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A Comparison of Two Bioethical Theories

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A Comparison of Two Bioethical Theories A Comparison of Two Bioethical Theories A thesis presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Master of Arts Gavin G. Enck June 2009 © 2009 Gavin G. Enck. All Rights Reserved. 2 This thesis titled A Comparison of Two Bioethical Theories by GAVIN G. ENCK has been approved for the Department of Philosophy and the College of Arts and Sciences by Arthur Zucker Associate Professor of Philosophy Benjamin M. Ogles Dean, College of Arts and Sciences 3 ABSTRACT ENCK, GAVIN G., M.A., June 2009, Philosophy A Comparison of Two Bioethical Theories (81 pp.) Director of Thesis: Arthur Zucker This thesis compares two bioethical theories in order to determine which theory is better for use by medical professionals. The two theories are Tom L. Beauchamp and James Childress’s “Principlism” and Bernard Gert, K. Danner Clouser, and Charles M. Culver’s “Moral Rules.” The structure of the paper is as follows: an explication of both theories, an examination of the similarities and differences between the theories, an evaluation of criticisms of both theories, and identification of the three advantages the Moral Rules theory has over Principlism. In the conclusion, I claim the Moral Rules is the better bioethical theory for the medical profession. Approved: _____________________________________________________________ Arthur Zucker Associate Professor of Philosophy 4 TABLE OF CONTENTS Page Abstract ............................................................................................................................... 3 Chapter 1: Introduction ....................................................................................................... 7 Principlism ...................................................................................................................... 8 Common morality ...................................................................................................... 10 The Process of Principlism: Specification, and Rules .................................................. 11 Ranking of principles ................................................................................................ 14 Autonomy ..................................................................................................................... 16 The obligation to respect the decisions of an autonomous person ........................... 16 Competence .................................................................................................................. 18 Autonomy as a Negative and Positive Obligation ........................................................ 20 Case#1 ....................................................................................................................... 21 Case #2 ...................................................................................................................... 23 Conclusion .................................................................................................................... 23 Nonmaleficence ............................................................................................................ 25 An obligation not to inflict harm on others. .............................................................. 25 The Concept of Harm ................................................................................................... 26 Beneficence ................................................................................................................... 27 Paternalism .................................................................................................................... 28 Justice ............................................................................................................................ 30 Chapter 2: Moral Rule ...................................................................................................... 32 Morality ........................................................................................................................ 33 5 Moral Disagreement ..................................................................................................... 34 Morality as an informal public system ...................................................................... 35 Irrational and Rational .................................................................................................. 37 Impartial ................................................................................................................... 38 Three types of beliefs ................................................................................................ 39 The Rules ...................................................................................................................... 41 The Ten Moral Rules ................................................................................................. 42 Duty .............................................................................................................................. 43 Rule Violations ............................................................................................................. 44 The ten questions for morally relevant facts ............................................................. 45 Applying the Moral Rules to Cases .............................................................................. 46 Chapter 3: Similarities and Differences ............................................................................ 50 A Common Morality Foundation ................................................................................. 50 Use of Principles and Rules .......................................................................................... 51 Practical over the Philosophical .................................................................................... 51 Differences .................................................................................................................... 52 The Place of beneficence .......................................................................................... 52 Criticism of Principlism ................................................................................................ 53 Conclusion .................................................................................................................... 61 The ten questions for morally relevant facts ............................................................. 63 Criticism of the Moral Rules ........................................................................................ 64 Common Morality and Inconsistencies ........................................................................ 68 Conclusion .................................................................................................................... 70 6 Why the Moral Rules are Better ................................................................................... 72 References ......................................................................................................................... 80 7 CHAPTER 1: INTRODUCTION This paper compares two theories of bioethics in order to determine which theory is better able for use by the medical profession. The theories are Tom L. Beauchamp and James Childress’s “Principlism” and Bernard Gert, K. Danner Clouser, and Charles M. Culver’s “Moral Rules.” The chapters in this paper unfold as follows. The first chapter is a synopsis of Principlism, the role of obligations, rules, its version of common morality, and specification. The second chapter is a synopsis of the Moral Rules with a focus on its version of the common morality, ten moral rules, and its rule violation process. The third chapter highlights similarities and differences between the two theories. The similarities between the theories are that each theory uses common morality is the foundational justification, both theories heavy reliance on principles and rules, and the overarching emphasis these theories being practical over philosophical. The central point of contention between these theories is the role beneficence to plays. The fourth chapter is a criticism of Principlism. This chapter illustrates the areas where Gert’s Moral Rules has distinct advantages over Principlism. The fifth chapter criticizes the application of the Moral Rules and the implied assumption that common morality is a consistent set of beliefs. The final chapter is why the Moral Rules gives the medical professional three advantages when dealing with bioethical dilemmas. The first advantage is the Moral Rule theory is systematic and therefore clear and concise for use by medical professionals. Second, the Moral Rules places greater emphasis on the inevitability of moral disagreement than Principlism. Third, the Moral Rules emphasis on nonmaleficence 8 makes it better equipped to deal with future dilemmas resulting from medical and technological breakthroughs. Principlism Principlism is an ethical theory created by Tom L. Beauchamp and James Childress to serve as a guideline (or “chapter headings”) in evaluating and guiding decisions in bioethical cases.1 Principlism is not just four principles; its foundation is in a common morality and the use of a process called specification to fill out the features of a case. Specification balances and ranks these principles. This chapter divides into five sections: an overview of the four principles, the common morality foundation from which Principlism draws
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