Balancing Old and New Approaches: Principlism Versus Proportionism

  • Paul WalkerEmail author
  • Terence Lovat
Part of the SpringerBriefs in Ethics book series (BRIEFSETHIC)


This chapter considers the four principles that have been distilled from the normative frameworks identified in the previous chapter, proposed as ways of guiding practical decision making in medical ethics. These are respect for autonomy, non-maleficence, beneficence, and justice. They have had considerable influence on moral decision making in clinical situations, and, at a minimum, they offer a common ethical language amongst clinicians. Shortcomings in their theoretical and practical application will be identified. Various understandings of autonomy—considered to be first amongst the four principles—will be considered. Critical re-examination suggests that our traditional understanding of autonomy is impoverished and requires re-evaluation. What is formed herein as the proportionist approach seeks a virtuous mean or balance-point in maoral decision making that takes account of the frameworks and principles identified in this and the previous chapter but in a way that is more grounded in the realities of the modern era (as will be expanded upon in the following chapters). It seeks to balance intrinsic rules and empirical consequences, hence utilizing but also going beyond the bounds of the deontological and teleological frameworks alone. Its starting point is the actual reality of the patient in their situation. It is put into clinical practice via a process we term dialogic consensus, a term we explore in Chaps.  4 and  5.


Autonomy Beneficence Clinical decision making Dialogic consensus Non-maleficence Principlism Proportionism Proportionist approach 


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© The Author(s) 2017

Authors and Affiliations

  1. 1.School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
  2. 2.School of Humanities and Social ScienceThe University of NewcastleNewcastleAustralia
  3. 3.University of OxfordOxfordUK

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