PRINCIPLES OF BIOMEDICAL ETHICS BEAUCHAMP PDF
Beauchamp and Childress, Principles of Biomedical Ethics, Fourth Edition. Engelhardt, H. Tristram Oxford: The Foundations of Bioethics. This article focuses on the primary principles of biomedical ethics and .. According to Beauchamp and Childress, the principle of respect for. Beauchamp, Tom L. Principies of biomedical ethics -. Tom L. Beauchamp, James F. Childressth ed. p. cm. ¡neludes bibliographical references and indexo.
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[Tom L Beauchamp; James F Childress; Teton Data Systems (Firm); STAT! on the best-selling tradition of previous editions, Principles of Biomedical Ethics. Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress. PDF download for Principles of Biomedical Ethics. By Tom L. Beauchamp. doi/occmed/kqu Principles of Biomedical Ethics, 7th. Edition. Tom L. Beauchamp and James F. Childress. Published by Oxford University Press.
In the writing of this work there was a strong influence of the psychiatrist Seymour Perlin, who insisted with the authors about the need to create a set of principles to guide the performance of professionals in biomedical issues 9. Up to now, seven editions have been made: in , , , , , and in The initial success of the bioethics of principles lies on its great plasticity to accommodate different moral theories and religious conceptions, and its proposal of universal applicability, even in the absence of an ethical agreement.
This universality is currently the most characteristic attraction, and its relative nature generates many followers. On the other hand, it is a great merit of Beauchamp and Childress to have incorporated the suggestions and criticisms of various analysts, as recognized by Clouser and Gert 10 , facilitating a debate that has enriched the whole work The seventh edition, published in 12 , reflects much of this evolution.
Another author, Raymond Devettere 14 , also distinguishes these two senses. Thus, such principles are considered as middle level ethical standards.
The difficulty lies in the fact that, since there are several principles, the question arises of the primacy between them, and in case they enter into conflict, it will be necessary to study the characteristics of the situation and determine which of them has the primacy. They are prima facie principles, a concept taken from W. Ross 15 , although this author does not speak of principles, but of prima facie duties, against the present duties that the moral agent discovers in the concrete case.
There is an obligation to fulfill the duties thus characterized, as long as they are not in conflict with another equivalent or more important obligation. The coherent model Another important change of perspective appears in the fifth edition 16 , following the critics and comments received in the first editions.
The authors present the so-called coherent model, which would encompass both the deductive model and the inductive model. It is also called a model of theory and application, with a structure similar to that of mathematical reasoning: conclusions proceed logically from the premises.
Principles of biomedical ethics
This model was followed in the first editions. It is, therefore, a moral system adapted to the complexity of moral life, in which there are many concrete situations to evaluate, difficult cases to solve.
The moral relevance is contained in the concrete cases, and not in the principles and rules. Only in a second moment, when reflecting on the moral judgments that have been given in similar situations can we speak of rules or principles. A paradigmatic example is the case series of Jonsen and Toulmin Beauchamp and Childress will say that this proposal is a model without content.
The reflective equilibrium And there is still a new and serious problem: the impossibility of resorting to the origin of moral theory to seek the solution when the prima facie principles come into conflict. To solve this problem they will use the Rawlsian concept of reflective equilibrium 18 , which is key to the principles of biomedical ethics. It is an instrument that, through reflection and dialectical adjustment, tries to optimize the foundation of moral approaches and obtain a greater internal cohesion of the moral system.
In other words, moral principles moral beliefs of a general nature and particular or concrete moral judgments are mutually corrected. However, as stated by Beauchamp and Childress in the sixth edition, a completely stable equilibrium cannot be guaranteed.
Rationalization and readjustment take place constantly and they conclude by saying that moral reflection is analogous to scientific hypotheses that we verify, modify or reject through experience and experimental thinking The common morality Faced with the possibility that their proposal might be criticized for allowing an ethical system that is, ate the same time coherent and immoral for example, a terrorist group, with coherent norms and rules , in the fifth edition the authors step up saying that their system is supported in judgments weighted as a result of the beliefs acquired over time Immediately, the question that will condition all its proposals and subsequent developments arises: where do these weighted judgments find support??
