Beauchamp vs. Singer

Part of my frustration with the current state of biomedical ethics education is an emphasis on Beauchamp's principlism (beneficience, non-maleficience, autonomy, justice). But such an approach is oftentimes too arbitrary. Beauchamp himself does not give a way to distinguish between which values take priority in which situation -- he only mentions that we ought to specify from principle to application, and then balance the four pillars. In this manner, he does not commit himself to any one theory of normative ethics. He admits that his framework is not a comprehensive theory -- which adds to why we ought not to learn about ethics through principlism first. 

I view him as spineless, and this attitude of compromise and can be seen in "Principlism and Its Alleged Competitors", where he explains that these approaches are really just saying the same thing as he is -- which is erroneous and seems to place himself above all the other theories (as his went on to become the preeminent theory used by all clinicians today). I'll use casuistry, for example. Casuistry begins by taking paradigm cases (cases where all the facts are known, including the circumstances of the case and the correct moral decision). Then, by changing the facts of the case to match IRL situations, we can change the resolution of the case. Thus, casuistry begins with the empirical case, and then derives the principles from the case, whereas principlism begins with the principles and then specifies the correct moral decision. 

Beauchamp seems to think that just because principlism and casuistry eventually end up having the same reasoning (i.e. reasoning from principles), that they are saying the same thing. This is simply false. The casuist does have a method for differentiating between the weighing of principles -- that is, we can look for analogous paradigm cases and contrast the facts of those cases with our current case. Rather than being stuck at the point of deliberating over the specification and balancing of principles, we can look towards which paradigm case matches ours the best. By building a taxonomy of cases, the casuist can then reason through the so-called "murky cases" better than the principlist can. But Beauchamp ignores all of this and, in a move revealing of his own psychology, calls for compromise -- because that is all the courage he can muster up.  

In contrast, I wanted to talk about philosophers who were willing to "bite the bullet" -- who had philosohopical convictions, despite there being hard truths to swallow. Singer -- a utilitarian -- comes to mind the swiftest. He thinks that animals have the same value as humans (as both have the capacity for pain), that we can euthanize the disabled, elderly, and infants, and that most people are evil because they do not give away almost all of their belongings to those in need of it. The truth is, I respect Singer more than Beauchamp. I respect someone who can stand of principle, who can be logically consistent with the theory that they accept to be true. 

In the case of medical ethics, we should also "bite the bullet". Instead of reasoning from the four principles, we ought to reason from normative theories. The utilitarian should bite the bullet by admitting that we can force treatments onto patients if it maximizes pleasure and minimizes pain. The deontologist should admit that they would not lie to save the Jewish fugitive hiding in their attic, with the Nazis at their doorstep. The virtue ethicist should admit that ethics is self-centered -- wrong actions are only wrong because they negatively affect the agent, rather than affecting the dignity of the victim. 

In closing, it is not the fault of my medical school alone that we teach biomedical ethics according to the four principles. It is healthcare's fault for viewing this inadequate theory as acceptable. I think we should move back towards normative ethics -- and then, we can stand on our beliefs not as a mere framework but as a complete, full theory of moral obligation.