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The key principles of principalism are; respect for persons; respect for self-determination; non-maleficience; do no harm; beneficence; promotion of justice; the fair and equitable determination of what is owed to a person including distribution of resources and fair treatment for individuals and society. The most significant area that principalism is applied is in the medical arena, especially in respect to bioethics.
It has its basis in the Catholic Church, but also has a
utilitarian approach where the greater society needs to benefit. Yet
this needs to be balanced against the rights of the individual. The
approach of the Catholic Medical Ethics uses these factors and creates
a method where there are protections determined by the Church, which
allows for a balanced approach with individual rights:
The theologians Charles Curran and Richard McCormick are
examples. In their medical ethical writings "conscience" trumped the
Magisterium, principally in the areas of sexual ethics. This is a red
herring because conscience, rightly formed, corresponds to truth and is
not autonomous or "self actualizing" as implied by Karl Rahner and
Henri de Lubac, heroes of the progressives. The ethic of
proportionalism, developed in part by Josef Fuchs and Louis Janssens,
suggested that a proportionately greater good, say a potential career,
might justify an abortion in an unwanted pregnancy, and could therefore
change the morality of an act. This theory is fundamental utilitarian
and is therefore incomparable with exceptionless norms such as abortion
and euthanasia.
Guinan then introduces principalism, which was set up to allow states
to oversee medical standards and to protect the welfare of society; as
well as balancing it with the individual. As the following excerpt will
illustrate the basic premise of principalism is the same as Catholic
Medical Ethics. It must be noted that principalism can be used in a
variety of arenas, e.g. law, politics, the workplace and the
environment; however there is a large body of research on principalism
and bioethics so this discussion will focus on this specific case
study. Guinan illustrates that the basic utilitarian and justice
principles that govern Catholic ethics governs principalism:
Bioethics arose in the past 30 years, in part, because of the need of
third parties, usually the federal [state] government, for oversight in
healthcare matters and the public’s need for the appearance of ethical
control. The predominant methodology of bioethics is "principalism".
Principalism is the regnant medical ethical system in the United States
today. It is essentially a system made up of mid level principles such
as beneficence, nonmalfiance and autonomy, which are conducive to
conflict resolution. The moral implications of principalism are neutral
although it can be, and usually is, employed in justifying a
proportionalist or utilitarian outcome.
The key similarity is the utilitarian approach, with a focus on
justice. Therefore the following section will discuss utilitarianism
and then illustrate how this benefits the welfare of society versus the
individual. The discussion will then turn to consider the human genome
and modern genetics and apply principalism to the problem, illustrating
principalism’s strength and weaknesses as a moral and ethical theory.
Utilitarianism and Principalism:
Traditional utilitarianism is not a theory of individual rights,
instead it views that the good of the community was a more important
aim for the law and government ruled by the people. Theorists such as
Edmund Burke believed that rights were natural, including life,
liberty and freedom but this theory was in the abstract, therefore they
should be given by society for the good of its people, because these
rights cannot be universal otherwise there is no place for cultural
diversity. Burke is one of the first theorists with the cultural
relativism argument ; the critics of universal human rights have
further advanced this in the 20th and 21st centuries. Burke’s move to
reject universalism was the first chip in these inherent rights ; how
can rights be inherent if they not available for everyone, because a
culture denies them. Jeremy Bentham advanced this. His theory held
that were no natural rights – the government for the good of society –
a form of utilitarianism, afforded rights . Therefore Bentham’s rights
were legal rights where one can do whatever one wants as long as the
law does not prohibit it i.e., rights are not stemming from the
individual but the states and the powers of governance (Positivism).
The problem with positivism or this early form of rights from utility
is that the law/governance are the basis of rights and because there is
no greater principle of human rights if the government decided no
longer to further human rights then there would be no logical reason to
condemn the change. Also this theory deals with citizens of a state
and rights and welfare of this particular class of people and there
seems to be no valid reason to deter society from ensuring that
everyone is healthy by the way of eugenics and abortion therefore
making it very hard to reconcile this theory as an aid to ensure that
the human genome project is not used for extreme eugenics. In the hands
of a Catholic Ethical Regime it would mean that a woman would not have
the right over her body and subject to the so called welfare of society
to preserve life. Therefore if principalism follows traditional
utilitarian approach, what is in the general welfare of society is
determined not by what is just, but by what the state, medical
establishment or state considers just. Therefore one has to consider
the modern approach of utilitarianism, which gives more powerful rights
to the individual over their body and self respect.
