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Medicine, Health Care and Philosophy

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20.07.2023 | Scientific Contribution

Abortion, euthanasia, and the limits of principlism

verfasst von: Brieann Rigby, Xavier Symons

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 4/2023

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Abstract

Principlism is an ethical framework that has dominated bioethical discourse for the past 50 years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics–a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education.

Richard Huxtable, ‘For and against the four principles of biomedical ethics’ (2013) 8(2/3) Clinical Ethics 39, quoting Tom Beauchamp and James Childress, Principles of Biomedical Ethics (Oxford University Press, 6th ed, 2009) 3.

Ibid 41.

Oliver Rauprich, ‘Principlism’ (2013) International Encyclopedia of Ethics 4086, 4087.

Ibid.

Tom Beauchamp, ‘The ‘Four Principles’ Approach to Health Care Ethics’ in Richard Ashcroft, Angus Dawson, Heather Draper and John McMillan (eds), The Principles of Health Care Ethics (John Wiley & Sons, 2007) 3.

Tom Beauchamp and James Childress, Principles of Biomedical Ethics 8th ed (New York: Oxford University Press, 2019) 24–25.

Ibid. 14-17.

Ibid 13.

Ibid.

We thank an earlier reviewer for highlighting this point.

Basil Varkey, ‘Principles of clinical ethics and their application to practice’ (2021) 30(1) Medical Principles and Practice 17, 19.

Thomas McCormick, ‘Principles of Bioethics’, UW Medicine, Department of Bioethics and Humanities, (Webpage) < https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics > .

Raanan Gillon, ‘Medical ethics: four principles plus attention to scope’ (1994) 309(6948) British Medical Journal 184.

McCormick (n 12).

Varkey (n 11) 18.

Ibid.

Beauchamp (n 6) 268.

Beauchamp (n 6) 17-25.

Beauchamp (n 6) 23.

Huxtable (n 1) 39.

Varkey (n 11) 18.

Bernard Gert, Charles Culver and K. Danner Clouser, ‘Common Morality versus Specified Principlism: Reply to Richardson’ (2000) 25(3) Journal of Medicine and Philosophy 308, 308.

McCormick (n 12).

Bernard Gert, Charles Culver and K. Danner Clouser, Bioethics: A Return to Fundamentals (Oxford University Press, 1997).

Jacqualine Lindridge, ‘Principlism: when values conflict’ (2017) 9(4) Journal of Paramedic Practice 158.

Ibid.

National Health and Medical Research Council, National Statement on Ethical Conduct in Human Research (Canberra: Australian Government, 2018).

Beauchamp (n 6) 1.

Rachel Goldstein, Jennifer Carlson and Nichole Tyson, ‘Dobbs v Jackson Decision: It’s Time to Get Uncomfortable’ (2022) 12(10) Hospital Paediatrics 364.

Franklin Miller, Howard Brody and Kevin Chung, ‘Cosmetic surgery and the internal morality of medicine’ (2000) 9(3) Cambridge Quarterly of Healthcare Ethics 353, 353–364.

Andrew McGee, Melanie Jansen and Sally Sheldon, ‘Abortion law reform: why ethical intractability and maternal morbidity are grounds for decriminalisation’ (2018) 58(5) Australia and New Zealand Journal of Obstetrics and Gynecology 594, 594–597.

Beauchamp (n 6) 92.

Katie Watson and Julie Chor (eds), Reproductive Ethics in Clinical Practice (Oxford University Press, 2021) 11.

Ibid 11.

Ibid 13.

Ibid 12.

Alphonso Gomez-Lobo and John Keown, Bioethics and the Human Goods: An Introduction to Natural Law Bioethics (Georgetown University Press 2015).

Ibid 57.

