After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to (...) bioethics limit diversity and prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems. (shrink)

In the seventh and most recent edition of their classic book, Principles of Biomedical Ethics, Tom Beauchamp and James Childress define a virtue as a character trait that is “socially valuable and reliably present” and a moral virtue as such a trait that is also both “dispositional” and “morally valuable”. The virtues that they single out as “focal” within biomedical ethics are compassion, discernment, trustworthiness, integrity, and conscientiousness. Not all is well in their treatment of (...) virtue. Beauchamp and Childress seem to worry that an ethical theory in which virtues are fundamental will neglect duties, rights, and societal needs. Further, they insist that there is no reason to think that, within ethical theory, one family of ethical concepts is the most important, nor that one theoretical approach is correct, or even superior to others. I will try to show, that there are strong reasons to see language, concepts, and matters of virtue as fundamental within normative ethical theory, both generally and in such specialized subareas as medical ethics. These reasons reveal themselves when we analyze concepts at the core of the alternative approaches to theorizing ethics that Beauchamp and Childress identify. (shrink)

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the (...) “standard” Jehovah’s Witness case that having autonomously chosen the authority of his religious institution, a Jehovah’s Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author’s view of the child of a Jehovah’s Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (shrink)

Public health ethics is a subfield of bioethics that focuses on population health. This study aims to conform the principles of biomedical ethics to Islamic values in the context of public health. It culturally helps to optimize health care delivery. The approach is based on the method of immanent critique. The principle of the common good in Islam has a rational justification to draw public interests and ward off harms. The rule of “no harm”, with an (...) emphasis on the preferability of preventing harm to increase benefits, is consistent with the principle of utility, intending to produce a maximum balance of benefit over harm in the context of public health. Thus, on the one hand, the government is obliged to prevent harm and improve public benefits and, on the other hand, as a steward of health and with reference to the article “limitation of the ownership dominance”, it has the right to protect public health with the least justifiable harm. Islam attention to human dignity, individual justice and good will in the rule of goodness implies that Islam, beyond distributive justice, knows that human flourishing and the cultivation of moral virtues are a requisite for the realization of social justice. The present study discusses about the adjustment of the principles of PHE to the principles of the Islamic jurisprudence and, at the same time, it explains why the optimal PH in Muslim societies requires research in order to define accurate indicators of benefit and harm based on the teachings of revelation and reason. (shrink)

In search of principles of health care in Islam -- Health and suffering -- Beginning of life -- Terminating early life -- Death and dying -- Organ donation and cosmetic enhancement -- Recent developments -- Epilogue.

Principles-based biomedical ethics has been a dominant paradigm for the teaching and practice of biomedical ethics for over three decades. Attractive in its conceptual and linguistic simplicity, it has also been criticized for its lack of moral content and justification and its lack of attention to relationships. This book identifies the modernist and postmodernist worldviews and philosophical roots of principlism that ground the moral minimalism of its common morality premise. Building on previous work by prominent (...) Christian bioethicists, an alternative covenantal ethical framework is presented in our contemporary context. Relationships constitute the core of medicine, and understanding the ethical meaning of those relationships is important in providing competent and empathic care. While the notion of covenant is articulated through the richness of meaning taught in the Christian Scriptures, covenantal commitment is also appreciated in Islamic, Jewish, and even pagan traditions as well. In a world of increasing medical knowledge and consequent complexity of care, such commitment can help to resist enticements toward the pursuit of self-interest. It can also improve relationships among caregivers, each of whose specific expertise must be woven into a matrix of care that constitutes optimal medical practice for each vulnerable and needy patient. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Volume 19, Issue 11, November 2019, Page 9-12.

