Dignity and the Founding Myth of Bioethics
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Published:2023-03
Issue:2
Volume:53
Page:26-35
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ISSN:0093-0334
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Container-title:Hastings Center Report
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language:en
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Short-container-title:Hastings Center Report
Author:
Reis‐Dennis Samuel
Abstract
AbstractIn this article, I reject the “principlism” of Tom Beauchamp and James Childress and argue that respect for autonomy is, and ought to be, the fundamental value of bioethics. To do so, I offer a reconstruction of what I call the field's “founding myth,” a genealogy that affords primacy to the right to be respected as a human being with dignity. Next, I examine the relationship between this basic right and a derivative right of autonomy. I suggest that principlism has promulgated an uncharitable understanding of respect for autonomy, one that ensures that the principle cannot occupy the central position I claim for it. Finally, I sketch a more plausible understanding of respect for autonomy and explore its implications.
Subject
Health Policy,Philosophy,Issues, ethics and legal aspects,Health (social science),Industrial and Manufacturing Engineering,Environmental Engineering
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2. One of the aims of the paper will be to explain why principlism despite its popularity as an ethical theory among bioethics instructors and students has not fully taken hold among practicing doctors and scientists who instead seem to prioritize respect for persons as the central biomedical principle. The further question though of why principlism has had such appealas a theoryis an interesting one that I do not have space to pursue in detail here. An anonymous referee has suggested to me plausibly that principlism's theoretical attraction may be due in part to the affinities between the weighing and balancing of moral values and the process of clinical reasoning with its weighing and balancing of risks and benefits. Relatedly the principlist rejection of absolutes may make it attractive to clinicians and scientists who so often work in the context of uncertainty. To stretch the analogy one might even say that some doctors’ reticence to give concrete medical guidance mirrors principlists’ reticence to give concrete ethical guidance. Of course whether such hesitancy constitutes prudence or an abdication of duty is a matter of interpretation.
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