Introduction Carol Mason Spicer Respect for autonomy, nonmaleficence, beneficence, and justice—the "Georgetown mantra"—these four principles of biomedical ethics assumed a major role early in the development of contemporary bioethics, with the 1978 publication of The Belmont Report, which discussed all but nonmaleficence, and the 1979 publication of Tom L. Beauchamp and James F. Childress's first edition of Principles of Biomedical Ethics. Despite the prominence and important influence of the principles in discussions of biomedical ethics, questions have arisen about the adequacy of such general principles, and a number of alternative methods or theories of ethics have now been introduced, or reintroduced, into the field. Given the close association of the Kennedy Institute of Ethics with the two, arguably, most prominent proponents of principles and with major proponents of several of the dominant alternatives, it seems most appropriate that the topic of the Institute's 1994 Advanced Bioethics Course was "Theories and Methods in Bioethics: Principlism and Its Critics." That course provided the theme and impetus for this special issue of the Kennedy Institute of Ethics Journal, which includes discussions of principle-based approaches to health care ethics and three alternative, or complementary, approaches: impartial rule theory, casuistry, and virtue ethics. In the first article, Tom Beauchamp introduces the theme of the issue. After outlining the principle-based approach to biomedical ethics that he and Childress defend, he discusses and responds to a number of the criticisms that have been leveled against their approach. Beauchamp considers the alternative approaches of impartial rule theory, casuistry, and virtue ethics, and concludes that, contrary to the way in which they are often presented, these alternatives "seem much more like good friends than hostile rivals." Robert Veatch, in the second article, focuses on a frequently cited concern about principles, namely, the problem of resolving conflicts among competing principles. He examines several strategies for resolving such conflicts and ultimately proposes a mixed-strategy in which consequentialist and nonconsequentialist principles first are balanced within each group, after which the result of balancing the nonconsequentialist principles is lexically ranked over the result of balancing the consequentialist ones. [End Page vii] Third, K. Danner Clouser summarizes some of the concerns about principlism that he and Bernard Gert have raised. He then presents impartial rule theory—or common morality—as an alternative to principlism, although, as he notes, this "alternative," developed by Gert as early as 1966, actually predates principlism by about 10 years. The Gert/Clouser account of morality is a general ethical theory, which can be "transliterated" into the culture of a profession, such as medicine. As such, it provides a theoretical foundation or justification for moral decision making, a foundation that they feel the principles of principlism lack. Thus, although the principles "represent some historically significant emphases," they do not have "an adequate unifying theory to coordinate these separate, albeit essential, features of morality." In the fourth article, Albert Jonsen provides a brief history of casuistry and explains the method of casuistic reasoning, a traditional method of interpreting and resolving moral problems that focuses on the circumstances of particular cases rather than on the application of ethical theories and principles. Jonsen concludes that although casuistry and principles are "alternative scholarly activities," both enterprises are necessary to moral judgment. Edmund Pellegrino, in the final feature article, discusses virtue ethics as another alternative to principles. He begins with an exploration of the origins and decline of virtue in both general and medical ethics. Pellegrino then argues that, for a variety of reasons, the restoration of a common moral philosophy and agreement on the good for humans that are needed to sustain a normative theory of virtue ethics are currently too remote to make it a viable possibility in general ethics. He maintains, however, that virtue likely can be restored as a normative concept in the ethics of the health professions where agreement on the telos of the healing relationship is more likely to occur. He concludes that a virtue-based ethics, nevertheless, must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. Finally, a selected bibliography on "Principles and Theory in Bioethics," prepared by Pat Milmoe McCarrick...
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Jan 1, 2020
Joseph Spino 
Open Access