We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals. The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, (...) and others. Featuring a wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues. Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms. (shrink)

A model for ethical problem solving -- Values in health and illness -- What is the source of moral judgments? -- Benefiting the patient and others : duty to do good and avoid harm -- Justice : allocation of health resources -- Autonomy -- Veracity : honesty with patients -- Fidelity : promise-keeping, loyalty to patients, and impaired professionals -- Avoidance of killing -- Abortion, sterilization, and contraception -- Genetics, birth, and the biological revolution -- Mental health and behavior control (...) -- Confidentiality : ethical disclosure of medical information -- Organ transplants -- Health insurance, health system planning, and rationing -- Experimentation on human subjects -- Consent and the right to refuse treatment -- Death and dying. (shrink)

This book offers a systematic analysis of the moral principles that should apply to biomedicine. We understand "biomedical ethics" as one type of applied ethics. In our discussions of ethical theory per se, we offer anaylses of levels of moral deliberation and justification and of the ways two major approaches interpret principles, rules, and judgments. The systematic core of the book presents four fundamental moral principles--autonomy, beneficence, nonmaleficence, and justice.

Islamic Perspectives on the Principles of Biomedical Ethics presents results from a pioneering seminar in 2013 between Muslim religious scholars, biomedical scientists, and Western bioethicists at the research Center for Islamic Legislation & Ethics, Qatar Faculty of Islamic Studies. By examining principle-based bioethics, the contributors to this volume addressed a number of key issues related to the future of the field. Discussion is based around the role of religion in bioethical reasoning, specifically from an Islamic (...) perspective. Also considered is a presentation of the concept of universal principles for bioethics, with a response looking at the possibility (or not) of involving religion. Finally, there is in-depth analysis of how far specific disciplines within the Islamic tradition -- such as the higher objectives of Sharia (maqāṣid al-Sharī'ah) and legal maxims (qawā'id fiqhīyah) -- can enrich principle-based bioethics. (shrink)

The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral (...) psychology. We empirically investigated the relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain. (shrink)

The Principles of Biomedical Ethics by Beauchamp and Childress is a classic in the field of medical ethics. The first edition was published in 1979 and “unleashed” the four principles of respect for autonomy, non-maleficence, beneficence, and justice on the newly emerging field. These principles were argued to be mid-level principles mediating between high-level moral theory and low-level common morality, and they immediately became very popular in writings about medical ethics. Over the (...) years Beauchamp and Childress have developed this approach and vigorously defended it against the various criticisms that have been raised. The 5th edition of this book is, as all the …. (shrink)

Beauchamp and Childress here collaborate to provide a set of action-guides or principles which in their judgment apply to a wide range of biomedical problems. Their work consists of eight chapters and two appendices. In the first two chapters attention centers on the nature of a moral dilemma and moral reasoning and on types of normative ethical theories. Chapters 3 through 6 discuss the principles of autonomy, nonmaleficence, beneficence, and justice, while chapters 7 and 8 deal, respectively, (...) with the professional-patient relationship and with the role that virtues, ideals, personal integrity, and conscience have to play in the moral life. Appendix I provides twenty-nine case studies illustrating dilemmas in biomedical ethics, and reference to those studies is made throughout the text. Appendix II gives the texts of important biomedical codes of ethics. (shrink)

: The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for (...) improving this leading text. (shrink)

This article explores the evolution of Principles of Biomedical Ethics by Tom Beauchamp and James Childress over its seven editions. Many changes have occurred in the text over the last thirty-five years, including the expansion of the section on virtue ethics, the modification of the authors’ position on physician-assisted suicide, and the addition of many other ethical theories to the original two found in the first editions. The basis for these changes and others seems to be (...) their development of the theme of the “common morality.” The author suggests that Beauchamp and Childress develop the connection between their common morality and metaphysics, as it would serve to strengthen their theory and make it less susceptible to changes in society’s opinions and traditions. National Catholic Bioethics Quarterly 14.3 : 459–475. (shrink)