Nina Roxburgh, ‘Whose rights are the most right? The Dilemma of Autonomy in a Society: On Abortion, Women, and Human Life’, Australian Institute of International Affairs (online, 23 July 2016) < https://www.internationalaffairs.org.au/news-item/whose-rights-are-the-most-right-the-dilemma-of-autonomy-in-a-society-on-abortion-women-and-human-life/#_ftn5 > .

Gomez-Lobo (n 38) 55.

Ibid 50-53.

Lorana Bartels and Margaret Otlowski, ‘A Right to Die? Euthanasia and the Law in Australia’ (2010) 17(4) Journal of Law and Medicine 532, 532.

Beauchamp (n 6) 189-191.

Ibid., 191.

Ibid., 188.

Ibid., 189.

Ibid., 155.

Julian Savulescu, ‘Autonomy, Interests, Justice and Active Medical Euthanasia’ in Michael Cholbi and Jukka Varelius, New Directions in the Ethics of Assisted Suicide and Euthanasia (Dordrecht: Springer, 2015); Lucie White, ‘Euthanasia, Assisted Suicide and the Professional Obligations of Physicians’ 3(10) Emergent Australian Philosophers 1. Gary Seay, ‘Euthanasia and Common Sense: A Reply to Garcia’ (2011) 36(3) The Journal of Medicine and Philosophy 321.

George Mendz and David Kissane, ‘Agency, Autonomy and Euthanasia’ (2020) 48(3) Journal of Law, Medicine and Ethics 555.

Neil Campbell, ‘A problem for the Idea of Voluntary Euthanasia’ (1999) 25(3) Journal of Medical Ethics, 242.

Bernadette Spina, ‘Ethical Justifications for Voluntary Active Euthanasia’, (1998) 3(1) Richmond Journal of Law and the Public Interest 71 citing Tom Beauchamp and James Childress, Principles of Biomedical Ethics (Oxford University Press, 4th ed, 1994).

Jonas-Sebastien Beaudry, ‘Death as ‘Benefit’ in the Context of Non-Voluntary Euthanasia’ Theoretical Medicine and Bioethics (2022) 43(5–6): 329.

Ibid; Mendz (n 50).

Bonnie Steinbock, ‘The Case for Physician Assisted Suicide: Not (yet) Proven’ (2005) 31(4) Journal of Medical Ethics 235, 236.

Henk Ten Have, ‘Respect for Human Vulnerability: The Emergence of a New Principle in Bioethics’ (2015) 12(3) Journal of Bioethical Inquiry 295, 395–408.

John McMillan, The Methods of Bioethics: An Essay in Meta-Bioethics (Oxford University Press, 2018) 51, 51–53.

Ibid 51.

Bartels, Lorana, and Margaret Otlowski. 2010. A right to die? Euthanasia and the law in Australia. Journal of Law and Medicine 17 (4): 532.

Beauchamp, Tom. 2007. The ‘Four Principles’ approach to health care ethics. In The Principles of Health Care Ethics, ed. Richard Ashcroft, Angus Dawson, Heather Draper, and John McMillan. New Jersey: John Wiley & Sons.

Beauchamp, Tom, and James Childress. 1994. Principles of Biomedical Ethics, 4th ed. Oxford: Oxford University Press.

Beauchamp, Tom, and James Childress. 2009. Principles of Biomedical Ethics, 6th ed. Oxford: Oxford University Press.

Beauchamp, Tom, and James Childress. 2019. Principles of Biomedical Ethics, 8th ed. Oxford: Oxford University Press.

Campbell, Neil. 1999. A problem for the idea of voluntary euthanasia. Journal of Medical Ethics 25 (3): 242.CrossRef

Gert, Bernard, Charles Culver, and K. Danner Clouser. 1997. Bioethics: A return to fundamentals. Oxford: Oxford University Press.

