Week 2 Historical context, scope, methods of bioethics

Question 1

what’s a Moral/Ethical Principle?

Answer 1

• A principle is a general rule or standard to guide moral conduct
• As ethical analysis requires justification, principles help us justify our
  choices, our actions
• Ethical justification answers the question:
• “if I do this rather than that in this situation, in the name of what could I say
  that my decision is the right (or least wrong) one?”
• In the name of what → a given principle
• An ethical principle is a rule of ethics.
• A principle needs to be distinguished from a value.
• A value is something we think is good, and think there should be more of.
• Honesty, for example, is a value.
• A principle is usually a rule that puts a value into practice.
• It’s fine to value honesty, but different people might suggest different principles for
  putting that value into action.
• One possible principle might be the rule, “Never lie.”
• Another possible principle putting the same value into action might be “Avoid lying, except to
  avoid doing serious harm to someone.

Question 2

Antiquity - Primum non nocere

Answer 2

Hippocrates
“First, do no harm” – Central principle emphasizing avoiding harm to patients.
Integral to the Hippocratic Oath.

Question 3

Antiquity - Beneficence

Answer 3

Hippocrates
Advocating for patient well-being, acting in their best interest.
Rooted in Hippocratic medicine.

Question 4

Middle ages - autonomy

Answer 4

Scholastic philosophers,
religious scholars
Emphasizing individual rights and choices, influenced by moral theology and natural
law.

Question 5

Modern times - justice

Answer 5

20th-century bioethicists
Encompassing fairness in medical care, equitable resource distribution, and
adherence to laws and moral standards. Integral to the four principles of bioethics.

Question 6

Nonmaleficence

Answer 6

We should avoid
causing needless
harm to others by our
actions.

Question 7

Autonomy

Answer 7

We should allow
rational people to be
self-determining,
except possibly
where:
* The Harm Principle
* Weak Paternalism
* Strong Paternalism
* The Welfare Principle

Question 8

Justice

Answer 8

• We should treat
  similar cases in similar
  ways, possibly
  according to:
• Equality
• Need
• Desert
• Contribution,
  Effort,
  Compensation
• Equality of
  Opportunity

Question 9

Beneficence

Answer 9

• We should promote
  the welfare of others
  by our actions.

Question 10

Principles of Biomedical Ethics - Beauchamp and Childress

Answer 10

1. respect for person
2. beneficence
3. justice

Question 11

Features of Principlism

Answer 11

• Aims to solve ethical dilemmas
• Had a huge impact in the biomedical
  field by reducing ethical decision- making to a dilemma with 4 easy-to- use principles
• Not as broad as Bioethics, mostly focused
  on what they call biomedical ethics:
• “We understand biomedical ethics as one type
  of applied ethics—the application of general
  theories, principles, and rules to problems of
  therapeutic practice, health care delivery, and
  medical and biological research” (Beauchamp, &
  Childress, 1979, viii)
• Principlism as a framework
• = Principles of action
• ≠ Moral theory
• Built on Universal principles
• Common to general moral
  standards
• Present in many ethical theories
• Apply to all cultures
• Principles on which everyone
  agrees
• Principles that are agreed upon
  when making a decision
• “The four principles derive from
  considered judgments in the
  common morality and medical
  traditions” (Beauchamp, &
  Childress, 2001, 23)
• Principles
• Vague indications for action +
  multiple interpretations
• For solving dilemmas
• Principles must be specified
  (contextualized)

Question 12

Principlism’s Claims

Answer 12

1. there are no norms intrinsic to medical practice that should
   guide determinations of what the best action is in medicine
2. there are fundamental ethical principles—autonomy,
   beneficence, nonmaleficence, and justice—shared among
   diverse ethical theories, that should guide ethical action in
   medicine and
3. particular moral judgments involve applications of [these]
   principles and rules to concrete situations.

