Beyond the principles of bioethics: facing the consequences of fundamental moral disagreement

Abstract

Given intractable secular moral pluralism, the force and significance of the four principles (autonomy, beneficence, non-maleficence, and justice) of Tom Beauchamp and James Childress must be critically re-considered. This essay examines the history of the articulation of these four principles of bioethics, showing why initially there was an illusion of a common morality that led many to hold that the principles could give guidance across cultures. But there is no one sense of the content or the theoretical justification of these principles. In addition, a wide range of secular moral and bioethical choices has been demoralized into lifestyle choices; the force of the secular moral point of view has also been deflated, thus compounding moral pluralism. It is the political generation of the principles that provides a common morality in the sense of an established morality. The principles are best understood as embedded not in a common morality, sensu stricto, but in that morality that is established at law and public policy in a particular polity. Although moral pluralism is substantive and intractable at the level of moral content, in a particular polity a particular morality and a particular bioethics can be established, regarding which health care ethics consultants can be experts. Public morality and bioethics are at their roots a political reality.