The “Four Principles” of Western Medical Bioethics and the Bioethics of Shīʿī Islam in Iran—Is the Claim of Universality by Both Justified?

Abstract

The four principles of Western medical bioethics, i.e., autonomy, nonmaleficence, beneficence and justice, published by Beauchamps and Childress in their seminal ‘Principles of Biomedical Ethics’, are understood as universal. However, Non-Western governments argue that they refer to Western cultural contexts, neglecting specifics of Non-Western, for instance Islamic, civilizations. This paper addresses the claim of bioethical universality of both the West’s and Iran’s Shīʿī Islamic bioethics. We describe the historical development and the normative sources of Western and Shīʿī bioethics, i.e., common morality, the ontogeny of human morality and Shī’ī Islamic religious foundation. Both concepts support nonmaleficence and justice yet diverge with respect to beneficence, autonomy and normative justification. The Iranian screening program for ß-thalassemia major exemplifies the differences in both concepts. We conclude that nonmaleficence and justice are universal moral rules based on the ontogeny of morality. Beneficence can be characterized as a universal moral ideal. In contrast, autonomy, appreciated in the West, is neither justified by common morality nor the ontogeny of morality and has no equivalent in more communitarian-oriented societies. It thus fails to quality as a universal norm.