Question 13

Autonomy definitions

Answer 13

autos = self
nomos = law, government, rule
That is: to give oneself one’s own law
* Autonomy brings together ethical issues concerning the freedom of
each individual to shape his or her own destiny
* Autonomy is the basis of the Kantian notion that it is not legitimate to
“commodify” the human person by using him or her only as a means
* In Western Bioethics, the “hard core” of autonomy is a principle of
authorization/permission:
* each of us has final authority over our own person
* the person’s permission is required for any action on his person

Question 14

“The moral notion of respecting the autonomy of other persons can
be formulated as the

Answer 14

principle of autonomy that must guide our
judgments about how to deal with moral agents capable of
determining their own actions and judgments”

Question 15

As a negative obligation:

Answer 15

Autonomous actions should not be
subjected to controlling constraints by others […]. As a positive
obligation, this principle requires respectful treatment in disclosing
information and fostering autonomous decision-making”
* Free and informed consent

Question 16

• Rules/methods related to autonomy:

Answer 16

• Obtain free and informed consent
• Tell the truth to the patient (not to third parties, unless the patient
  authorizes) to assist the patient’s autonomous decision making
• Preserve privacy
• Protect confidential information
• Advance directives: the possibility of determining treatment in advance, in
  case the patient is no longer able to decide for himself or herself

Question 17

Maxims associated with respect for autonomy

Answer 17

Do not take refusal of treatment as a personal criticism
* Accept that the patient has a different value system
* Accepting scientific and medical uncertainty and not hiding it from the
patient
* Be aware that the patient is in a dependent position and not simply
take advantage of it in the name of efficiency

Question 18

Beneficence definition

Answer 18

• The good of the patient is the guiding principle of medical action, the
  moral motor of the action of caring
• Evolution of the principle
• 1979: Positive beneficence requires providing benefits and the principle of
  utility requires balancing harms and benefits
• 2001: “Positive beneficence requires agents to provide benefits. Utility
  requires that agents balance benefits and drawbacks to produce the best
  overall results” (Beauchamp, & Childress, 2001, 165)
• Risk/Benefit Analysis

Question 19

Beneficence
* The good of the patient in a given concrete situation is
multidimensional:

Answer 19

• saving life
• to heal; to reverse the course of the disease
• to slow down / mitigate the course of the disease
• prolonging life
• relieving pain and suffering
• improve comfort
• overcome disability, rehabilitate, re-educate
• advise the patient on his or her health
• listening, being present

Question 20

Non-maleficence definition

Answer 20

• The obligation not to inflict harm on others
• Based on the ancient maxim of primum non nocere – first, do no
  harm
• Evolution of the principle
• 1979: Prohibition of inflicting harm on innocent persons
• 2001: The principle of nonmaleficience asserts an obligation not to inflict
  harm on others” (Beauchamp, & Childress, 2001, 113)

Question 21

• Rules/maximums related to non-maleficence:

Answer 21

• Distinctions and rules that govern non-treatment/assisted dying decisions and
  physician-assisted suicide
• do not initiate treatment v. discontinue treatment
• ordinary vs. extraordinary treatment
• intended effects v. expected effects
• kill v. let die
• Protection of patients who lack the capacity to judge
• The benefit-burden balance

Question 22

Justice definition

Answer 22

The principle that addresses the social context
* How to distribute resources in a way that respects the equal
consideration due to each person and their needs (e.g., in a triage
situation)
* Ethical issues of macro-allocation:
* Identifying the right resource allocation key for health policy choices at the aggregate
level (e.g., which primary care or screening program to favor)
* Ethical issues of micro-allocation:
* Allocating limited resources to individual patients.

Question 23

Justice (or lack of it)

Answer 23

• It is easier to identify injustice….
• for example, to do research on institutionalized populations while the
  benefits of that research accrue to those who can afford good quality care
• …than to formulate positive criteria for justice
• for example, how to manage the waiting line for a kidney transplant:
• most urgent medical need?
• the best predictable medical outcome?
• first come, first served?

Question 24

Upon what should Justice be based?

Answer 24

• We should treat similar cases in similar ways, possibly according to:
• Equality
• Benefits and burdens should be equally distributed.
• Need
• Those with greater need should receive more benefits so as attain an eventual equilibrium.
• Desert-based approaches:
• Contribution
• People should be rewarded for their work activity according to the value of their contribution to
  the social product.
• Effort
• People should be rewarded according to the effort they expend in their work activity.
• Compensation:
• People should be rewarded according to the costs they incur in their work activity.
• Equality of Opportunity:
• People should have the relevant kind of equal opportunity to achieve greater or lesser
  amounts of goods.

Question 25

What is Common Morality?

Answer 25

“set of universal norms shared by all persons committed to morality”
(B&C)
* That is, every person (regardless of culture, institution, social role, etc.)
who cares about morality should agree that these rules should be followed.
* (This is one of the fairly common ways of justifying a normative framework, basing it
on an appeal to universality.)
* Common morality includes, but is not limited, to:
* prohibitions against cruelty, dishonesty, etc.
* certain virtues (such as courage or generosity) as being morally commendable.

