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Common Morality Principles in Biomedical Ethics: Responses to Critics

Published online by Cambridge University Press:  13 September 2021

James F. Childress*
Affiliation:
Institute for Practical Ethics and Public Life, University of Virginia, Charlottesville, VA 22904, USA
Tom L. Beauchamp
Affiliation:
The Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA
*
*Corresponding author. Email: jfc7e@virginia.edu

Abstract

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems.

Type
Research Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

1. The first edition of Principles of Biomedical Ethics was published in 1979: Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press; 1979. In this paper, we refer both to Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press; 2013, which recent critics would have had access to, and to Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 8th ed. New York: Oxford University Press; 2019, for our most recent statements of our positions.

2. See note 1, Beauchamp, Childress 2013, at 3; 2019, at 3.

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3. Rhodes, R. The Trusted Doctor: Medical Ethics and Professionalism. New York: Oxford University Press; 2020 CrossRefGoogle Scholar.

4. Gert, B, Culver, CM, Clouser, DK. Bioethics: A Return to Fundamentals. New York: Oxford University Press; 1997 Google Scholar.

5. Gert, B, Culver, CM, Clouser, DK. Bioethics: A Systematic Approach. 2nd ed. New York: Oxford University Press; 2006 CrossRefGoogle Scholar. (This is the second edition of their book Bioethics: A Return to Fundamentals with a new subtitle.) Probably, the most complete statement of Gert’s common morality theory appears in Gert B. Common Morality: Deciding What to Do. New York: Oxford University Press; 2004.

6. See note 3, Rhodes 2020, at 13.

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7. See note 1, Beauchamp, Childress 2013, at 6; 2019, at 6.

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8. See note 1, Beauchamp, Childress 2013, at 6–8; 2019, at 7–8.

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9. See note 3, Rhodes 2020, at 346, 21, 6 italics added. In support of her claim that PBE views particular morality as “merely an extrapolation” from common morality, Rhodes refers to PBE, 7th edition, p. 352, where nothing of this sort is discussed or even mentioned. See note 1, Beauchamp, Childress 2013, at 352. See note 3, Rhodes 2020, at 346, fn. 2.

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10. See note 3, Rhodes 2020, at 21.

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11. See note 1, Beauchamp, Childress 2013, at 5, italics added; 2019, at 5.

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12. See note 3, Rhodes 2020, at 29–30.

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13. See note 3, Rhodes 2020, at 5.

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14. See note 3, Rhodes 2020, at 345, italics added.

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15. See note 1, Beauchamp, Childress 2013, at 5–6, 412–15; 2019, at 5–6, 445–49.

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16. See note 3, Rhodes 2020, at 345, 31, 40.

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17. See note 3, Rhodes 2020, at 38.

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18. See note 3, Rhodes 2020, at 345, 31, 40.

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19. See note 3, Rhodes 2020, at 31.

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20. Katz, J. The Silent World of Doctor and Patient. New York: Free Press; 1984 Google Scholar; reprint ed. Baltimore, MD: Johns Hopkins University Press; 2002. This book relies heavily on the principle of respect for autonomy and its connection to requirements of informed consent.

21. See note 3, Rhodes 2020, at 42, 346.

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22. See note 3, Rhodes 2020, at 30–31. Rhodes refers to all medical professionals as “doctors” or “physicians” for economy of expression, but this nomenclature masks several important differences in power and authority in decision making by different professionals in health care, for instance, physicians, fellows, and nurses.

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23. See note 3, Rhodes 2020, at 53.

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24. At least twice in The Trusted Doctor, this fundamental duty is stated as “fundamentalduty,” either accidentally as a misprint or deliberately in order to make a point about its centrality and significance. See note 3, Rhodes 2020, at 54.

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25. See note 3, Rhodes 2020, at 70. At one point Rhodes suggests that “perhaps we can consider the broad implicit endorsement from the community of medical professionals of the sixteen duties of medical ethics … to be something akin to a Rawlsian ‘overlapping consensus.’ As I have suggested by employing real and hypothetical examples for deriving the sixteen duties of medical ethics, agreement on those core responsibilities can be achieved through a process of reflective equilibrium.” See note 3, Rhodes 2020, at 284, fn. 2. This is not further developed in The Trusted Doctor.

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26. For a superb analysis of how common morality principles can be brought to bear on real-world problems of medical ethics, see Gordon, J-S, Rauprich, O, Vollmann, J. Applying the four-principle approach. Bioethics 2011;15:293300 CrossRefGoogle Scholar.

27. See note 3, Rhodes 2020, at 54, 68, 93.

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28. See note 3, Rhodes 2020, at 286, Table 11.2, The Duties of Medical Ethics.

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29. This is not primarily about preserving the language of beneficence and nonmaleficence. Other terms may be used for these clusters of moral duties and activities. The point here focuses on the need to include those moral duties in the list of recognized moral duties or principles.