The answer lies in the concept of common morality, borrowed from Frankena and Ross 21 , which the authors elevate to the category of moral theory extensively developed in the new edition The theory of common morality draws its premises directly from the morality shared by all members of a society, including principles such as respect for people, taking into account their well-being, treating them justly etc.
From these principles the concrete norms that allow to approach the ethical dilemmas are extracted. As Beauchamp and Childress point out in the fifth edition, the existence of a universal moral order is recognized, but there are various theories about that moral order.
Nevertheless, these theories show common characteristics, which can be grouped into three: a they rely on commonly shared moral beliefs and do not need to resort to reasoning or an intrinsic natural order; b they distrust any ethical theory that is not compatible with moral judgments considered meaningful or pre-theoretical; c all these theories are pluralistic; there are always two or more non-absolute principles prima facie that constitute the general basis of the normative system, as is the case of the four principles of bioethics How to resolve conflicts between principles?
The four principles, by their condition of very general principles, must be translated or made concrete in specific norms, that is, they demand specification. But to specify the principles is to reduce them to less indeterminate rules, in order to facilitate moral decision, providing them with content to guide concrete actions.
And many times those rules come into conflict. Beauchamp and Childress provide two tools for their application: specification and weighting. Specification The specification method seeks to reduce principles to less indeterminate rules, with the aim of expediting the resolution of moral issues. The specified principle would be as follows: informed consent for these patients will be obtained whenever possible, and the remaining cases will be acted upon in accordance with the legislation in force in the jurisdiction.
It is clear that these are still unresolved issues and, so, in addition to the specification, it is necessary to use the second tool: weighting. Weighting The weighting of principles consists in determining which principle, rule, right or duty, has a higher weight in a particular situation. In this definition the authors assume the perspective of Ross For Ross, the important thing is to arrive at the major conflict by comparing the obligations that get into conflict in a way similar to how weight is compared in a scale.
Principles of Biomedical Ethics
Paradoxically, one moves from the prima facie obligation which is not a true obligation to the actual or actual obligation which is. It is therefore necessary to evaluate the principles and standards to determine how they are ranked in each specific situation. They insist that weighting is not simple intuition. It is necessary to provide adequate reasons to justify the choice, always seeking the most coherent solution to the moral life.
Limitations of principlism There has been abundant criticism to principlism since its appearance We will only present some of the most important issues, commenting on the examples proposed by the authors. Absence of a theory of moral action In the first place, the search for principles that are easy to apply in order to maximize results in a way that is credible and the formulation of agreed procedures has led to the abandonment of truly ethical principles and the substitution of a fundamentally technical way of reasoning.
In principle there is no theory of action.
Specifically, Beauchamp and Childress do not explain what they understand by moral action moral act or human act This and other ethical concepts are taken for granted. Therefore, this moral norm ceases to be absolute in the medical field.
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What is meant by an absolute moral norm? It is that norm that does not allow exceptions of any kind, whatever the intention and the circumstances of the agent. Consequently, the acceptance of this norm permits to affirm the existence of intrinsically evil acts, that is to say those that are always ethically disordered. This is one of the most debated moral questions in the last three decades, closely related to another of the most controversial issues of recent times: the notion of moral object as the source of the morality of human acts.
What is their reasoning? From this premise they deduce - from the logical point of view - that, in these same cases, it will also be justified to positively help a patient to die. We need to know the motive of the agent whether benevolent or malicious, for example , or whether it is a decision of the patient or another person, or the consequences of the act. For the authors, what is morally important is not the type of action involved killing or letting die but the intent of the decision maker and the consequences of that decision.
Although we agree on the importance of intention and circumstances, the authors do not take into account the other essential element of the moral act, the moral object of action the object that chooses the will, the type of action, the medium chosen. It is possible that a person does not know all the consequences of what he or she is doing, but they can always or should be able to answer the question: what is he or she doing?
What action is he or she doing?
If we continue with the example above, sometimes it will be right to let die - to follow the natural course of the disease -, and in other times to let die has the same moral value as the action of killing. Is killing always a bad action? So why is killing not within this category? They admit then that there are actions that are bad, disordered in themselves. The difficulty of not distinguishing different types of moral actions, even though they have the same consequences, entails a significant distortion of the morality of the action.