Gert, Bernard, Charles Culver, and K. Danner Clouser. 2000. Common morality versus specified principlism: Reply to Richardson. Journal of Medicine and Philosophy 25 (3): 308.CrossRef

Gillon, Raanan. 1994. Medical ethics: Four principles plus attention to scope. BMJ 309 (6948): 184.CrossRef

Goldstein, Rachel, Jennifer Carlson, and Nichole Tyson. 2022. Dobbs v Jackson Decision: It’s time to get uncomfortable. Hospital Paediatrics 12 (10): e364.CrossRef

Gomez-Lobo, Alphonzo, and John Keown. 2015. Bioethics and the human goods: An introduction to natural law bioethics. Washington: Georgetown University Press.CrossRef

Huxtable, Richard, 2009 ‘For and against the four principles of biomedical ethics’ (2013) 8(2/3) Clinical Ethics 39, 39, quoting Tom Beauchamp and James Childress, Principles of Biomedical Ethics (Oxford University Press, 6^th ed,) 3

Jonas-Sebastien Beaudry. 2022. Death as ‘benefit’ in the context of non-voluntary euthanasia. Theoretical Medicine and Bioethics 43 (5–6): 329.

Lindridge, Jacqualine. 2017. Principlism: When values conflict. Journal of Paramedic Practice 9 (4): 158.CrossRef

McCormick, Thomas. 2018. ‘Principles of Bioethics’, UW Medicine, Department of Bioethics and Humanities, (Webpage). <https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics>

McGee, Andrew, Melanie Jansen, and Sally Sheldon. 2018. Abortion law reform: why ethical intractability and maternal morbidity are grounds for decriminalisation. Australia and New Zealand Journal of Obstetrics and Gynecology 58 (5): 594–597.CrossRef

McMillan, John. 2018. The Methods of Bioethics: An Essay in Meta-Bioethics. Oxford: Oxford University Press.CrossRef

Mendz, George, and David Kissane. 2020. Agency, autonomy and euthanasia. Journal of Law, Medicine and Ethics 48 (3): 555.CrossRef

Miller, Franklin, Howard Brody, and Kevin Chung. 2000. Cosmetic surgery and the internal morality of medicine. Cambridge Quarterly of Healthcare Ethics 9 (3): 353.CrossRef

National Health and Medical Research Council (Cth), National Statement on Ethical Conduct in Human Research (2018)

Rauprich, Oliver, (2013) ‘Principlism’. International Encyclopedia of Ethics 4086, 4087

Roxburgh, Nina, ‘Whose rights are the most right? The Dilemma of Autonomy in a Society: On Abortion, Women, and Human Life’, Australian Institute of International Affairs (Online, 23 July 2016) <https://www.internationalaffairs.org.au/news-item/whose-rights-are-the-most-right-the-dilemma-of-autonomy-in-a-society-on-abortion-women-and-human-life/#_ftn5>

Savulescu, Julian. 2015. Autonomy, interests, justice and active medical euthanasia. In New directions in the ethics of assisted suicide and euthanasia, eds. Michael Cholbi and Jukka Varelius. Springer.

Spina, Bernadette. 1998. Ethical justifications for voluntary active euthanasia. Richmond Journal of Law and the Public Interest 3 (1): 71.

Steinbock, Bonnie. 2005. The case for physician assisted suicide: Not (yet) Proven. Journal of Medical Ethics 31 (4): 235.CrossRef

Ten Have, Henk. 2015. Respect for human vulnerability: The emergence of a new principle in bioethics. Journal of Bioethical Inquiry 12 (3): 295.CrossRef

Varkey, Basil. 2021. Principles of clinical ethics and their application to practice. Medical Principles and Practice 30 (1): 17.CrossRef

Watson, Katie, and Julie Chor. 2021. Reproductive ethics in clinical practice. In Oxford University Press, ed. Katie Watson and Julie Chor. Oxford.

Titel: Abortion, euthanasia, and the limits of principlism
verfasst von: Brieann Rigby
Xavier Symons
Publikationsdatum: 20.07.2023
Verlag: Springer Netherlands
Erschienen in: Medicine, Health Care and Philosophy / Ausgabe 4/2023
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-023-10162-y

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