Background There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' were presented by the authors as universal and applicable to any culture and society. Mawlana, a great figure in Sufi tradition, had written many books which not only guide people how to worship God to be close to Him, but also advise (...) people how to lead a good life to enrich their personality, as well as to create a harmonious society and a peaceful world. Methods In this study we examined the major works of Mawlana to find out which of these 'Four Principles of Bioethics' exist in Mawlana's ethical understanding. Results We have found in our study that all these principles exist in Mawlana's writings and philosophy in one form or another. Conclusions We have concluded that, further to Beachump and Childress' claim that these principles are universal and applicable to any culture and society, these principles have always existed in different moral traditions in different ways, of which Mawlana's teaching might be presented as a good example. (shrink)

Bioethics mediation is increasingly used as a method in clinical ethics cases. My goal in this paper is to examine the implicit theoretical assumptions of the bioethics mediation method developed by Dubler and Liebman. According to them, the distinguishing feature of bioethics mediation is that the method is useful in most cases of clinical ethics in which conflict is the main issue, which implies that there is either no real ethical issue or if there were, they are not the key (...) to finding a resolution. I question the tacit assumption of non-normativity of the mediation method in bioethics by examining the various senses in which bioethics mediation might be non-normative or neutral. The major normative assumption of the mediation method is the existence of common morality. In addition, the four-principle formulation of the theory articulated by Beauchamp and Childress implicitly provides the normative content for the method. Full acknowledgement of the theoretical and normative assumptions of bioethics mediation helps clinical ethicists better understand the nature of their job. In addition, the need for a robust philosophical background even in what appears to be a purely practical method of mediation cannot be overemphasized. Acknowledgement of the normative nature of bioethics mediation method necessitates a more critical attitude of the bioethics mediators towards the norms they usually take for granted uncritically as valid. (shrink)

This is the text of a paper (along with appendixes) delivered at the 2019 annual meeting of the Minnesota Philosophical Society on Oct 26 in Cambridge, MN. -/- Beauchamp and Childress’s “Four Principles” (or “Principlism”) approach to bioethics has become something of a standard not only in bioethics classrooms and journals, but also within medicine itself. In this teaching-focused workshop, I’ll be doing the following: (1) Introducing the basics of the “Four Principles” approach, with a special (...) focus on its relation to the common morality and the importance to weighing and balancing of competing norms. (2) Comparing and contrasting this to other potential approaches, such as those provided by virtue ethics, act utilitarianism, casuistry, and competing versions of principles-based ethics. (3) Considering the ways in which the principles-based approach can best be implemented for lower-level, introductory bioethics classes, where the average student may have little background knowledge in either philosophy or medicine. I’ll be presenting sample activities, case studies, and lesson plans. There will be considerable time reserved for discussion at the end, so that participants can exchange ideas relating to the teaching of both bioethics and other varieties of applied ethics. (shrink)

The four-principle approach to biomedical ethics is used worldwide by practitioners and researchers alike but it is rather unclear what exactly people do when they apply this approach. Ranking, specification, and balancing vary greatly among different people regarding a particular case. Thus, a sound and coherent applicability of principlism seems somewhat mysterious. What are principlists doing? The article examines the methodological strengths and weaknesses of the applicability of this approach. The most important result is that a sound and comprehensible (...) application of the four principles is additionally ensured by making use of the organizing meta-principle of common morality, which is the starting point and constraining framework of moral reasoning. (shrink)

Background: The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - havebeen extremely influential in the field of medical ethics, and are fundamental for understanding the currentapproach to ethical assessment in health care. This study tests whether these principles can be quantitativelymeasured on an individual level, and then subsequently if they are used in the decision making process whenindividuals are faced with ethical dilemmas. Methods: The Analytic Hierarchy Process was used as a tool (...) for the measurement of the principles. Four scenarios, whichinvolved conflicts between the medical ethical principles, were presented to participants and they madejudgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if theywere in the situation. Results: Individual preferences for these medical ethical principles can be measured using the Analytic HierarchyProcess. This technique provides a useful tool in which to highlight individual medical ethical values. Onaverage individuals have a significant preference for non-maleficence over the other principles, however, andperhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specificethical dilemmas. Conclusions: People state they value these medical ethical principles but they do not actually seem to use them directly in thedecision making process. The reasons for this are explained through the lack of a behavioural model to accountfor the relevant situational factors not captured by the principles. The limitations of the principles in predictingethical decision making are discussed. (shrink)