The four principles approach to biomedical ethics points to respect for autonomy, beneficence, non-maleficence and justice as the norms that should guide moral agents working in the biosciences, and particularly in health care. While the approach is well known, it is not without its critics. In this paper, which is primarily aimed at health professionals and students (from various disciplines) who are studying health care ethics, I consider four problems with the four principles, which respectively (...) claim that the approach is imperialist, inapplicable, inconsistent and inadequate. In keeping with the aims of the ‘five-minute focus’, the primary objective is to introduce these debates, rather than seek to resolve them. However, I will suggest that the approach does have its merits, not least for time-pressed clinicians who are keen to keep an eye on the ethical dimensions of their practices, and for students training in the health care professions, provided that they appreciate that the approach provides only a starting point for, and not the end point of, moral deliberation. (shrink)

This book brings together the debate concerning personal identity and central topics in biomedical ethics. Based on a metaphysical account of personal identity in the sense of persistence and conditions for human beings, conceptions for beginning of life, and death are developed. Based on a biographical account of personality, normative questions concerning autonomy, euthanasia, living wills and medical paternalism are dealt with. By these means the book shows that “personal identity” has different meanings which have to be distinguished (...) so that human persistence and personality can be used to deal with central questions in biomedical ethics. (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)

Not long ago, a colleague chided me for using the term "the biological revolution. " Like many others, I have employed it as an umbrella term to refer to the seemingly vast, rapidly-moving, and fre quently bewildering developments of contemporary biomedicine: psy chosurgery, genetic counseling and engineering, artificial heart-lung machines, organ transplants-and on and on. The real "biological revo lution," he pointed out, began back in the nineteenth century in Europe. For it was then that death rates and infant mortality (...) began to decline, the germ theory of disease was firmly established, Darwin took his famous trip on the Beagle, and Gregor Mendel stumbled on to some fundamental principles of heredity. My friend, I think, was both right and wrong. The biological revolution did have its roots in the nineteenth century; that is when it first began to unfold. Yet, like many intellectual and scientific upheav als, its force was not felt for decades. Indeed, it seems fair to say that it was not until after the Second World War that the full force of the earlier discoveries in biology and medicine began to have a major impact, an impact that was all the more heightened by the rapid bi omedical developments after the war. (shrink)

From the 5th edition of Beauchamp and Childress' Principles of Biomedical Ethics, the problem of common morality has been given a more prominent role and emphasis. With the publication of the 6th and latest edition, the authors not only attempt to ground their theory in common morality, but there is also an increased tendency to identify the former with the latter. While this stratagem may give the impression of a more robust, and hence stable, foundation for their (...) theoretical construct, we fear that it comes with a cost, namely the need to keep any theory in medical ethics open to, and thereby aware of, the challenges arising from biomedical research and clinical practice, as well as healthcare systems. By too readily identifying the moral life of common morality with rule-following behaviour, Beauchamp and Childress may even be wrong about the nature of common morality as such, thereby founding their, by now, classic theory on quicksand instead of solid rock. (shrink)

The four principles approach to biomedical ethics (4PBE) has, since the 1970s, been increasingly developed as a universal bioethics method. Despite its wide acceptance and popularity, the 4PBE has received many challenges to its cross-cultural plausibility. This paper first specifies the principles and characteristics of ancient Chinese medical ethics (ACME), then makes a comparison between ACME and the 4PBE with a view to testing out the 4PBE's cross-cultural plausibility when applied to one particular but very (...) extensive and prominent cultural context. The result shows that the concepts of respect for autonomy, non-maleficence, beneficence and justice are clearly identifiable in ACME. Yet, being influenced by certain socio-cultural factors, those applying the 4PBE in Chinese society may tend to adopt a "beneficence-oriented", rather than an "autonomy-oriented" approach, which, in general, is dissimilar to the practice of contemporary Western bioethics, where "autonomy often triumphs". (shrink)

Tom Beauchamp and James Childress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a 'common morality', or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the (...) absence of a full-blooded analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empirical method of determining the common morality's norms is suggested. In this paper, I outline this method, before arguing that it is difficult to see how it might be thought to achieve its purpose. (shrink)

