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Principlism and Casuistry: Different Names for the Same Thing? Sara Kolmes

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Principlism and Casuistry: Different Names for the Same Thing? Sara Kolmes Florida State University Libraries 2016 Principlism and Casuistry: Different Names for the Same Thing? Sara Kolmes Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] FLORIDA STATE UNIVERSITY COLLEGE OF ARTS AND SCIENCES PRINCIPLISM AND CASUISTRY: DIFFERENT NAMES FOR THE SAME THING? By SARA KOLMES A Thesis submitted to the Department of Philosophy in partial fulfillment of the requirements for the degree of Master of Arts 2016 Sara Kolmes defended this thesis on April 15, 2016. The members of the supervisory committee were: David McNaughton Professor Directing Thesis Piers Rawling Committee Member Aline Kalbian Committee Member The Graduate School has verified and approved the above-named committee members, and certifies that the thesis has been approved in accordance with university requirements. ii ACKNOWLEDGMENTS Thank you to my thesis committee for all of their suggestions, patience, and support. I'd like especially to thank my thesis director, David McNaughton, for his invaluable advice and assistance. iii TABLE OF CONTENTS Abstract ............................................................................................................................................v RIVAL ACCOUNTS .......................................................................................................................1 META-ETHICAL QUESTIONS.....................................................................................................5 THE CASE OF ANENCEPHALIC INFANTS ...............................................................................8 CASUIST METHODS...................................................................................................................15 PRINCIPLIST METHODS ...........................................................................................................18 JUSTIFICATIONS FOR CASUISTRY ........................................................................................21 JUSTIFICATIONS FOR PRINCIPLISM......................................................................................24 COMPARITIVE LOGIC OF JUSTIFICATION ...........................................................................27 PRINCIPLIST CRITICISMS OF CASUISTRY ...........................................................................31 CASUIST CRITICISMS OF PRINCIPLISM ...............................................................................37 A "DEADLOCK" OF PRINCIPLES .............................................................................................40 References ......................................................................................................................................42 Biographical Sketch .......................................................................................................................44 iv ABSTRACT Tom Beauchamp and James Childress describe a method for analyzing ethically troubling medical situations in their standard work Principles of Biomedical Ethics. Beauchamp and Childress's method is intended to allow those who are not professional philosophers, or who do not share allegiance to the same ethical systems, to have productive debates about what should be done in any specific medical case. "Principlism", as this method is called, is perhaps the most well known method of bioethical case analysis. Shortly after principlism emerged, Albert Jonsen and Stephen Toulmin argued in their book The Abuse of Casuistry that reviving the casuist method of analyzing cases would serve the purposes of bioethical analysis better than principlism. Jonsen and Toulmin argue this is due to casuistry’s superior ability to avoid coming to a “deadlock” of principles, its ability to deal better with concrete cases, and its ability to represent the context of cases more accurately. Jonsen and Toulmin worry that discussions of ethics which are not rooted in cases will not give specific enough advice, may give impractical advice that is obviously unhelpful in the context of real cases, and most importantly may become so caught up with things like exact definitions of terms or principles that they will never be able to give ethical guidance at all. Since then, casuistry and principlism have been characterized as rival accounts of how to conceptualize bioethical debates in the most productive way. In order to clarify what is at stake in selecting one of these two methods to analyze bioethical cases, I will try to pinpoint exactly where the practical differences between the two theories lie. An ideal method for analyzing specific issues that arise in medical contexts would be both theoretically sound (insofar as it succeeds in meeting the theoretical requirements it is inspired by, generally to treat like cases equally) and practical (in order to ensure that it is useable by the medical professionals who will be confronted with these situations and that it can reliably result in consensus solutions). This means that analyzing the theories and practical applications of principlism and casuistry is necessary for comparing the two. The practicality of the two methods of analyzing bioethical cases can be compared by comparing the actual way each method treats moral problems. This can be done both by comparing the actual explicit instructions that principlists and casuists give to those examining medical situations, and by running a model case through each method. v In order to evaluate methods of bioethical analysis, it is necessary to clarify the theoretical justification for the specific methods suggested. Standardizing the justifications for the two theories will help compare them, as they make use of different intellectual canons and so use terms in ways which are not compatible. The substantive differences between the justifications for the two theories can be made explicit in this way. The final aspect of analyzing the two theories is to look at what proponents of the theories claim are the differences between the methods. This should also include analysis of arguments as to why rival theories are inferior for leaving things out or including unnecessary requirements. This will mainly consist of looking at criticisms of principlism by casuists and vice versa, and determining if the criticisms are apt. If the criticisms are apt, then this will highlight differences between the ways in which principlists and casuists approach cases. If there is no difference between principlism and casuistry on any of these analyses, one of two things is true. Either there is no difference between principlism and casuistry, or the difference between principlism and casuistry is not captured by a practical analysis. The latter suggests that principlist and casuist rejections of meta-ethical or metaphysical concerns is disingenuous if principlists and casuists maintain there is a difference between the two theories. In either case, a shift in debate strategies is necessary. Either principlists and casuists must engage in debate regarding issues beyond practical interpretation of cases, or they must abandon the rhetoric of difference between them. vi RIVAL ACCOUNTS Tom Beauchamp and James Childress describe a method for facilitating debate about what to do in response to ethically troubling medical situations in their standard work Principles of Biomedical Ethics. This method has been widely referred to as principlism, although Beauchamp and Childress' use of the word "principle" is not related to the meta-ethical position of the same name or the claims that several theory-driven philosophical approaches to ethics make to be based on ethical principles. They developed this method because they believe that the traditional philosophical method for analyzing ethical dilemmas is not helpful for resolving specific cases in medical ethics. They fear that philosophical ethics is focused solely on abstract issues like terminological distinctions, meta-ethical questions, and developing algorithmic ethical analysis methods, and so is not helpful for practical cases even if a perfect philosophical method of ethics were to be constructed.1 They also express concern that this perfect philosophical method of ethics could ever be found, given the entrenched status of seemingly irresolvable disagreements between ethical theories.2 Bioethical cases must often be solved quickly and must always be solved decisively, and Beauchamp and Childress argue that traditional philosophical ethical methods aren't suitable for achieving these goals. Albert Jonsen and Stephen Toulmin explain that their revival of casuistry was motivated by their experiences on the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1974, which led them to have similar concerns about the ability of abstract debate to provide practical solutions to problems. Jonsen and Toulmin point out that the methods with which they were able to reach a consensus seemed to be much closer to traditional case-based ethical methods than those which center on principles. It seemed to them that intractable disagreements arose between members of the commission about abstract principles, but that members of the commission were able to easily come to agreement about what should happen in specific cases. The authors argue that because of this, case based ethics is uniquely suited to reaching a consensus in biomedical ethics in a way that improves on using the 1 Beauchamp, Tom L. , and James F. Childress. Principles of Biomedical Ethics. 7th ed.
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