This article, published originally in French just after the 1989 release of Jean-Luc Marion’s book Reduction and Givenness, consists of a sustained critical study of the manner in which Marion advances from the basic principles of phenomenology. Henry outlines briefly three principles, “so much appearance, so much being,” “the principle of principles” of Ideas I, “to the things themselves!” before entering into a lengthy dialogue with Marion’s proposal of a fourth principle: “so much reduction, so much givenness.” (...) Henry submits each principle to critique, highlighting that they contain confusing premises. Henry is appreciative of Marion’s capacity to root the appearing of phenomena in givenness, but he ultimately finds problematic the gap between the call and response that is a fundamental structure of Marion’s fourth principle. Henry, in contrast, develops his own theme of pure givenness, expressed in the form of subjectivity he calls auto-affection, in the final pages of the article. (shrink)

Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ethics. It is argued that principlism is an inappropriate model for clinical ethics as it is neither sufficiently action-guiding nor does it emphasise the professional integrity of the clinician. An alternative model is proposed for decision (...) making in the realm of clinical ethics. (shrink)

This commentary briefly argues that the four prima facie principles of beneficence, non-maleficence, respect for autonomy and justice enable a clinician (and anybody else) to make ethical sense of the author's proposed reliance on professional guidance and rules, on law, on professional integrity and on best interests, and to subject them all to ethical analysis and criticism based on widely acceptable basic prima facie moral obligations; and also to confront new situations in the light of those acceptable (...) class='Hi'>principles. (shrink)

The French molecular biologist François Jacob outlined a theory of evolution as tinkering. From a methodological point of view, his approach can be seen as a biologic specification of the relation between laws, describing coherently the dynamics of a system, and contingent boundary conditions on this dynamics. From a semiotic perspective, tinkering is a pragmatic concept well-known from the information-theoretic anthropology of Claude Lévi-Strauss. In idealized contrast to an engineer, the tinkerer has to accept the concrete restrictions on his material (...) resources as only gradually changeable constraints on his projects. Jacobian biopragmatics examines evolution as a biologic analogue to human tinkering devoid of any projecting subjectivity. To validate this analogy, four basic principles concerning main formal aspects of evolutionary objects, agents, histories, and consistency criteria are proposed. (shrink)

Participatory design amalgamates the expertise of interdisciplinary specialists with the taskspecific expertise of end-users. Groupware design is widely recognised as benefiting from participative approaches. Recognition of this ideal, however, does not preclude the failure of groupware design due to poor communication and inadequate understanding between participants. We provide a grounding in the problems affecting groupware success, and introduce four design principles that guide all those involved in design around the pitfalls that have been encountered, some repeatedly, by groupware.

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)

The principles underpinning Islam's ethical framework applied to routine clinical scenarios remain insufficiently understood by many clinicians, thereby unfortunately permitting the delivery of culturally insensitive healthcare. This paper summarises the foundations of the Islamic ethical theory, elucidating the principles and methodology employed by the Muslim jurist in deriving rulings in the field of medical ethics. The four-principles approach, as espoused by Beauchamp and Childress, is also interpreted through the prism of Islamic ethical theory. Each of the (...) four principles is investigated in turn, looking in particular at the extent to which each is rooted in the Islamic paradigm. This will provide an important insight into Islamic medical ethics, enabling the clinician to have a better informed discussion with the Muslim patient. It will also allow for a higher degree of concordance in consultations and consequently optimise culturally sensitive healthcare delivery. (shrink)

Gillon is correct that the four principles provide a sound and useful way of analysing moral dilemmas. As he observes, the approach using these principles does not provide a unique solution to dilemmas. This can be illustrated by alternatives to Gillon’s own analysis of the four case scenarios. In the first scenario, a different set of factual assumptions could yield a different conclusion about what is required by the principle of beneficence. In the second scenario, although (...) Gillon’s conclusion is correct, what is open to question is his claim that what society regards as the child’s best interest determines what really is in the child’s best interest. The third scenario shows how it may be reasonable for the principle of beneficence to take precedence over autonomy in certain circumstances, yet like the first scenario, the ethical conclusion relies on a set of empirical assumptions and predictions of what is likely to occur. The fourth scenario illustrates how one can draw different conclusions based on the importance given to the precautionary principle. (shrink)

Although principles, as a framework to resolving moral dilemmas are still debated and seem to be in a philosophical quagmire, there are strong arguments that by specification one can resolve case-specific dilemmas in certain areas of bioethics. When it comes to genetic screening and testing however, the problem at the base is a moral disagreement on higher-order principles—such as the status of the embryo and parental issues. No amount of specification can resolve these issues without a dose of relativism. (...) We explore a possibility of agreement on debatable areas specifically in regard to genetics—such as conferring status to the embryo solely for purposes of preventing genetic selection; but it is difficult to see how this can be incorporated into law without extrapolation to other areas. We conclude therefore that the four-principles approach, albeit valuable for expounding opposing views and discussing issues, cannot either alone or by specification, help resolve issues of genetic screening and testing without agreeing on higher order principle. This does not seem to be a possibility in the near future. (shrink)