Modern utilitarian theorists have extended the theory of Bentham, but
have put it in more modern terms. Instead of maximising the pleasures
and desires of the individual the government would be maximising the
general welfare of individuals therefore minimising frustration of
wants and preferences . Therefore what one can see is that the
governing bodies must put the general welfare first, yet minimise the
individual’s needs – therefore causing a conflict of rights between
what is in the name of the society and what the individual wants. The
problems with this theory is it is socially constructed, there is no
autonomy of being and no argument for universal rights that transcend
all cultures and religions, therefore falling short of what is needed
for an all-encompassing human rights theory, as the general welfare can
be different for differing cultures. In this argument the foetus or
the defective or diseased individual may not be provided for because
the general welfare of the state and the good of the people may be
contrary to the life and future of this defective individual. Yet there
is more to principalism, which is based on justice, fairness and
restorative justice therefore it seems to be closer to the utilitarian
approach of Rawls. Rawls’ theory is based on providing justice to all
individuals, whilst protecting the interests and general welfare of the
society.
Rawl’s in his thesis for engendering human rights states that
justice is the prime basis of all government and to ensure justice
human rights are the obvious means and end to ensure justice is
fulfilled. Rawl’s theory is based on a few key ideas, which are the
rights and duties of government/institution of society and the burdens
and benefits of citizens co-operating. Rawls bases his theory that each
individual has an inherent and inviolable being set in justice – this
being cannot be overridden for the welfare of the society. This theory
does not fall foul to the arguments against modern utilitarianism.
Rawl’s does use the social contract fiction of Hobbes and Locke,
however the basis of moving from ignorance (state of nature) is reason
and this reason set up on principles of justice that his social
contract is based upon. These principles are; 1) that each person has
basic rights and liberties in accordance with freedom; and 2) there is
distributive justice, where inequalities are restrained by the greatest
benefit of least advantaged and each person has the condition of fair
equality of opportunity. These principles cannot be derogated for the
public good and liberty is the supreme principle. .
Rawl’s theory is very important when looking at human rights theories
because it begins to tackle the universality of human rights based on
justice, as well as the inequalities apparent in society. The theory
does have flaws but it one of the more comprehensive theories setting
up basis rights and freedoms. Unfortunately, again this theory is
based on a social contact fiction and blurs the edges of reality.
Rawl’s theory may fail when it comes to non-citizens, because they have
not contracted with the state to uphold their rights. Yet Rawls would
probably argue that his theory is based on justice and the social
contract is based upon a very theoretical plane, where justice prevails
and in favour of justice these rights would be afforded to all citizens
and all future persons/foetus’ by the government or it would not be
just and equal; as a government based on justice would be. This is
probably the most pertinent form of utilitarianism in the principalist
train of thought because it balances the general welfare of the society
with the rights of the individual. It also is based on the notion of
justice and as the basic precepts of principalism focused on were the
rights of the individual, society and the rules of fairness and
justice. Therefore when considering the philosophical role of
principalism in medical ethics the Rawlsian version of utilitarianism
needs to be considered as the ethical and moral basis of principalism.
It also has to be considered that a key factor of both Rawlsian
utilitarianism and principalism is that the rule of law is supreme as
long as it follows the rules of natural justice. In addition it argues
that there is a form of universal ethics in much the same manner that
the Catholic Church’s approach argued. Yet in the modern era of
bioethics it is being argued that this universalism does not work
because the balancing of justice, individualism and the greater benefit
of the society cannot be reconciled. This is an interesting critique
because it fails to consider the justification of human rights, where
these principles are reconciled through modern utilitarian approaches
such as Rawls. Therefore indicating a short-sightedness concerning
principalism in the present arena of bioethics, which may be due to the
connections between principalism and Christian Bioethics and fears that
the state and medicine needs to be secular. This went against the
reasoning of this form of bioethics, which was meant to be secular in
line with the congressional mandate in 1978:
Modern bioethics was confected by congressional mandate in 1978 in the
U.S., when a commission produced the Belmont Report. This report
identified three ethical principles: respect for persons (now referred
to as 'autonomy'), justice (now referred to as 'fairness'), and
beneficence. The Belmont ethics was known as 'principalism', and was a
totally new way for defining right and wrong. It is still used
extensively in the official journals and other publications of the
medical and surgical professions. Its principles also pervaded
business, engineering, the legal profession, and the media. However, it
gradually broke down, and it is now admitted that principalism did not
work because there was no way simultaneously to reconcile the values of
all three principles. As a result, Belmont ethics has become obsolete
and is being replaced by pragmatic ethics.