BackgroundThis study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.MethodThis study is based on 12 semi-structured (...) interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.ResultsIn this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice.ConclusionThis study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress – respect for autonomy, beneficence, nonmaleficence and justice – are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting. (shrink)

Recent advances in biomedical technology and therapeutic procedures hace generatad a moral crisis in modern medicine. The cast strides made in medical science and technology have creatred options which only a few decades earlier would have been relegated to the realm of science fiction. Man, to a significant degree, now has the ability to exercise control not only over the stages of disease but even over the very processes of life and death, With the unfolding of new discoveries and (...) techniques, the sceintific an dintellectual communities have developed a keen awareness of the ethical issues which arise out of man's enhanced ability to control his destiny. In response to the concern over questions of this nature, there has emerged the rapidly developing field of bioethics. Jews, to whomall such questions are quests not only for applicable humanitarian principles but for Divine guidance, must, of necessity, seek answers in the teachings of the Torah . "The Torah of God is Perfect" ( Psalms 19:8), and in its teachings the discernign student will find eternally-valid answers to even newly-formulated queries. As Physicians and patients turn to Rabbinic authorities for answers, Jewish scholars seen to elucidate and expound the teachings of the torah in these vital areas of concern. The present essay hgihlights some of the ethical issues faced by the Jewish physician who faithfully observes his tradition in all matters including his daily practise of medicin. Although more questions are raised than answered, the aim of this essay will have been achieved if the reader is stimulates to pursue these issues in the extensive writings on the subject now available in English CiteULike Connotea Del.icio.us What's this? (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)

Two positions that Rosamund Rhodes puts forward are the proper starting point for this commentary: 1. Medical ethics based on the common morality that uses a body of abstract principles or rules are not ‘an adequate and appropriate guide for physicians’ actions’. 2. We need, but do not have, a true professional medical ethics for physicians, which must be ‘distinctly different’ from ethics based on common morality. I will argue that both positions are mistaken. Rhodes does (...) not analyse what she means by a professional ‘medical ethics’ and does not supply content for what she calls ‘medical professionalism’. ‘Common morality‘ is also not given a precise meaning. However, I set aside these problems of conceptual clarity and concentrate on a paradigm case of professional ethics for physicians (and others) in interactions with patients. My example is The Belmont Report. Belmont is almost certainly a document that, in the USA, has for four decades been highly influential on physicians, especially physicians engaged in clinical research. It is not merely research ethics. In full satisfaction of the American Board of Medical Specialties’ ‘definition of medical professionalism’, The Belmont Report puts forward a system of ethical principles showing that physicians and other health professionals must conduct research in the service of the public interest and the well-being of patient–subjects. The Belmont Report also satisfies the earlier delineated conditions of medical professionalism in the American Board of Internal Medicine’s ‘Physician Charter’, which are stated in terms of the ‘fundamental principles’ of the primacy of patient welfare, patient autonomy and social justice.1,1–3 Belmont more than satisfies these conditions of medical professionalism. Indeed Belmont may well be the source of the principles …. (shrink)

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence (...) and justice, and that the methods offered for specification and balancing of principles are inadequate. (shrink)

This chapter contains sections titled: General Ethical Issues Cellular, Genetic and Tissue Engineering Biomaterials, Prostheses and Implants Biomedical Imaging and Optics Neural Engineering References and Further Reading.