Since there is a moral difference between killing through an action or through an omission because from the moral point of view what is important is the type of action that the doctor chooses and not the type of death. Other ways of describing the action would be more appropriate and more accurate, such as: a removing a clinically useless vital support device; b not commencing a dialysis treatment in a terminal patient; c not performing resuscitation maneuvers in a young patient who could recover without sequelae after such maneuvers.
In all three actions, the consequence is the same: death. But what can be observed is that if in the first two there may be no intentionality to provoke it, this is clear in the third one The question is whether it is, in all cases, the same moral action.
To answer, it is necessary to introduce another element that does not take into account the authors: the perspective from which the person acts. Beauchamp and Childress limit themselves to a purely physical analysis of the action. Confusion about the moral norm We find a critique of principlism of greater importance when approaching the concept of moral norm. Although this topic is included by the authors in the first chapter of the seventh edition 12 , no substantial changes are observed with respect to previous editions.
As Requena points out, Beauchamp and Childress argue that there are some specific rules that are virtually absolute 31 , that is, they could be absolutes, but they are rare and the exceptions should be specified in their statements.
As an example, these authors claim that the term kill does not necessarily imply a bad action or a crime, and that the no-killing rule is not absolute. They add that the standard justification of killing in self-defense, to rescue a person threatened by the immoral action of others or accidental death prevent us from considering an action as bad simply because it is killing The inadequate conception of human action, previously exposed, reappears and that is problematic to properly understand the moral norms.
This is the key point. It is a disoriented action of the will or, in other words, it is a type of bad action in itself. Hence, the norms that specifically condemn actions that always involve a disorder in the will, cannot have exceptions. In fact, there are many conditions that lay for the justification of assisted suicide.
However, once the door to exceptions to this rule is opened, it is very difficult to contain abuses. For example, failure of the newborn with Down syndrome to correct a tracheoesophageal fistula could be justified by reference to poor patient quality of life in the future.
Confusion between the moral and the legal spheres Finally, a problem present in the North American context is the close connection of moral norms with the legal sphere. Wulff 34 points out, as a defect of principlism, the lack of distinction between the moral and legal spheres. Civil laws govern external behaviors, not objects wanted by the will.
These legal norms safeguard certain human goods, which in specific circumstances may not be at stake, thus allowing for legitimate exceptions.
If moral life and moral laws are simply considered as civil laws, exceptions to any norm can certainly be found, leaving aside the very nature of moral life. Absence of hierarchy in the principles This is where one of the most forceful criticisms against principlism is found, not sufficiently solved in the last edition.
These criticisms are based on the fact that it is not possible to apply the principles to specific cases because there are no sufficiently solid ethical reasons or arguments that can justify their hierarchy. Hence, different results are obtained according to who and how they use them and, therefore, these cannot serve as guidelines for the decision. Botros 35 explains it with an example, that of the doctor who discovers a tumor in a woman and fears that if it gives him a choice between two treatment alternatives, she will choose the less aggressive alternative, but that will be worse in the long term.
From the utilitarian perspective, the doctor will take into account the principle of beneficence and silence the possibility of this treatment thinking about the good of the patient.
From the deontological perspective, in which the autonomy of the patient prevails, the doctor does not consider hiding any of the alternatives, giving all the information so that the patient decides freely.
Botros stresses the incoherence that exists in one of the key points of principlism, presenting itself as a system in which different philosophical conceptions can coincide and pretending that, based on different principles, it is possible to arrive at the same solution.
This author will say that the answer cannot come from the beginning but from another element related to the principle and that determines the solution Absence of an ethical theory Another criticism directed at principlism is that it lacks a sufficiently solid argumentative structure to be able to resolve moral conflicts. Although in its latest edition the ethical dilemma is addressed again 12 , the tool of weighting the principles, proposed by Beauchamp and Childress, leads to a resolution of conflicts that is totally subjective and purely intuitive, leading the system towards moral relativism.
Principles of biomedical ethics
And, in fact, this was not the intention of the authors, but that has been the result. Arras 36 and Turner 37 bring the example of the debates about abortion.
When this issue is raised between the principle of autonomy and the principle of non-maleficence, depending on whether one or the other is adopted, the results will be diametrically opposed. If the choice is made from a radical feminist perspective, the principle of autonomy prevails.
