responsibilities of physicians, Prentice-Hall, Englewood Cliffs, NJ 1984.
83.
Pellegrino argues that Paternalism assumes that the doctor knows better what is in the patient’s best interest. “Paternalism, whether benignly intended or not, cannot be beneficent in any true sense of the word. Beneficence, and its corollary, non-maleficence, require acting to advance the patient’s interest, or at least not harming them. It is difficult to see how violating the patient’s own Perception of his welfare can be a beneficent act. Paternalism is obviously in a polar relationship. With autonomy, but it is also diametrically opposed to beneficence and non-maleficence as well”, Pellegrino E.D., op. cit., p. 357.
84.
Idem.
85.
Ibid., p. 358.
86.
Ibid., p. 355.
87.
Jonsen A.R., “Casuistry: An Alternative or Compliment to Principles?”, p. 247.
88.
Pellegrino E.D., “Toward a Virtue-Based Normative Ethics for the Health Professions”, p. 253.
89.
MacIntyre, A, After Virtue, 1984. , Whose Justice? Which Rationality?, Indiana: University of Notre Dame Press, 1988. , Three Rival Versions of Moral Enquiry, Indiana: University of Notre Dame Press, 1990.
90.
Pellegrino E.D., op. cit., p. 263.
91.
Ibid., p. 266.
92.
Idem.
93.
Ibid., p. 254.
94.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, p. 194.
95.
Baier, A., Moral Prejudices, Cambridge: Harvard University Press, 1994
96.
Beauchamp. T.L., op. cit., p. 194.
97.
Ibid., p. 195.
98.
Pellegrino E.D., Thomasma D.C., For the Patient’s Good: The restoration of Beneficence in Health Care, New York: Oxford University Press, 1988 pp. 7−8.
99.
Veatch R.M., “Resolving Conflict Among Principles: Ranking, Balancing, and Specifying, in Kenn. Inst. of Ethics J., Vol. 5, No. 3, pp. 199−218.
100.
Veatch R.M., “Models for Medicine in a Revolutionary Age.” In Hastings Cent Rep. 2 No. 3 (1972), pp. 5−7. , A Theory of Medical Ethics, 1981. , The Patient-Physician Relation, 1991.
101.
Brody H., “The Physician/Patient Relationship.”, in Medical Ethics, ed. Veatch R.M., Jones and Bartlett Publishers, 1989, p. 70.
102.
Idem.
103.
Ibid., p.71.
104.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship.: the Need for a Better Linkage”, p. 356.
105.
Idem.
106.
Veatch R.M., The Patient-Physician Relation, p. 2.
107.
Veatch R.M., “Resolving Conflict Among Principles: Ranking, Balancing, and Specifying”, pp. 199−218.
108.
Ibid., p. 201.
109.
Ibid., p. 202.
110.
Ibid., p. 209.
111.
Veatch R.M., “Which Grounds for Overriding Autonomy Are Legitimate?” in Hastings Cent. Rep. Vol. 26 No. 6, p. 43.
112.
Ibid., p. 42.
113.
Veatch R.M., op. cit., p. 210 & p. 212.
114.
Veatch R.M., op. cit., p. 43.
115.
Idem.
116.
Pellegrino E.D., “The Four Principles and the Doctor–Patient Relationship.: the Need for a Better Linkage”, p. 359.
117.
Veatch R.M., The Patient-Physician Relation, p. 4.
118.
Pellegrino E.D., op. cit., p. 359.
119.
Giacchi E., “Amerai il prossimo tuo come te stesso”, Parte Terza: La Vita in Cristo, Sezione seconda: I dieci Comandamenti, Capitolo secondo: Articolo 5: Il quinto Comandamento, nn 2272.
120.
Veatch R.M., “Which Grounds for Overriding Autonomy Are Legitimate?”, p. 43.
121.
Veatch R.M., The Patient-Physician Relation, p. 161.
122.
Childress J.F. “Principles-Oriented Bioethics, An Analysis and Assessment From Within”, p. 77.
123.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, 1994.
124.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, 1986.
125.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship.: the Need for a Better Linkage”, p. 359.
126.
Engelhardt, H.T., op., cit., p. vii.
127.
Idem.
128.
Ibid., p. xi.
129.
Ibid., p. x.
130.
Engelhardt H.T., Wildes K.W., “The Four Principles of Health Care Ethics and Post-modernity: why a libertarian interpretation is unavoidable”, in Principles of Health Care Ethics, p. 136.
131.
Engelhardt H.T., op. cit., p. x.
132.
Engelhardt H.T., Wildes K.W., op. cit., p. 137.
133.
Engelhardt H.T., op., cit., p. 70.
134.
Engelhardt H.T., Wildes K.W., op. cit., p. 138.
135.
Ibid., p. 137.
136.
Ibid., p. 143.
137.
Ibid., pp. 144−145.
138.
Ibid., p. 145.
139.
Idem.
140.
Ibid., p. 146.
141.
Nelson J.L., “Everything Includes Itself in Power: Power and Coherence in Engelhardt’s Foundations of Bioethics”, in Reading Engelhardt, Kluwer Academic Publications 1997, pp. 17−18.
142.
Ibid., p. 18.
143.
Ibid., p. 16.
144.
Ibid., p. 17.
145.
Engelhardt H.T., op. cit., p. x.
146.
Nelson J.L.., op. cit., p. 21.
147.
Ibid., pp. 21−22.
148.
Engelhardt H.T., op. cit., p. 70.
149.
Nelson J.L., op. cit., p. 22.
150.
This argument in itself points to the phenomenology of the doctor-patient relationship: based on beneficence; for there can be no other reason, other than for strategic gain, why a doctor should enter into such a relationship. This view is recalled in the section of the phenomenology of the Physician-patient relationship.
151.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, New York: Oxford University Press, 1986, pp. 105−108.
152.
Hauerwas S., “Not All Peace is Peace: Why Christians Cannot Make Peace with Engelhardt’s Peace”, in Reading Engelhardt, p. 39.
153.
Engelhardt H.T., Jr., Foundations of Biomedical Ethics, p. 117.
154.
Ibid., p. 120.
155.
Hauerwas S., op. cit., p. 40.
156.
Idem.
157.
Ibid., p. 41.
158.
Ibid., p. 42.

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Medical School, University of Malta, Msida, Malta
Pierre Mallia

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Mallia, P. (2013). Critical Overview of Principlist Theories. In: The Nature of the Doctor-Patient Relationship. SpringerBriefs in Ethics, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4939-9_2

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DOI: https://doi.org/10.1007/978-94-007-4939-9_2
Published: 01 August 2012
Publisher Name: Springer, Dordrecht
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