Principles of Biomedical Ethics:
Reflections on a Work in Progress
JAMES F. CHILDRESS
The subtitle of this chapter may be unsettling—”a Work in Progress” may suggest that yet another edition of Principles of Biomedical Etbics(hereafter PBE) is on the way. Perhaps there will be another edition, a sixth edition, but for now I will focus on some themes that, in my judgment, have been important as this work has evolved from our initial discussions to the present and on some issues that require further attention, in part to address critics' legitimate objections. It is probably unnecessary to note that these are my personal reflections and that Tom Beauchamp may have a very different interpretation.
I will use the term “principlism” as a shorthand expression for PBE's framework. Even though the term “principlism” originated as a scornful label for our approach, it is useful because it is more succinct than, say, a “principles-based approach” or “the four-principles approach.” Often a pejorative label becomes accepted and even used by those it derides. So I will use the label “principlism” in a neutral sense and with the understanding that it actually covers a variety of positions, not simply the one that PBE presents.
Tom Beauchamp and I knew each other at Yale Divinity School, where we both studied in the early 1960s, before he commenced his doctoral studies in philosophy at the Johns Hopkins University. As far as I can recall, we didn't meet again until I interviewed for the Joseph P. Kennedy, Sr., Professorship in Christian Ethics at the Kennedy Institute of Ethics in 1974. Then, after I accepted that appointment in 1975, we began discussing ethical theories, particularly because of his utilitarian and my