Question 26

What is common morality’s relation to the Four Principles?

Answer 26

• B&C claim that the Four Principles represent an extension (and
  expansion) of this universal morality, specifically applied to the
  context of modern (bio)medicine and health research.
• Some main advantages of this approach are that:
• it allows us to engage in (bio)ethical inquiry without agreeing beforehand on
  (contentious) questions of ethical theory,
• while simultaneously
• offering substantive, universal “middle-level” principles that can serve to
  explain and justify particular judgments about (bio)ethical cases.

Question 27

Prima facie principles (at first glance)

Answer 27

• Principles are not absolute
• They are binding in the first analysis only
• Prima facie principles are rather approximate rules of action than
  mechanically applicable geometrical axioms
• When several principles are in contradiction or tension, one must try to
• reconcile them as far as possible (compromise) or
• decide which one has priority (arbitration)
• One cannot a priori establish an abstract hierarchy of principles
• Arbitration between principles can only be done in a specific concrete
  situation

Question 28

How Can We Apply the Four Principles?

Answer 28

• B&C argue that their principles are general norms that must be
  specified further to be applied to particular cases
• (by spelling out to whom they apply, which actions they require, and so on).
• The process of specification is not fully determined by the norm itself
  (or the underlying common morality).
• Even when these norms are fully specified, they hold only prima facie,
  and that norms can conflict with (and be overruled by) other norms in
  particular cases.

Question 29

How can I use the four princples

Answer 29

• Resolution approach
• Principles are equal
• Ethical dilemmas ≠ Ethical problems
• Dilemma:
• From Ancient Greek lēmma, premise
• Thus, the Ancient Greek dilemma refers to two premises
• a difficult situation in which someone is forced to make a choice between two things of
  equal importance
• Two principles in conflict
• Which one should be preferred?
• Abstraction of people, daily life, organization

Question 30

What’s a Moral Dilemma?

Answer 30

• Minimalistic definition:
• Moral dilemmas involve conflicts between moral requirements.
• Source of a moral dilemma:
• an agent regards herself as having moral reasons to do each of two actions, but
  doing both actions is not possible.
• Example: Saving the lives of everyone in the trolley problem (i.e., you can’t at the same time
  puller the lever and not pull the lever).
• The crucial features of a moral dilemma are these:
  1. the agent is required to do each of two (or more) actions;
  2. the agent can do each of the actions;
  3. but the agent cannot do both (or all) of the actions.
• The agent thus seems condemned to moral failure; no matter what she does, she will
  do something wrong (or fail to do something that she ought to do).

Question 31

Two Steps Approach
for Resolving Moral
Dilemma

Answer 31

1. Specification
   * adding specific content to general
   principles
2. Balancing
   * determining the relative weight of
   conflicting principles

Question 32

Specification - adding specific content to general principles

Answer 32

• involves adding more specific and descriptive content
  to flesh out a principle
• “Specification is a process of reducing the
  indeterminacy of abstract norms and
  generating rules with action-guiding content”
  (B&C)
• narrow the scope of principles by “spelling out
  where, when, why, how, by what means, to whom,
  or by whom the action is to be done or avoided”
  (B&C)
• For example, we can specify the principle of
  justice by adopting a rule that prohibits
  distributing medical resources on the basis of
  privileges or in a way that would further
  discrimination.

Question 33

Balancing - determining the relative weight of conflicting principles

Answer 33

• Involves deliberation and judgment about “the
  relative weights and strengths of different moral
  norms” (B&C)
  1. Attempting to determine the:
• comparative weight, priority, strength,
• or stringency of moral principles
  2. in particular cases where they come into conflict
  3. in order to reach a conclusion about which principle
  is the overriding consideration that ought to be
  followed.
• For example, if a patient requires a life-saving medical
  intervention but is refusing treatment, the health care team
  must judge whether beneficence or respect for autonomy is the
  weightier norm.

Question 34

The weighting of the principles

Answer 34

• What weight should be given to each principle?
• Arbitration or trade-offs are made through a process that B&C call
  “weighting”.
• Weighting involves examining and evaluating the relative weight or
  power of principles
• This evaluation is not purely intuitive or subjective
• It involves stating valid reasons

Question 35

Under what conditions can a breach of a
prima facie principle be permitted?

