Comprehensive Notes on Applied Ethics and Principlism in Biomedical Ethics

Applied Ethics

What Applied Ethicists Do

Applied ethics focuses on real-world ethical problems. It arguably began with Judith Jarvis Thomson's "A Defense of Abortion" (1971), which argued that abortion is permissible even if a fetus has a right to life. Thomson analyzed the actual claims in the abortion debate, sparking ongoing discussions and inspiring others to apply philosophical analysis to concrete ethical issues.

Areas of Applied Ethical Study

Applied ethics covers various situational areas, employing similar methods. Examples include:

• Animal Ethics: Is eating meat permissible?

• Biomedical Ethics: On whom can we perform medical tests?

• Business Ethics: Do corporations have moral status?

• Environmental Ethics: Should we curb climate change for future generations?

• Information Ethics: Is pirating music permissible?

• Law: Should recreational drug use be illegal?

• Philosophy of the Family: What do children owe their parents?

• Practical Distributive Justice: How much should we give to charity?

• Procreative Ethics: Is abortion permissible?

• Sexual Ethics: Should prostitution be legal?

Applied ethicists focus on specific cases rather than abstract theories, addressing real-world ethical situations. They aim to determine the moral status of scenarios people encounter and those with practical importance.

Methods in Applied Ethics

Applied ethicists use argument from analogy and bare-difference argument. These methods reveal relevant moral components and help draw conclusions about actual cases. Applied ethicists avoid arguing from a baseline normative ethical theory and appeal to widely shared intuitions.

Arguments from Analogy

Thomson's violinist example is an argument from analogy:

Imagine waking up kidnapped by the Society of Music Lovers and hooked up to an unconscious, famous violinist who needs your body for nine months to survive. Is it permissible to unhook yourself?

This analogy relates to abortion cases. While differences exist, the applied ethicist explains why they aren't morally relevant. The morally relevant factors are similar: someone is connected to another moral subject for nine months to ensure survival. By judging responses to the analogous case, relevant intuitions are uncovered, constructing an argument about abortion.

Bare-Difference Arguments

Example:

Smith and Jones will split an inheritance with their cousins. Smith drowns his cousin; Jones lets his cousin drown. The bare difference is that Smith killed his cousin, and Jones let his cousin die.

Is Smith morally worse than Jones, or are they equally bad? This helps determine if there's a moral difference between killing and letting die, which can be applied to euthanasia questions (killing a terminally ill patient vs. allowing the illness to take its course).

Bare-difference arguments and arguments from analogy illuminate applied ethical questions, allowing us to act as responsible moral agents.

Conclusion

Applied ethics uses philosophy to address moral issues in practical disciplines by analyzing ethical problems.

Principlism in Biomedical Ethics

Introduction to Principlism

Principlism is an approach to solving ethical problems in medicine and science, developed by Tom Beauchamp and James Childress in their 1977 book, Principles of Biomedical Ethics.

Instead of relying on ethical theories like Kantianism, Consequentialism, Virtue Ethics, or Care Ethics, which often lead to disagreements, principlism offers a set of core principles that most ethicists can agree on. These principles are designed to be detailed enough to guide analyses and decisions, yet flexible enough to adapt to different cases and cultures.

Beauchamp and Childress defend four principles central to medical ethics: respect for autonomy, non-maleficence, beneficence, and justice.

The Four Principles

1. Respect for Autonomy

Respect for autonomy involves respecting individuals' capacity to make their own decisions. In clinical settings, physicians evaluate patients' decision-making capacities by checking if patients understand their diagnosis and treatment options, appreciate the risks and benefits, and offer reasons for their decisions.

Competent adults can generally decide their own healthcare, provided medical professionals explain the situation clearly. Autonomy varies by degrees; children can make some choices but not complex medical ones. Impairments like sedation or unconsciousness can affect decision-making capacity. Advance directives, living wills, and conversations with loved ones can guide care when a patient cannot decide. These enable medical teams and families to respect a patient’s autonomy, even when the patient cannot decide at that moment.

2. Non-Maleficence and Beneficence

Non-maleficence means avoiding harm, while beneficence means doing good. These are two sides of the same coin, as medicine often involves risky treatments to achieve health. Medical practitioners often say, “First, do no harm” (non-maleficence) and “Cure sometimes, treat often, comfort always,” listing the good things practitioners do. Practitioners balance harms and benefits of available options.

3. Conflicts with Autonomy: Paternalism

Non-maleficence and beneficence can conflict with autonomy. Paternalism, overriding patients’ wishes for their own good, was once common. For example, a doctor might not have told a patient about their terminal lung cancer to avoid distressing them (non-maleficence overriding autonomy). Today, such paternalism is often condemned. Conflicts still arise; a patient with strict religious beliefs might refuse a life-saving blood transfusion. Medical practitioners might recommend the transfusion (beneficence) but respect the patient's autonomy to refuse, even if it leads to death.

4. Justice

Justice concerns the fair distribution of benefits and burdens. In medical ethics, this involves asking who an institution serves and at what cost to whom. Many wealthy countries provide state-funded healthcare, believing it is fair and that easy access to care lowers costs and improves health outcomes. Some countries redistribute wealth through taxes to support citizens' well-being.

Systemic issues are complex and involve policy. Some physicians argue that healthcare practitioners cannot address justice at the bedside but should care for the patients in front of them. However, practitioners can advocate for justice by asking whether a practice can better accommodate marginalized groups or improve access to resources. Offering gender-affirming categories on paperwork or asking specific, relevant questions are contemporary examples. Addressing bias and stigma can improve access to community resources and healthcare, promoting justice.

Conclusion

Respect for autonomy, non-maleficence, beneficence, and justice work best together, with no single principle always taking priority. When principles conflict, ethicists must balance competing demands through critical dialogue involving all stakeholders, providing the best chance to resolve ethical problems.