The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, (...) agreement may be nearer at hand. (shrink)

This special issue commemorates the 40th anniversary of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics with a collection of original essays addressing some of the major themes in the book. It opens with intellectual autobiographies by Beauchamp and Childress themselves. Subsequent articles explore the topics of common morality, specification and balancing of moral principles, virtue, moral status, autonomy, and lists of bioethical principles. The issue closes with a reply by Beauchamp and Childress to the other (...) authors. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment (...) for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (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)

English-speaking research on morally right decisions in a healthcare context over the past three decades has been dominated by two major perspectives, namely, the Four Principles, of which the principle of respect for autonomy has been most salient, and the ethic of care, often presented as a rival to not only a focus on autonomy but also a reliance on principles more generally. In my contribution, I present a novel ethic applicable to bioethics, particularly as it concerns (...) human procreation, that I argue is a promising alternative to these two approaches. According to this new moral theory, an act is right just insofar as it treats people’s capacity to commune with respect, where communing is a matter of identifying with others and exhibiting solidarity with them. This ethic is inspired by relational ideals of communion and harmony from the African philosophical tradition, but is shown to be attractive to a broad, indeed global, audience, with regard to its implications for the morality of reproduction. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

Despite tendencies to compete for a prime place in moral theory, neither virtue ethics nor the four principles approach should claim to be superior to, or logically prior to, the other. Together they provide a more adequate account of the moral life than either can offer on its own. The virtues of principlism are clarity, simplicity and (to some extent) universality. These are well illustrated by Ranaan Gillon’s masterly analysis of the cases he has provided. But the vices (...) of this approach are the converse of its virtues: neglect of emotional and personal factors, oversimplification of the issues, and excessive claims to universality. Virtue ethics offers a complementary approach, providing insights into moral character, offering a blend of reason and emotion, and paying attention to the context of decisions. The cases provided can be more adequately understood if we combine the approaches. Both should foster the virtues of humility and magnanimity. (shrink)

I will argue that there are difficulties with the application of the four principles approach to incompetent children. The most important principle – respect for autonomy – is not directly applicable to incompetent children and the most appropriate modification of the principle for them is not clear. The principle of beneficence – that one should act in the child’s interests – is complicated by difficulties in assessing what a child’s interests are and to which standard of interests those (...) choosing for children should be held. A further problem with the four principles approach is that parental authority does not follow clearly from the four principles. (shrink)

This essay reexamines the four-principle approach to biomedical ethics in the context of ethics education in general and in relation to possible ethics discourse within a community of inquiry in particular. A community of inquiry is the setting for learning and education in philosophy for children. This community enables children to acquire critical thinking and other skills as part of democratic education. The use of the four principles approach tends to contribute to a practice that limits critical (...) thinking skills because of the constraints on the conceptual tools that tend to be used. It has also had the effect of promoting conceptual ambiguity by encouraging the use of limited conceptual molds, thus giving rise to the possibility of multiple interpretations among diverse users, especially in the field of global bioethics. While recognizing the continuing appeal of the approach as a conceptual tool for ethical decision-making the essay brings out the limitations that need to be overcome in order to promote the clarity that the four principles approach is meant to possess. (shrink)

Within the latter half of the 30-year history of bioethics there has been an increasing pressure to address bioethical issues globally. Bioethics is not traditionally a theory-based enterprise, rather the focus has been problem related. With the introduction of the global perspective, theory has, however, become more important. One of the best known, probably the best known, theory of bioethics is the one presented by Tom L. Beauchamp and James F. Childress in their PrinciplesofBiomedicalEthics in 1979. This theory is known (...) as the or the approach or It is the attempt to create a global framework for bioethics on the four principlesthat I will scrutinize in this paper. (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)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued (...) to be compatible with a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

Those philosophers who gave a negative answer to all four questions were called "eel-wrigglers" by the Buddhists. It was impossible to fix their position either for approval or for rejection. They would criticize any view, positive or negative, but would not themselves hold any. And it was difficult for a serious person to enter into any controversy with them.

Following the development of the selectionist theory of the immune system, there was an attempt to characterise many biological mechanisms as being ‘selectionist’ as juxtaposed with ‘instructionist’. However, this broad definition would group Darwinian evolution, the immune system, embryonic development, and Chomsky’s principles-and-parameters language-acquisition mechanism together under the ‘selectionist’ umbrella, even though Chomsky’s mechanism and embryonic development are significantly different from the selectionist mechanisms of biological evolution and the immune system. Surprisingly, there is an abstract way using two dual (...) mathematical logics to make the distinction between genuinely selectionist mechanisms and what are better called ‘generative’ or symmetry-breaking mechanisms. This distinction is outlined in this note. (shrink)