Answer 35

• There are better ethical reasons for acting in accordance with the
  overriding principle than the one being transgressed
• The objective (sought by the infringement of a principle) has a good
  chance of being achieved
• No ethically preferable alternative scenario has been found
• Efforts are made to minimize the breach and its consequences
• The decision is unbiased and not influenced by morally inappropriate
  information.

Question 36

Weighting principles

Answer 36

• This process of specification, weighing, and balancing allows for a
  considerable range of moral diversity, and arguably captures a
  phenomenon that is central to our experience of moral life (i.e., of
  feeling conflicted and unsure).
• There will always remain the possibility of encountering genuine
  moral dilemmas, in which morality can demand (or appear to
  demand) that:
• we do two or more mutually incompatible actions,
• or we may have moral reasons both to do an action and refrain from doing it.

Question 37

Jehovah’s Witness:
What principles are relevant? A Jehovah’s Witness must receive a
blood transfusion to save his life.
He refuses because of his religious
beliefs.

Answer 37

Beneficence (saving lives) and Autonomy (person living according to their beliefs)
* Many ethical dilemmas are interpreted as
resulting from a conflict between the
principles of beneficence and autonomy:
which ethical issue is to be preferred?
* It is often more constructive to consider
the imperative of beneficence in light of
the principle of autonomy
* The benefits and burdens associated with
treatment must be assessed in terms of
the individuality of the patient
-Argument: person has religious beliefs but they’re still able to make an autonomous decision

Question 38

Principlism aims at solving ethical dilemmas, i.e. being confronted
with two morally relevant options, but only having the capacity to
apply one of them (at the expense of the other)

Answer 38

1. Specification
   * allows to clarify which are the 2 most
   important principles and which are in conflict,
   notably by contextualising their relevance and
   antagonism.
2. Balancing
   * aims to resolve the dilemma by establishing
   which of the two is more “weighty” than the
   other, and therefore should be prioritized.

Question 39

Specification & Balancing summary

Answer 39

• The Specification and Balancing Approach is a fundamental framework in the field of bioethics, and it was
  developed by Tom L. Beauchamp and James F. Childress in their influential book “Principles of Biomedical
  Ethics.” This approach provides a systematic way to analyze and make ethical decisions in the context of
  healthcare and medical ethics. Let’s break it down for your undergrad students:

Question 40

Specification summary

Answer 40

• Specification: This part of the approach involves identifying and clarifying four foundational ethical principles that guide decision-making in healthcare ethics. These principles serve as a framework for evaluating ethical issues and dilemmas:
  1. Autonomy: Autonomy emphasizes the importance of respecting an individual’s right to make their own decisions about their healthcare. It involves informed consent, which means that patients have the right to be fully informed about their medical
  conditions, treatment options, and potential risks and benefits, and they have the right to accept or refuse treatment based
  on this information.
  2. Beneficence: Beneficence focuses on the principle of doing good or promoting the well-being of the patient. Healthcare professionals should act in ways that maximize benefits and minimize harm to the patient. This principle encourages
  healthcare providers to act in the best interests of their patients.
  3. Non-Maleficence: Non-maleficence is closely related to beneficence but specifically emphasizes the duty to do no harm. Healthcare professionals should avoid causing harm to patients and should carefully weigh the risks and benefits of any
  medical intervention to ensure that it does not result in unnecessary harm.
  4. Justice: Justice emphasizes the fair distribution of healthcare resources and the equitable treatment of all patients. It involves ensuring that healthcare services and benefits are distributed fairly and that no one is discriminated against based
  on irrelevant factors like race, gender, or socioeconomic status.

Question 41

Balancing summary

Answer 41

Once these principles are specified and understood, the balancing part of the approach comes into play. This involves weighing these principles against each other
when they come into conflict. In many real-world healthcare situations, these principles can sometimes clash, making it challenging to make a clear-cut decision.
* To resolve such conflicts, the Specification and Balancing Approach encourages
individuals involved in healthcare decision-making, such as healthcare professionals, patients, and ethicists, to carefully consider the context and circumstances. They should
evaluate the relative importance of each principle in a particular case and determine
how to strike a reasonable balance among them. This often requires thoughtful
deliberation and ethical reasoning to arrive at a morally justifiable decision.
* Specification and Balancing Approach developed by Beauchamp and Childress provides a
framework based on four principles (autonomy, beneficence, non-maleficence, and
justice) and encourages a careful balancing of these principles in situations where they
may conflict, helping individuals arrive at ethically sound decisions in the complex field of
health ethics.