This argument that principalism is now obsolete is frightening, because
it seems to be arguing that universalism is obsolete. This creates
problems for human rights theorists arguing for fair and just
governance, which balances the right of the individual with the general
welfare of society. The following discussion will consider pragmatism
and its cultural relavitist approach and argue that it is not the best
approach, because it fails to understand that bioethics has much
influence on human rights and governance theory in general. This
influence is even more pertinent because of the human genome project,
which is high profile and publically linked to human rights and
governance issues.
Pragmatic Ethics & Cutltural Relavitism:
Pragmatic bioethics is predominantly an American affair. In essence, it
holds that in order to solve moral problems, one must ascertain the
outcome most desirable to the parties involved and also construct a
means for its realization. It puts great emphasis on the duty of
influencing the community in order to solve social problems. At the
same time it stresses the contention that there are no absolute fixed
moral norms and that one should follow no principle or philosophy,
natural law, or God's law. Instead, one is counseled to use these
resources as tools to achieve a "reflective equilibrium," resulting in
a balance of moral theories, principles, and intuitions, in order to
produce a consensus about the best outcomes.
This approach is a response to princpalism and its basis in Catholic
bioethicss, but as mentioned earlier there are problems with this
response because it is denying fundamantal human rights of individuals.
This approach is primarily a cultural relavatist approach as will be
seen in the following discussion.
The arguments from cultural relativists are the main set of criticisms
of universal human rights. The first and most basic of rights – freedom
and autonomy in a secular state – is criticized as very Eurocentric and
fails to allow for cultural differences. The main part of universal
human rights theory is based upon morality and the cultural relativist
would argue that morality is subject to the culture, history and
religious founding of each society. Therefore ‘there are no human
rights absolutes, that the principles which we may use for judging
behaviour are relative to the society in which we are raised, that
there is infinite cultural variability and that all cultures are
morally equal or valid’. This argument undermines the basis of all
human rights theory because they all stem from the basis that there is
a universal morality. Also it would view non-citizens as an area that
each culture would deal with its own cultural norms. The main argument
against universality in the 20th and 21st Centuries comes from the
resistance to Western Economic Imperialism. Shestack illustrates
Claude Levi-Strauss argument in the following manner – all cultures and
their differences need to be respected as equally moral to that of the
West and that the Universality angle is just another attempt of the
West imposing its morality on other cultures, which he believed must be
stopped as other cultures should be allowed to develop and evolve
naturally. Most would agree that the West should not impose its views,
governance and culture upon other cultures. Human rights theorists are
arguing that morality is outside and transcends these human
constructions and is common to all persons, and not part of the
development of a society, as cultural relativists would argue. Is it
fair that in the name of cultural identity that repression should be
allowed causing ‘an obligatory homogeneity and diminishing the place of
the individual in the calculus of identity politics’? The most
common answer would be no, no-one is saying that cultural identity
should be obliterated instead that it is not part of the transcendental
nature of the morality of basic human rights and freedoms. These
rights and freedoms are not there to suppress culture but should be the
logical ends for a culture to aspire to. As Shestack argues that
gross human rights violations are not affirmed in any valid culture and
in fact the religions and culture basis itself on acting for the good
of its people and ‘most confirmed relativist scholars are repulsed at
practises which are highly coercive and abusive and accept that at
least some human rights values are absolute’. This does affect the
problem of non-citizens, as it would mean these human rights are
absolute and cannot be disregarded just on the basis of citizenship.
Therefore the cultural relativist argument does not sufficiently argue
against fundamental freedoms and rights, and in the end provides an
argument for fundamental human rights. Also it provides no basis but
cultural norms to create law from and the reality is that the cultural
norm is defined by the oligarchy; whereby this oligarchy is the
government and determined by the primary political powers in the state.
