Principalism In Biomedical Ethics

In 1979, in the widely influential Principles of Biomedical Ethics (hereafter, Principles), Beauchamp and Childress first proposed that it might be possible to make “substantative and universalizable” (Gillon) claims about medical ethics, on the basis of respect for four prima facie principles derived from a “common morality,” or a set of norms shared by all persons (Beauchamp and Childress, 1979). These principles are autonomy, beneficence, non-maleficience, and justice, and roughly speaking refer to the normative requirements to, respectively, (1) respect the right of an individual to self-rule over his or her individual body and to respect the decision-making capacity of those competent to make decisions; act with an intent (2) to benefit and (3) not to harm people; and (4) promote fairness in distribution of risks and benefits when making decisions. …show more content…
In its simplest form, principalism argues that “a prima facie obligation must be fulfilled unless it conflicts with an equal or stronger obligation” (p. 15) and that analyzing any biomedical moral dilemma in terms of the non-hierarchical balance of the above four principles will allow the moral agent to specify the particular commitments of the relevant norms and eradicate or minimize the conflicts between them. It is widely applied to three major areas of biomedical decision-making: clinical care, biomedical research, and policy-making around issues such as organ transplantation and genetic enhancement. For the purposes of this section, which considers the clinical problem of a person who might voluntarily starve to death, I will focus solely on principalism as it pertains to the right to refuse medical