Question 42

Steps to specification and balancing

Answer 42

1. Identify the Ethical
   Dilemma
   -Begin by recognizing and defining the ethical
   dilemma in the healthcare context.
   -Begin by recognizing and defining the ethical
   dilemma in the healthcare context.
2. Specification of
   Ethical Principles
   -Using the Specification part of the approach,
   clarify and specify the two most relevant ethical
   principles involved that are in conflict.
   -In this case, you would identify autonomy and beneficence as the key principles in
   conflict, and contextualize
3. Balancing
   -The heart of the approach lies in the Balancing
   step. You would need to carefully weigh the
   importance and relevance of each principle in
   the specific case.
   -Consider factors like the severity of the patient’s condition, the likelihood of success
   with the treatment, the patient’s capacity to make decisions, and the potential harm
   that could result from both respecting autonomy and pursuing beneficence.
   * On one hand, respecting autonomy may involve honoring the patient’s decision
   even if it puts their life at risk.
   * On the other hand, pursuing beneficence may involve overriding the patient’s
   autonomous decision to ensure their best interests and well-being.
4. Ethical Deliberation
   -Engage in ethical deliberation by exploring and
   discussing the potential implications of each
   course of action and explore alternative options,
   if any.
   -Develop on the potential implications of either prevailing on the other one.
5. Arriving at a
   Resolution
   -Based on careful consideration and weighing of
   the principles, aim to arrive at a resolution that
   strikes a reasonable balance between autonomy
   and beneficence.
   -The goal is to make an ethically justifiable decision that respects the patient’s
   autonomy while also promoting their overall well-being to the extent possible.
6. Conclusion and
   Reflection
   -Finally, document the decision-making process
   and rationale for the chosen course of action.
   -It’s essential to reflect on the decision and, if necessary, revise it in light of changing
   circumstances or new information.

Question 43

Key features of Principlism

Answer 43

• Pluralism:
• there is an irreducible plurality of fundamental moral principles rather than one
  supreme principle
• Non-absolutism:
• every principle has prima facie stringency and can be overridden by a weightier
  principle in certain circumstances.
• Non-axiologically structured:
• it is principle based; right-making and wrong-making features are not grounded in
  good-making and bad-making features

Question 44

Links with the Big Three?

Answer 44

B&C’s own presentation gives considerable time/attention to moral
virtues (Chap.2), which they argue are
* “no less important in moral life” than the principles are (32).
* In particular, they identify caring as a “fundamental orienting virtue”
for health professionals (37),
* And offered an account of the “Five Focal Virtues” of compassion,
discernment, trustworthiness, integrity, and conscientiousness.
* Links with Deontology and Utilitarianism are present, but with less
strong ties.

Question 45

Critiques: Georgetown Mantra phenomenon

Answer 45

• Narrowing the ethical demands down to 4 principles
• The paradigm of principism limits the range of options that one
  sees as available for navigating ethical conflicts
• The habit of limiting ethical discourse to the 4 principles is
  then dangerous
• There are other ethical obligations that must be considered for a
  complete case analysis

Question 46

Is there such a thing as Common Morality?

Answer 46

• Lack evidence for a widespread agreement on moral norms that the
  common morality posits,
• Even if there is, in fact, such consensus, this may not provide
  normative justification for these norms
• (Turner 2003; 2004; DeGrazia 2003; T. L. Beauchamp 2003).

Question 47

Too much emphasis on individuals
(too individualistic)

Answer 47

Principlism is thus a reductionist, arbitrary approach, claiming to be
universal but not being so and excluding everyday life from the
resolution of ethical dilemmas
* Principlism diminishes the importance of social, emotional and
political context.

Question 48

Jim Childress’s Answer: Community

Answer 48

Either to:
1. Add a new principle of community
2. Reinterpret all principles through the lens of community
1. A principle of respect for community generates “an obligation to
respect the values and interests of the community in research and,
wherever possible, to protect the community from harm.”
* (Ezekiel Emanuel & Charles Weijer)
* Implications: community consultation, participation, etc

2. Reinterpretation of principles through lens of community
   * Beneficence
   * Already societal benefits balanced against risks to research subjects
   * Extension: Include risks to particular communities
   * Respect for Persons
   * embedded in their communities & their beliefs, values & practices
   * Cautionary note: persons are not reducible to their communities
   * Justice
   * Already attention to vulnerable populations & impact of group
   classifications
   * Extension: participation of communities in design & conduct of research

Question 49

Feminist critique of Autonomy in Principlism

Answer 49

• Principlism gives too much weight to autonomy
• Principlism has a mistaken conception of autonomy:
• autonomous individual as self-made, atomistic, isolated, totally independent,
  disembodied, rationalistic, etc.
• Relational Autonomy:
• Proposal of relational autonomy to overcome these distortions
• Relations: both positive & negative
• Some relations are oppressive
• Susan Sherwin: “Relational autonomy redefines autonomy as the social
  project it is, but it does not deny that autonomy ultimately resides in
  individuals.