The argument is that the woman is the owner of her body and her destiny. If it is done from a pro-life approach, in which the key is the sacredness of life and human dignity, the priority principle is that of non-maleficence: not to destroy the embryo or irreparably damage a human life.
In fact, as Holm 38 states, the rules of Beauchamp and Childress are purely formal, they do not serve to guide our decisions and with the weighting it is possible to justify any behavior. Clouser and Gert 10 conclude that they are not moral principles in the manner of Rawls 18 , or the principle of utility of Stuart Mill, but are mere slogans.
Final considerations The bioethics of principles has constituted a new paradigm in the clinical ethics, proposing great contributions, among which we must highlight the propitiation of a deep dialogue between authors and critics, which in turn has generated a current of continuous improvement Likewise, it has presented an ambitious goal: to offer a proposal of universal applicability, a system that allows progress even in the absence of an ethical agreement, with the capacity to adapt to different moral theories, religious conceptions or cultures Perhaps for this reason it has been widely disseminated and articulated for the use of all ethical committees.
But it is also clear that their shortcomings have raised opposition from many areas, difficult gaps to reconcile with moral theories that claim to be universal Among them are the use of prima facie principles as a starting point, which closes the door to consider that there are intrinsically immoral actions; or the reduction of medical deliberations to physical actions and external results without taking moral action into account; or the variability and ambiguity in the application of the principles, which allows someone or another to do so, provided that it is convincing To solve this, a common theory, a common morality, has been sought, which is known, but is not applied WorldCat is the world's largest library catalog, helping you find library materials online.
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Drawing from contemporary research--and integrating detailed case studies and vivid real-life examples and scenarios--they demonstrate how these prima facie principles can be expanded to apply to various conflicts and dilemmas, from how to deliver bad news to whether or not to withhold or withdraw life-sustaining treatments. Illuminating both theory and method throughout, Principles of Biomedical Ethics, Seventh Edition, considers what constitutes moral character and addresses the problem of moral status: It also examines the professional-patient relationship, surveys major philosophical theories--including utilitarianism, Kantianism, rights theory, and virtue theory--and describes methods of moral justification in bioethics.
Ideal for courses in biomedical ethics, bioethics, and health care ethics, the text is enhanced by hundreds of annotated citations and a substantial introduction that clarifies key terms and concepts. A clarified and more concise treatment of the common morality and its distinction from both particular moralities and the broad descriptive use of the term "morality" Ch.
New sections on degrees of moral status and the moral significance of moral status Ch. A revised section on the therapeutic use of placebos and expanded coverage of theories of autonomy and information-processing issues Ch.
New material on historical problems of underprotection and recent problems of overprotection in human subjects research Ch. A new section on expanded access and continued access in research and a relocated and integrated discussion of surrogate decision making for incompetent patients Ch.
A distinction between traditional theories of justice and more recent theories like capabilities and well-being Ch. A new section on clinical ethics and research ethics Ch. A whole new section on virtue theory, which expands the account from Ch. Find a copy online Links to this item online. Allow this favorite library to be seen by others Keep this favorite library private.
Find a copy in the library Finding libraries that hold this item Electronic books Additional Physical Format: Document, Internet resource Document Type: Ref Online service Find more information about:Clinical bioethics focuses, therefore, on decision-making, where simultaneous knowledge of ethical principles and more general philosophical principles is required, as well as its practical application. They add that the standard justification of killing in self-defense, to rescue a person threatened by the immoral action of others or accidental death prevent us from considering an action as bad simply because it is killing Drawing from contemporary research--and integrating detailed case studies and vivid real-life examples and scenarios--they demonstrate how these prima facie principles can be expanded to apply to various conflicts and dilemmas" Although in its latest edition the ethical dilemma is addressed again 12 , the tool of weighting the principles, proposed by Beauchamp and Childress, leads to a resolution of conflicts that is totally subjective and purely intuitive, leading the system towards moral relativism.
In: Post SG, ditors.
Is killing always a bad action? The difficulty lies in the fact that, since there are several principles, the question arises of the primacy between them, and in case they enter into conflict, it will be necessary to study the characteristics of the situation and determine which of them has the primacy.
Bioethics [Internet]. Another author, Raymond Devettere 14 , also distinguishes these two senses.
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