30. See note 3, Rhodes 2020, at 356.

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31. Pellegrino, , ED, Thomasma, , DC. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press; 1988 Google Scholar.

32. See note 3, Rhodes 2020, at 356.

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33. See note 3, Rhodes 2020, at 19.

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34. See note 3, Rhodes 2020, at 128.

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35. Even though the seventh edition of PBE, which Rhodes most often references, is quite clear that both consequentialist arguments (based on beneficence/nonmaleficence and connected with trust needed for diagnosis and treatment) are important along with respect for autonomy and privacy, Rhodes claims that in PBE we justify confidentiality “in terms of respect for autonomy.” See note 3, Rhodes 2020, at 128, fn. 15. We do both. See note 1, Beauchamp, Childress 2013, at 316–32; 2019, at 342–53.

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36. See note 3, Rhodes 2020, at 54.

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37. See note 3, Rhodes 2020, at 137, 134.

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38. See note 3, Rhodes 2020, at 131.

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39. See note 3, Rhodes 2020, at 284.

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40. See note 3, Rhodes 2020, at 129–130, fn. 17. Contrast PBE: See note 1, Beauchamp, Childress 2013, at 10–11, 208, 319; 2019, at 10–11, 223, 346, 377n70, on the important Tarasoff case, which continues to be heatedly controversial and has not gained a settled position in the community of physicians after many years of discussion. This case also concerns the limits of trust.

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41. See note 3, Rhodes 2020, at 284, Table 11. See note 1, Beauchamp, Childress 2013, at 17–24, esp. 23; 2019, at 17–24, esp. 23.

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42. See note 3, Rhodes 2020, at 29–30.

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43. This is from Baker’s Slide 12 in his presentation at the Symposium on “Common Morality, Solidarity, and Trust” at the 15th World Congress of Bioethics in June 2020.

44. Baker, , R. The Structure of Moral Revolutions: Studies of Changes in the Morality of Abortion, Death, and the Bioethics Revolution. Cambridge, MA: The MIT Press; 2019 CrossRefGoogle Scholar, at 211. We respond to a number of our critics who hold this position in chap. 10 of PBE; see note 1, Beauchamp, Childress 2019, at 449–56.

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45. See note 1, Beauchamp, Childress 2013, at 3; 2019, at 3.

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46. See note 1, Beauchamp, Childress 2013, at 2–5, 404–24; 2019, at 3–5, 439–58.

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47. See note 1, Beauchamp, Childress 2013, at 17–24; 2019, at 17–24.

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48. See note 44, Baker 2019, at 211, italics added.

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49. See note 1, Beauchamp, Childress 2013, at 15–25; 2019, at 15–25.

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50. See note 1, Beauchamp, Childress 2019, at 19; compare 2013, at 19, using different examples.

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51. See note 44, Baker 2019, at x, 213.

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52. See note 1, Beauchamp, Childress 2013, at 5; 2019, at 5.

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53. See note 1, Beauchamp, Childress 2013 and 2019, chap. 5 and 6.

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54. See note 44, Baker 2019, at 212.

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55. See note 54.

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56. See Childress J, Fan R, Wang M. A dialogue on the four principles of bioethics. Chinese Medical Ethics 2020;33(11):1295–9 [in Chinese], and Fan R, Xu H, Cai Y, Zhang Y, Bian L, Wang Q, et al. Ethical principles: Different perspectives. Chinese Medical Ethics 2019;32(5):591–601 [in Chinese]. These Chinese scholars contrast Confucian conceptions of filial piety with what they view as the Western liberal, individualist conception depicted in Daniels N. Am I My Parents’ Keeper? An Essay on Justice Between the Young and the Old. New York: Oxford University Press; 1988.

57. Beauchamp TL. The compatibility of universal morality, particular moralities, and multiculturalism. In: Teays W, Gordon J-S, Renteln AD, eds. Global Bioethics and Human Rights: Contemporary Issues. Lanham, MD: Rowman & Littlefield; 2014:28–40.

58. See note 44, Baker 2019, at 211–3.

note 44

59. See note 44, Baker 2019, at 213.

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60. See note 1, Beauchamp, Childress 2019, at 444–9.

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61. See note 44, Baker 2019, at x, 18, 39–49, passim.

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62. See note 1, Beauchamp, Childress 2013, at 94, 412–5; 2019, at 445–9.

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63. See note 1, Beauchamp, Childress 2013, at 92–4; 2019, at 90–2.

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64. Baker R. Bioethics and human rights: A historical perspective. In: Teays W, Gordon J-S, Renteln AD, eds. Global Bioethics and Human Rights: Contemporary Issues. Lanham, MD: Rowman & Littlefield; 2014:92–100, at 98.

65. See note 64, Baker 2014, at 98.

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66. See note 1, Beauchamp, Childress 2013, at 14, 85, 108, 371–3; 2019, at 405–8, 414, 422n51.

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