Principles of Biomedical Ethics, 7th Edition:

Abstract

This book has to be one of the most important and influential books in the field of bioethics. Now in its seventh edition, over the past 35 years, the authors have tried to keep the text up to date with developments in the field; strengthening their arguments, addressing issues raised by critics and taking account of newly published material on the topics covered. In this, the authors have been largely successful and although the book follows the basic structure of the sixth edition, the revisions are not insignificant. The book is set out in three parts. In Part I, ‘Moral Foundations’, the authors consider what constitutes moral character and address the problem of moral status. Part II, ‘Moral Principles’, argues for and thoroughly develops four principles at the core of moral reasoning in health care: respect for autonomy, non-maleficence, beneficence, and justice. Finally, Part III, ‘Theory and Method’, surveys major philosophical theories in biomedical ethics. In the first part of the book, the authors provide their account of the common morality, and how this differs from particular moralities, as well as the broad descriptive meaning of the term ‘morality’. However, what matters most in the moral life is not just an adherence to moral rules but having a reliable character, a good moral sense and an appropriate emotional responsiveness. Chapter 2, therefore, specifically concentrates on moral virtues, moral character, moral ideals and moral excellence. Specifically for health professionals, compassion, discernment, trustworthiness, integrity and conscientiousness are seen as being the five focal virtues. This then leads to a chapter on moral status, discussing why we have obligations to some individuals and not others, and which beings have rights and which do not. These ‘moral foundations’ often seem to be overlooked in discussions that tend to concentrate more on the analysis and justification of acts and policies using the language of ethical principles, rules, obligations and rights. However, application of the ‘principles’ requires judgement, which in turn depends on character, moral discernment and an individual’s sense of responsibility and accountability. The mid section of the book, and by far the larger part, devotes itself to each of the four moral principles—respect for autonomy, non-maleficence, beneficence and justice—providing valuable discussion illustrated by numerous examples derived from clinical practice. The final chapter in Part II of the book then shows how the four principles can be put to use in an interpretation and appraisal of rules of veracity, privacy, confidentiality and fidelity with specific attention to professional–patient relationships. New to this edition is a welcome section on clinical ethics and research ethics and how the distinction between these has affected thinking about professional ethics. Indeed, three of the principles, respect for autonomy, beneficence and justice, have become the specific requirements for regulating research: informed consent, a favourable risk–benefit ratio and the fair selection of subjects. Principlism does not, of itself, set out to be a comprehensive ethical theory, instead being a set of principles that are shared and can be justified by a range of existing ethical theories. In the final part of the book, comprising two chapters, the authors examine ethical theory and method in ethics. Specifically, they consider four influential theories—Utilitarianism, Kantianism, Rights theory and Virtue ethics—and how these cast light on important aspects of moral thinking in the biological and medical sciences. Overall, therefore, the four principles are just that—principles. They do not, of themselves, allow ‘deductive conclusions’ but rather provide a framework (or even a useful checklist) for the analysis of biomedical dilemmas informed by the ‘moral commitments’ which the prin ciples provide. This four principles approach has not been without criticism from professional ethicists, but one misinterpretation is the important error in thinking that the principle of ‘respect for autonomy’ overrides all other moral considerations. Indeed, the authors have always argued that competing moral considerations validly override respect for autonomy under many conditions: to give one example, if personal choices endanger public health. Finally, in addition to the book itself, there is now also a companion website that includes suggestions on how the book may be used effectively in an educational context with questions on each chapter to assess understanding, additional reading, useful exercises and cases for discussion. Overall, the authors have expanded their arguments and discussion in the field of bioethics maintaining this as one of the most important texts in the field. It is essential reading for anyone with an interest in bioethics; for occupational health professionals, it is a book that should be accessible on the library shelf. ★★✩✩ (Refer