Pragmatism in bioethics: been there, done that.

It has often been remarked that bioethics is a quintessentially American phenomenon. Broadly speaking, bioethics as a field has tended to enshrine the value of autonomy, it places individual rights above communal well-being, and it has adopted a largely permissive and optimistic view of emerging biotechnologies. In contrast to much European thinking at the intersection of ethics and medicine, American-style bioethics has been resolutely middlebrow, eschewing grand philosophical schemes in favor of pragmatic policy-making and democratic consensus. It was, then, perhaps only a matter of time before various theorists began proposing a marriage between bioethics and pragmatism, which is the homegrown American philosophy. The rise of a distinctly pragmatic strain of bioethical thinking promises to add a new dimension to the methodological ferment that has energized this field during the past ten years. Since the beginning of the contemporary bioethics movement in the 1970s, the field’s lingua franca and dominant methodological orientation has been the “principlism” of philosopher Tom Beauchamp and religious ethicist James Childress.1 Instead of grounding moral inquiry in either philosophical theory or the particulars of concrete situations, principlism has sought to locate the crux of moral reasoning in the identification, interpretation, and balancing of “middle-level” moral principles, such as those bearing on individual autonomy, beneficence, and justice. So dominant has been principlism’s reign within the field of bioethics that commentators routinely refer to Beauchamp and Childress’s articulation of these principles as the “Georgetown mantra.” 2