Balancing Principles in Beauchamp and Childress :: Beauchamp Childress Ethics Essays

Balancing Principles in Beauchamp and Childress ABSTRACT: In the latest edition of Principles of Biomedical Ethics, Tom Beauchamp and James Childress provide an expanded discussion of the ethical theory underlying their treatment of issues in medical ethics. Balancing judgements remain central to their method, as does the contention that such judgements are more than intuitive. This theory is developed precisely in response to the common skepticism directed at "principlism" in medical ethics. Such skepticism includes the claim that moral reasoning comes to a dead halt when confronted by competing conflicts between moral norms in a given pluralistic situation. In this paper, I use examples from the text to show that despite the authors’s arguments to the contrary, balancing judgements are the product of unreasoned intuitions. Given the necessity of some such judgements in any principle-based system, my argument highlights the degree to which principled ethical reasoning rests upon an arational core. "Principlism" is the term often used, sometimes derisively, to refer to a method of moral reasoning found in medical ethics and elsewhere. At the core of principlism is the idea that ethical justification rests primarily, if not exclusively, in appeals to more general or "higher level" moral norms under which any more particular ethical claim can be subsumed. Principles of Biomedical Ethics, by Tom Beauchamp and James F. Childress, has for many critics in medical ethics exemplified the worse sins of "principlism." From its first edition, the authors have argued for the importance and usefulness of general principles for justifying ethical judgments about policies and cases in medical ethics. The organization of their book reflects this conviction, dividing discussion of particular ethical problems under the rubrics of the key ethical principles which the authors believe should govern our moral judgments: principles of autonomy, nonmaleficence, beneficence and justice. It was always a caricature of their views to label them as straight-arrow deductivists. (1) At the very least, they have from the first insisted on the necessity of making judgments about the proper balance to be struck between competing ethical commitments when they are in conflict. Since Beauchamp and Childress disavow appeal to any overarching framework from which such a balancing judgment could be derived, particular moral judgments could never for them be simple deductions from any single moral principle. But then one may ask how Beauchamp and Childress handle one of the key criticisms of principlism, which points to the inevitable conflict among principles in the sort of pluralistic system favored by many, (2) and the resulting need to "balance" or prioritize the norms in conflict.