As the following discussion of bioethics this will cause problems,
especially in reference to abortion law in the US which would deny the
right for the women to choose just because a powerful political lobby
would deny this fundamental right. It is true that if principalism was
based on Catholic principles the outcome could be the same; however in
the modern approach to human rights and religious belief abortion is
allowable because the woman is a human, whilst a foetus is arguably not
human until birth. Another key factor to remember is that even though
principalism mirrors Catholic Bioethics, in its basic belief of
universal models of justice and human rights, it has a secular approach
so the concerns of Christian morality are not a factor.
Human Genome Project, Abortion Law, Bioethics and Principalism:
The debates legally and ethically surrounding cloning are on the
cutting edge of human rights law; however how can the law deal with
something as controversial as cloning if the laws surrounding abortion
is still contested by states . This discussion is going to consider the
implications of allowing therapeutic cloning on legal, moral and
ethical basis focusing on principalism and pragmatism by their
considering the approach taken in the precedental cases of Roe v Wade
and Vo v France . Habermas focuses on the main problem with the human
cloning and the possibility of eugenics being instituted, which is that
there is no longer individuality and freedom of the person is no longer
apparent. In addition there is a possibility that a super race will be
created and be the elite of society and those who do not fall into that
category is a lesser person, without the same rights and freedoms of
the elite. This will create at the best a class system and at the worst
a system of slavery, i.e. those who do not fall into the elite sectors
are owned by the elite to keep or dispose as of when wished. Therefore
causing a irreparable breach of human rights theory where each
individual is equal and has inherent rights and freedoms, which is part
of the essence of the individual or afforded to the individual by the
government because in order to fulfil a just and fair society. This
will cause an unjust and unfair society. Also one has to consider if it
is in line with human rights to terminate or alter the natural life of
a future individual in respect to a supposed better life, as dictated
by the scientific community. It is this route which may lead to
determining life on racial background or perhaps hair colour because
these characteristics are not the best possible human specimen; which
could lead to extreme eugenics as with the Nazis and mass
sterilizations. In short the possible abuses of human rights are down
to what humanity does with the power of therapeutic cloning, because if
the state allows this aspect in manipulating the genes will it results
in extreme eugenics and the creation of the super race? Principalism
with it universal system of rights and rules of natural justice would
not allow such abuses of human rights, therefore providing a system of
bioethics that would ensure that the general welfare of society and the
individual is protected. This means that the state cannot determine
what it considers is the best approach, which the pragmatist approach
would allow; the approach is subject to a universal set of rules of
which do no harm is the primary rule. Principalism also can determine,
on a universal set of rights and laws, between a human/citizen and the
protection of a non-human; rather than leaving the determination to the
moral beliefs of the government. This is very important because the
government can determine that eugenics is right because the disabled
are not human or abortion is wrong because women are not equal
citizens. Pragmatism allows society to determine the moral compass
because the elite determine what is right and not a universal set of
laws:
Pragmatists are willing, using the influence of the elites in society,
and using the power of the judiciary, where necessary, to compel others
to do their will in many matters which are morally disputed. As a
justification of this 'will to power' it necessarily follows that they
must be assumed to act on the basis of a knowledge of the truth about
the good (or at least of how to arrive at that truth) with a certainty
that others either deny or do not possess. This is ironic, since one of
the fundamental tenets of pragmatism is the assertion that objectively
true moral laws do not exist.
The main concern with therapeutic cloning and the law is from a human
rights basis, if the modern pragmatist approach is taken such concerns
are null and void. Therefore a return to the principalist approach is
necessary or bioethics is determined by the moral compass of the elite
and not by a general set of laws based on universal laws of justice. As
Curran argues the pragmatist approach fails the Hippocratic Oath of do
no harm; however the additional problems of Catholic Bioethics to the
rights of women over there body makes secular principalism the best
approach. This is supported by the law of the UN, which support
universal human rights that balances these rights with the general
welfare of the society as the following discussion will illustrate. The
main area of law that discusses these problems is the international
human rights and this centres the problem of the human genome project,
where the advancements in cloning have stemmed from. . The main piece
of International Humanitarian Law that concerns the Human Genome
Project is the Universal Declaration on the Human Genome and Human
Rights (UNHGHR) 1997. In addition at the European level there was the
European Convention for the Protection of Human Rights and the Dignity
of the Human Being with regard to the Application of Biology and
Medicine: Convention on Human Rights and Biomedicine 1997 and the
additional protocol of 1998 with regard t o the application of biology
medicine on the prohibition of cloning human beings. These instruments
“recognize that, in the absence of appropriate standards, human genome
research carries risks and may have a negative impact on both present
and future generations, especially regard to discrimination, health
care, cloning and other experimentation” . In short the method of how
one determines the law has to be balanced in order for the both the
positive and negative aspects of the human genome are properly
considered, i.e. the rights of the individual versus the general
welfare of society.
