Critical Overview of Principlist Theories
نویسنده
چکیده
In this chapter three approaches to principles are reviewed. Firstly the FourPrinciple approach as described by Tom Beauchamp and James Childress. Secondly Robert Veatch’s theory of medical ethics based on a contract relation and lexical ordering of principles giving priority to autonomy. Finally Engelhardt’s Principle of permission, amending his first edition which was based on a two-principle approach of beneficence and autonomy. Clearly the authors of these three models are ‘principlists’ themselves and the scope here is to go beyond simple principles. One however, must start with understanding the implications of these models and perhaps why they feel that virtue may not be that necessary. Common to all three positions is the philosophical and non-clinical background of the authors. All argue from a liberal point of view and indeed view beneficence, or rather, statements like ‘for the good of the patient’, as paternalistic. At least, my reading of them shows that this is where they are coming from. Although Engelhardt has a medical background as well, his carrier is academic philosophy; and it is perhaps significant that of the three theories he is the one to take a warmer view to character, which led him to be more reductionist in the number of principles. He is left with the two main contentions—that of doing good, and that of justice, which aims to do good to society and the patient as well.
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