Question 50

Failure to provide unambiguous guidance

Answer 50

Principlism fails to provide unambiguous guidance regarding the
morality of particular actions, and it amounts to a major flaw
* (Clouser and Gert 1990; Gert, Culver, and Clouser 2000; Peterson 2017).
* Principles cannot be applied at all times and in all places (Marshall, & Koenig, as
cited in Alvarez, 2001)
* Principles have become rational standards by which cultures are
judged without respect for their history and local elements (Marshall, & Koenig,
as cited in Alvarez, 2001

Question 51

What Principlism proponents would argue

Answer 51

• According to Raanan Gillon, the four principles
  provide a:
• transcultural,
• transnational,
• transreligious, and
• transphilosophical
• framework for ethical analysis.
• Principlism is by far the most dominant approach
  to (bio)ethical and applied health ethics analysis.

Question 52

1. Transcultural Application:

Answer 52

• Universality: Gillon emphasizes that these four principles offer a universal framework. This is important in a globalized world where diverse cultures frequently intersect, especially in health care settings.
• Cultural Sensitivity: Even while being transcultural, principlism does not mandate a strict one-size-fits-all approach. The principles can be adapted and weighted differently based on specific cultural or situational contexts.

Question 53

2. Comprehensive Ethical Analysis:

Answer 53

• Holistic Evaluation: The four principles cover a wide array of ethical considerations. While autonomy respects individual freedoms and decisions, beneficence and non-maleficence ensure welfare and safety. Justice underscores fairness and equality. Together, they provide a holistic view of any ethical situation.
• Substantive Moral Claims: As Gillon suggests, these principles can explain and justify a vast majority of moral claims in medical ethics. They provide a solid foundation upon which specific policies, guidelines, or decisions can be built.

Question 54

3. Pedagogical Relevance:

Answer 54

• Structured Learning: Principlism offers a structured way for students and professionals to engage with bioethical issues. Instead of wading through a morass of complex issues, one can systematically apply these principles to dissect and
  understand the ethical dimensions of a situation.
• Influential Text: Beauchamp and Childress’s “Principles of Biomedical Ethics” stands as a testament to the pedagogical strength of principlism. As one of the most influential books in modern bioethics, it has shaped the ethical understanding of countless healthcare professionals.

Question 55

4. Pragmatic Utility:

Answer 55

• Clarity in Decision-making: In the ever-evolving and complex world of healthcare, professionals often need clear guidelines to make decisions. Principlism provides a consistent framework that can be applied across various scenarios, from clinical dilemmas to research ethics.
• Bridging Different Ethical Theories: Principlism can act as a bridge between different ethical theories. Whether one approaches a problem from a deontological, utilitarian, virtue ethics, or another standpoint, the four principles can provide a
  common ground for discussion and resolution.

Question 56

5. Evolution and Flexibility

Answer 56

• Adaptable to Change: While the principles themselves remain consistent, their interpretation and application can evolve with time, societal changes, and advancements in medicine. This dynamic nature ensures that principlism remains relevant.
• Inclusion of New Ethical Insights: Over time, the understanding of each principle can be enriched with insights from various disciplines, cultures, and philosophies, ensuring a well-rounded and updated approach.

Question 57

6. Widespread Acceptance:

Answer 57

Pervasive Use: The fact that principlism is the dominant approach in ethical healthcare analysis speaks to its utility and acceptance. Many institutions, committees, and professionals rely on it for guidance.

Question 58

According to these Principism advocates

Answer 58

you can’t ask an
ethical framework to compensate for those who use it.
Thus, the fact that the framework is versatile, allows for
nuanced and contextualized application.
Proper application lies in the hands of the people who use
Principism.
[we can (dis)agree with this, but it highlights the importance of paying attention to
both the actual ethical framework and the way(s) to use it]

Question 59

Key Strengths

Answer 59

Provide structured guidance so that anyone using them will have a
clear, ordered set of considerations or questions to address so that
ethical issues will be highlighted.
* Easy-to-use