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The principles approach.

Tom Beauchamp was a philosophy consultant to the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.

Much of the thinking about principles of biomedical ethics that eventuated in Principles of Biomedical Ethics had already been put in place well before 1976. Also, in mid-1976 I joined the staff of the National Commission for the Protection of Human Subjects to develop a philosophically polished statement of principles to be called the Belmont Report, the initial drafting of which had been undertaken by Stephen Toulmin.

The Belmont Report ultimately had, I believe, an enormous impact on the development of biomedical ethics. From 1978 to 1983 or so it had a much wider impact on the field than the book Jim Childress and I had published. The principles articulated in the Belmont Report--respect for persons, beneficence, justice--are not the so-called Georgetown principles. The drafting I did at the National Commission and the exchanges I had with staff and commissioners provided me with a large data base for discussions with Jim, but what we regarded as commission mistakes also helped us find what we thought was a better conception of the number and the content of the principles.

In a nutshell, I thought then and still do that the commission was mistaken in the way it delineated the principle of respect for persons. I thought it was mixing together two independent principles: a principle of respect for autonomy and a principle of protection and avoidance of harm to incompetent persons. Jim thought, and argued vigorously, that the principle of beneficence should be distinguished from the principle of nonmaleficence. These two views forged our account of the four principles and eventuated in a substantively different philosophical analysis of two of the three commission principles. Moreover, the third of the commission principles, justice, was never extended beyond research ethics, whereas Jim and I saw it as a principle of biomedical ethics that was far more important in areas other than research ethics.

It has become fashionable in recent years to criticize the "principles approach" as too limited. Our view has been that a careful analysis and specification of principles is consistent with a wide variety of types of ethical theory, including virtue theory and some accounts that came to recent prominence after we wrote the book, such as communitarian theories, casuistical theories, the ethics of care, etc. We have tried to articulate the view that one does not have to select and exclude types of theory in the attempt to build a principle-based account of biomedical ethics. A principle-based approach is not a one-sided, exclusionary, and even tyrannical approach to bioethics. The idea that you should drop principles in order to articulate a casuistry of cases, a communitarian ethic, a system based on virtues, and the like seems to me a one-sided and short-sighted vision.

The four-principles approach, as we have developed it, also rejects the view that there is a canon for bioethics, including a canon for four principles. There is no scripture, no authoritative interpretation of anything analogous to scripture, and no authoritative interpretation of that large mass of judgments, rules, standards of virtue, and the like that we often collectively sum up by use of the words such as morality or bioethics.
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Author:Beauchamp, Tom L.
Publication:The Hastings Center Report
Date:Nov 1, 1993
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