The Human Genome Project has created much debate in the legal arena,
because it has not been denied that there will be many benefits reaped
from determining the genome, in respect to prolonging life and reducing
the risk or eradicating diseases. On the other hand, it has been
considered whether it can go too far whereby individuality or the right
for risk couples can naturally have families without the intervention
of the state. This will limit the freedoms of the individual, which may
also cause the possibility that the right to family life may be
interfered with by the state; also there could be the additional fear
that the individual’s life may not be increased in value and enjoyment
but actually degrades the individual’s life. This is especially with
regards to designer babies, even if the baby designed is to cure
another child; however not too long ago in vitro fertilization was
condemned, but today it is used as a means to allow those who have
difficulty conceiving a chance to have their own child, or allows for
parts of the human body to be cloned to create a perfect donor organ or
save the life of another child that the family has had. The problems
with such cloning is illustrated in cases such as Roe v Wade where the
state laws of Texas limited abortion to saving life and had no
consideration of the possible harm to the woman’s human rights. In this
case human rights law won and the state laws of Texas where held to be
unconstitutional. The approach taken was a principalist approach;
whereas if the pragmatist approach was taken the determination of the
elite, which opposes abortion in this sate, would have succeeded. Yet
if there are such archaic laws governing the body of the woman, how
will the laws surrounding cloning be limited? In the case of Vo v
France it was held that the protection of the life of the child has to
be sufficient on the grounds of Article 2; therefore this leads to two
competing arguments surrounding therapeutic cloning, i.e. creating a
child to save another child’s life protects this right; however how
about the rights of the cloned child does it get the same protection is
it right to create a child on these grounds. The answer is yes if the
child is wanted and loved, but the rights of the unborn child need to
be considered because the ends do not always outweigh the means
especially when it comes to a new life, i.e. the woman is fully human
so the principalist approach needs to be applied not the morals of the
elite. This mirrors the case of Roe v Wade, which illustrates the life
of the mother is also an important factor, i.e. it is her body and all
must be consulted and respected in reference to her rights and not the
beliefs of the society, i.e. the principalist approach.
Conclusion:
The pragmatist approach is dangerous because the elite determine what
is right, which may allow women’s bodies to be determined not by
natural laws of justice by their moral compass. This can lead to
movements such as the Nazi’s eugenics rather than balancing the rights
of the individual and the general welfare othe society. In fact some
could argue the Christian bioethics is determined by the elite of the
church and denies the rights of the woman over her body. The
principalist approach creates a balance of the general welfare of
society and the individual rights, which is based on human rights and
the laws of natural justice with the primary rule of do no harm. This
is the approach, maybe not in terminology, that modern human rights
theorists are advocating especially the growing importance of Rawlsian
utilitarianism which has married the key concepts of protecting the
general welfare of society with a system of transcendental human rights:
So long as no one is hurt, no one's will is violated, and no one is
excluded or discriminated against, there may be little to worry about.
Fitting well with our society's devotion to health, freedom, and
equality, this outlook governs much of today's public bioethical
discourse.
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Leslie P. Thiele (1999) Environmentalism for a New Millennium: The
Challenge of Co-Evolution, Oxford, Oxford University Press pgs. 30-112
J. Turney (1998) Frankenstein’s Footsteps: Science, Genetics and Popular Culture, New Haven, Yale University Press
University of Dallas Paper, Surveying the Debate of Germline Gene Therapy,
Wheeler, Sondra. Ethical Issues in Germline Genetic Engineering. 20 Nov. 2002
Worldwatch (2004) State of the World 2004: Progress Towards a Sustainable Society, London, Earthscan
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