Records the papers and commentaries, with an edited discussion, presented at an international consultation convened by the Council for International Organizations of Medical Sciences (CIOMS) to guide revision of the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The Guidelines, first issued in 1982 and then revised in 1993, are being updated and expanded to address a number of new and especially challenging ethical issues. These include issues raised by international collaborative trials of drugs in developing countries, (...) especially expensive drugs, and the use of placebo controls in randomized clinical trials. Others arise from the complexity of research in human genetics, including stem-cell research, and in reproductive biology. Throughout, particular attention is given to the difficult questions that arose during the heated debate over trials in developing countries, of short-duration zidovudine (AZT) therapy to reduce perinatal transmission of HIV. The International Ethical Guidelines for Biomedical Research Involving Human Subjects set out a code of research ethics that is widely used by ethical review committees and other bodies responsible for reviewing and overseeing the ethical design of studies and conduct of research. The revision of the Guidelines is being coordinated by CIOMS, in collaboration with WHO. The consultation centered on seven specially commissioned papers, authored by international experts that explore some of the more difficult issues in depth. Each is followed by an invited commentary, often expressing opposing views, and a summary of the issues or conclusions that emerged during the subsequent debate. The first paper, on justice in international research, deals with the question of whether proposals for research to be conducted in a developing country should make provision for future access of the population involved to the interventions under investigation. Also considered are questions that arise when research uses populations in developing countries to investigate interventions that will be of exclusive benefit to the industrialized world. Case studies of recent drug trials and their research protocols are discussed to illustrate circumstances in which use of populations in developing countries is justified or constitutes exploitation. Ethical challenges of the randomized controlled trial are considered in the second paper, which includes a discussion on the equitable distribution of benefits and risks, the use of placebo for controls, and the obligation to ensure that the participation of controls does not compromise their medical care or endanger their health. A paper on informed consent in international health research considers how cultural factors influence communication and language in the informed-consent process and respect for privacy and confidentiality in the research. Subsequent papers address issues in genetics research and reproductive biology, including the moral status of fetuses and the use of embryos in research, and examine the contribution which international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. The final paper gives an overview of capacity building and the role of communities in international biomedical research. (shrink)

This book discusses a strategy for the future adoption of human enhancement technologies in a pluralistic society. The book argues that biomedical technology capability, ethical evaluation and effective public policy are all needed to ensure that enhancement technologies are adopted as a common good, consistent with Christian ethical principles.

