Abstract
BackgroundThe principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral psychology. We empirically investigated the relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain.MethodsWe evaluated the perceived degree of “morality” of 14 values relevant to medicine (n1 = 317, students and professionals) and 14 values relevant to business & finance (n2 = 247, students and professionals). Ratings were made along four dimensions intended to characterize different aspects of morality.ResultsWe found that compared to other values, the principles-related values received lower ratings across several dimensions that characterize morality. By interpreting our finding using a clustering and a network analysis approach, we suggest that the principles can be understood as “bridge values” that are connected both to moral and non-moral aspects of ethical dilemmas in medicine. We also found that the social domain (medicine vs. business & finance) influences the degree of perceived morality of values.ConclusionsOur results are in conflict with the common morality hypothesis of Beauchamp and Childress, which would imply domain-independent high morality ratings of the principles. Our findings support the suggestions by other scholars that the principles of biomedical ethics serve primarily as instruments in deliberated justifications, but lack grounding in a universal “common morality”. We propose that the specific manner in which the principles are taught and discussed in medicine – namely by referring to conflicts requiring a balancing of principles – may partly explain why the degree of perceived “morality” of the principles is lower compared to other moral values.
Highlights
The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals
We added the “principlefocused – consequentialist” dimension in order to include a reference to the classic teleological vs. deontological distinction in ethical theory (PRI-CON). This served as a test to examine whether the notions of autonomy, care, non-maleficence and justice are evaluated as “principles” as in the approach of biomedical ethics; we found no indications in this regard
These results demonstrate that the dimensions more non-moral (MO-NMO), COM-SELF and COOP-COMP are more closely associated among themselves than with dimension PRI-CON
Summary
The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are grounded in human moral psychology. We empirically investigated the relationship of the principles to other moral and non-moral values that provide orientations in medicine. The authors’ contribution has been celebrated as one of the most important methodological inventions of of the principles in the common morality was emphasized in later editions. At the beginning of the most recent 7th edition, published in 2013, Beauchamp and Childress state that the common morality “refers to norms about right and wrong human conduct that are so widely shared that they form a stable social compact” Appealing to norms of the common morality will work better for practical decision-making [4]
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