Foundations of Healthcare Ethics Theory to Practice

Ethical principlism is a popular ethical theory in healthcare ethics. It is based around four principles: beneficence, non-maleficence, autonomy and justice. Some codes of ethics, which try to provide guidance in healthcare, make use of these principles. This chapter will first explore what each of these principles involves, consider some examples of the principles in action and look at some of the difficulties and limitations of principlism. Principlism is at its best when the four principles work together to provide a framework for moral action, and at its worst when principles come into conflict. For example, showing respect for patient autonomy may not always lead to treatment that would be in a patient’s best interests, and so could conflict with the principle of beneficence.

It is no surprise that when we discuss standards of moral conduct or seek guidance in moral decision-making that we appeal to moral principles that help us make decisions about how we should act. Different normative moral theories have different starting points, so we can arrive at different views about what is good and what is morally right. Different theories, starting from different principles, result in different moral rules. This suggests that where there are challenging moral issues in the healthcare area, there will be considerable difficulty in finding agreement about what course of action is morally appropriate. Ethical principlism is a possible way forward: it proposes that, despite differences among ethical theories, there is a common core morality, and invites us to consider our moral decision-making within a framework of four moral principles. That is, it is claimed that whatever our starting point in moral theory might be – whether it is utilitarianism, virtue ethics, deontology or natural law – if we begin from the framework of ethical principlism, then the more likely we are to reach an agreed decision on a moral question. The appeal of ethical principlism is that it will help us to make justifiable moral decisions rather than establish what is objectively morally right. Principlism assumes that because there will be an overlap among the various moral rules enunciated by different normative theories which yield a common core morality, there will be acceptance of the four principles that form the framework within which moral questions are considered.