Many alternatives or supplements to principalism seek to reconnect medical ethics with the thoughts, feelings, and motivations of the persons directly involved in ethically troublesome situations. This shift of attention, from deeds to doers, from principles to principals, acknowledges the importance of the moral agents involved in the situation — particular practitioners, patients, and families. Taking into account the subjective, lived experience of moral decision-making parallels recent efforts in the teaching of medicine to give the patient''s subjectivity — (...) his or her personal experience of being sick or disabled — epistemological parity with scientific medicine''s objective, biomedically-oriented view of the person''s sickness or disability.Moreover, the shift from principalism to principals signals a growing realization that ethical problems in the profession of medicine are inseparable from its practice. Philosophers and other humanists working in medicine should resist the temptation to institutionalize a professional role as solver of ethical problems, clarifier of values, or mediator of disputes and work instead to help practitioners practice medicine reflectively. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Reading Karl Barth, Interrupting Moral Technique, Transforming Biomedical Ethics by Ashley John MoyseJoshua DanielReading Karl Barth, Interrupting Moral Technique, Transforming Biomedical Ethics Ashley John Moyse NEW YORK: PALGRAVE MACMILLAN, 2015. 263 PP. $100.00Reading Karl Barth, Interrupting Moral Technique, Transforming Biomedical Ethics by Ashley John Moyse is a work in fundamental theological bioethics. Rather than an applied approach that attends to particular dilemmas (...) or issues—which falls prey to the "moral technique" that is Moyse's main target—the author articulates an embodied ethical practice of postures, grounded in Karl Barth's theology, which promotes conversation over solitary reflection and plurality by way of particularity. Beyond usual complaints about contemporary biomedicine and bioethics, Moyse's subtle point is that standard bioethics, trapped in the totalizing grammar of common morality theory, functions as a technique, a tool to produce decisions more efficiently from the abstracted, disengaged stance of an impersonal agent. Hence, bioethics itself mimics the very technologies that provoke bioethical perplexities in the first place. What's needed, according to Moyse, is less a new theory than a new catechesis that can interrupt and transform standard bioethics at the level of embodied practice. [End Page 221]After an introduction that outlines the book's argument and perspective, the first chapter gives an account of bioethics' grounding in common morality theory (specifically, Tom Beauchamp and James Childress, and Bernard Gert). Ultimately, common morality is judged to be sinful, presuming that the proffered moral mastery of bioethics can secure the human good. Over the next three chapters, Moyse articulates, on the basis of Karl Barth and ancillary others, three postures of human flourishing involving dispossessing ourselves of moral mastery, each aligned with a theological virtue. First is the posture of openness or embodied solidarity, understood as a combination of the availability of our full attention to the other, with the fidelity to remain so available. Theologically, this aligns with love as self-surrender to the other and relates to Barth's account of humanity as cohumanity, existing essentially in encounter and community. Second is the posture of agency, understood as the freedom to act recognizant of the particular and provisional character of our decisions. This aligns with hope and is grounded in Barth's account of God's command as permission discerned through conscience and with others. Third is the posture of respect, which is a coalescence of openness and agency in view of our temporal finitude, consisting of reverence for the life we're given and resolve to live it in the face of illness and death. This aligns with faith and relates to Barth's account of God's command to live as the freedom to will to live within limitations. Moyse concludes with an illustration of how these postures might be exercised not as an application to a particular dilemma or issue but as a catechetical re-envisioning of our common moral space.Moyse makes a convincing case that Barth is a profitable theological resource for transforming bioethics, particularly in terms of shifting ethical attention from principles and rules to actual persons. While the exposition of Barth is excessive, much of it simply shoring up the book's theological credentials, what Moyse builds from it is salient. Still, he might have theorized the concept of posture more. The term is provocative in its corporeally concrete implications but vague as an ethical category. Moyse differentiates postures from Aristotelian habits yet doesn't clarify how postures differ from virtues. That Moyse aligns his postures with theological virtues only sharpens the problem. Relatedly, this reviewer wishes Moyse had engaged Edmund Pellegrino's medical ethical work: their shared discontent with principles-based bioethics but divergent intuitions of what bioethics should be (Pellegrino favoring a more philosophical, virtue-ethical, and humanistic perspective) would have helped define Moyse's contribution more sharply. Ultimately, these dissatisfactions are testimonies to this reviewer's appreciation for the substance of Moyse's own ethical voice and desire to hear it more clearly. [End Page 222]Joshua DanielUniversity of ChicagoCopyright © 2017 Society of Christian Ethics... (shrink)

Background Nursing is regulated by a set of professional standards. Whilst many forms of ethics apply to nursing, the biomedical ethical framework is common, involving autonomy, beneficence, non-maleficence and justice. In healthcare, nurses often encounter ethical dilemmas that require them to navigate conflicting ethical principles. However, how nurses adhere to these principles in such situations is unclear. Research Aim To explore how registered nurses adhere to ethical principles when dealing with ethical dilemmas at work. Research (...) Design A qualitative descriptive study design. Participants and Research Context Between August and December 2023, 21 registered nurses were recruited from a teaching hospital through purposive sampling. Data were collected through semi-structured in-person interviews or online video conferencing. Braun and Clarke’s thematic analysis approach was employed to analyse the data. Ethical Considerations Interview participation was voluntary. Written consent was obtained before participation. Participants’ real identities were replaced with pseudonyms. This study was approved by the SingHealth Centralised Institutional Review Board. Findings The data analysis developed four major themes and 15 subthemes. The four major themes are “Addressing the dilemma,” “Contemplating the principles and consequences,” “Coordinating for well-informed, ethical decision,” and “Self-reflecting and finding consolation.” Conclusion This study explains how nurses navigate and uphold ethical principles when caring for patients to the best of their ability. Fully adhering to ethical principles can be challenging for caring for actively dying patients. Further research can expound on nurses’ experiences and adherence to ethical principles in complex clinical cases. (shrink)