Ethical Analysis: PRINCIPLISM. Patrick T. Smith, Ph.D.

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1 Ethical Analysis: PRINCIPLISM Patrick T. Smith, Ph.D. Lecturer, Department of Global Health & Social Medicine Core Faculty, Harvard Center for Bioethics

2 The Case of Dolores

3 Some Ethical Questions What are the moral obligations of the formal hospice care team to Dolores in this case?

4 Some Ethical Questions What about the moral obligations to Jill?

5 On Principles and Principlism

6 Some Key Concepts: Moral Principles Common Morality Principlism

7 Some Key Concepts: Moral Principles Common Morality Principlism

8 Some Key Concepts: Moral Principles Common Morality Principlism

9 Two Forms of Principlism Monistic Theories (e.g. utilitarianism)

10 Two Forms of Principlism Pluralistic Systems- employ a number of basic moral principles drawn from common morality

11 Some Basic Principles of Bioethics

12 Nonmaleficence (not harming)

13 Beneficence (benefitting)

14 Respect for Autonomy

15 Justice (Distributive Sense)

16 Principlism in Practice (Four Step Process)

17 Principlism Four Step Process 1. Identify Moral Norms 2. Specify Norms in Context 3. Make Balanced Judgments 4. Aim for Coherence

18 Principlism Four Step Process 1. Identify Moral Norms 2. Specify Norms in Context 3. Make Balanced Judgments 4. Aim for Coherence

19 Principlism Four Step Process 1. Identify Moral Norms 2. Specify Norms in Context 3. Make Balanced Judgments 4. Aim for Coherence

20 Principlism Four Step Process 1. Identify Moral Norms 2. Specify Norms in Context 3. Make Balanced Judgments 4. Aim for Coherence

21 The Case of Mr. Smith

22 Specifying Do No Harm

23 1. Health care professionals should not harm patients intentionally. (general moral principle) Principlism Four Step Process

24 Principlism Four Step Process 2. Providing aggressive life-sustaining treatments to dying patients that generate significant burdens for them without significant corresponding benefits causes harm. (specification of general norm to end-of-life care)

25 3. The case of Mr. Smith is an instance of providing aggressive lifesustaining treatment in a dying patient that generates significant burdens without significant corresponding benefits. (judgment as to the application of the specific norm to the case) Principlism Four Step Process

26 Principlism Four Step Process 4. Therefore, aggressive life-sustaining treatment should not be provided for Mr. Smith. (ethical conclusion)

27 Limitations of Principles: Necessary though not Always Sufficient

28 Avoiding Two Extremes Principles are the only Adequate Feature of Ethical Jus9fica9on Principles are Unnecessary

29 Limitations of Principles in Ethical Analysis 1. They suffer from a degree of vagueness. 2. Conflicts of principles are not resolved by appeal to a more fundamental one. Tom Tomlinson, Methods in Medical Ethics, Chapter 2.

30 Limitations of Principles in Ethical Analysis 1. They suffer from a degree of vagueness. 2. Conflicts of principles are not resolved by appeal to a more fundamental one. Tom Tomlinson, Methods in Medical Ethics, Chapter 2.

31 Limitations of Principles in Ethical Analysis 3. Principles don t appear to be epistemically basic. 4. They do not capture the full scope of morality. Tom Tomlinson, Methods in Medical Ethics, Chapter 2.

32 Limitations of Principles in Ethical Analysis 3. Principles don t appear to be epistemically basic. 4. They do not capture the full scope of morality. Tom Tomlinson, Methods in Medical Ethics, Chapter 2.

33 The Indispensability of Principles

34 The Indispensability of Principles 1. Necessary appeal to them when seeking ethical justification. Tom Tomlinson, Methods in Medical Ethics, Chapter 1.

35 The Indispensability of Principles 1. Necessary appeal to them when seeking ethical justification. 2. Help with satisfying universalizability criterion. Tom Tomlinson, Methods in Medical Ethics, Chapter 1.

36 The Indispensability of Principles 1. Necessary appeal to them when seeking ethical justification. 2. Help with satisfying universalizability criterion. 3. Help identify what is ethically important. Tom Tomlinson, Methods in Medical Ethics, Chapter 1.

37 Concluding Thoughts on Principles and Principlism

38 Sources: Beauchamp, Tom L. and James F. Childress Principles of Biomedical Ethics, Seventh Edition. New York: Oxford University Press. Gert, Bernard, Charles M. Culver, K. Danner Clouser Bioethics: A Systematic Approach, Second Edition. New York: Oxford University Press. Smith, Patrick T The Patient-Family Dyad as Interdependent Unit of Hospice Care: Toward An Ethical Justification, Hospice Ethics: Policy and Practice in Palliative Care, edited by Timothy W. Kirk and Bruce Jennings. New York: Oxford University Press. Sugarman, Jeremy and Daniel Sulmasy Methods in Medical Ethics, Second Edition. Washington, D.C., Georgetown University Press. Tomlinson, Tom Methods in Medical Ethics: Critical Perspectives. New York: Oxford University

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