Principles of Biomedical Ethics by Tom J. Beauchamp and James F. Childress, and: The Concise Dictionary of Christian Ethics ed. by Bernard Stoeckle (review)

BOOK REVIEWS S~l By showing us where we have been, Halsey helps us to raise the question : What next? He has done a good piece of work. In such work, even its faults stimulate. The book would serve very well for assignment in courses on American Catholicism in this century, were it available in paper. American Enterprise Institute for Public Policy Research Washington, D.C. MICHAEL NOVAK Principles of Biomedical Ethics. By ToM J. BEAUCHAMP and JAMES F. CHILDRESS. New York; Oxford: Oxford University Press, 1979. Pp. 314. The Concise Dictionary of Christian Ethics. Edited by BERNARD STOECKLE. New York: The Seabury Press, 1979. Pp. ~85. Principles of Biomedical Ethics is a co-authored book so well integrated that one cannot detect the separate contributions. Perhaps a Formgeschichte expert might unravel the threads. Beauchamp and Childress are frequent fare in the Hastings Institute and Kennedy Institute publications. This latter-day review (August, 1980) still finds the work of current interest and value for those who are engaged in the study and in the daily ambiguity of the ethics of medicine and health care. The opening sentence of the preface (ascribed to both authors) sets the purpose and parameters of the work: " This book offers a systematic analysis of the moral principles that should apply to biomedicine." Too many books in this over-blooming field concentrate on a biomedical ethical casuistry. It is the lack of this book's proposed systematic analysis that may even contribute to the burgeoning burden of books whose thrust is to draw individualized solutions or decisions flowing from the situationally oriented cases that are studied. The penchant for proposing particularities may well be because this is the market for a clientele whose education is based on the problem oriented approach to patient care. There are eight chapters, two appendices, and a reasonably detailed index in this well conceived and executed work. Its individual contribution is primarily in chapters three through six where the authors deal with their assessment of the significant principles of biomedical ethics: the principles of autonomy, non-maleficence, beneficence and justice. Appropriately this is preceded by a discussion of morality and ethical theory and is followed by a specific application of the last principle, that of justice in its commutative form, to the area of the patient-physician relationship. BOOK REVIEWS Biomedical ethics is not a unique speciality. It is ethics applied to the biomedical field with perhaps some special problems consequent upon the ever expanding technology that affects and afflicts this area, that is, moral reasoning applied to specialized moral dilemmas, a reasoning subject to the usual procedures of " doing ethics". Beauchamp and Childress prescribe a descending order from theories, to principles, to rules, to judgments and specific actions. Ethical theories should stand the test of internal consistency and coherence, of comprehensive completeness. There ought to be no more principles or rules than are necessary, and yet the system must be complex enough to account for the whole range of moral experiences. And it must account for what we really do. Moral guides need to be final or overriding, universalizable and socially oriented. Beyond this could come " why ought an ought to ought " or metaethics. Beauchamp and Childress did not intend to and do not enter that preserve. Utilitarian and deontological theories are taken apart and reassembled. The basic contrast presented is between " rule utilitarianism" and " rule deontologism ". Act utilitarianism and act deontologism are dismissed along with a rejection of the outright situational ethics of a Joseph Fletcher. If one ignores the " straw men " a good case can be made for either system with Beauchamp (?) or Childress(?) somewhat favoring act deontologism. As in theological dogmas, so in ethical principles there are hierarchy and interdependence. For our authors and for very many others this basic principle is autonomy. The very basis of morality is autonomy, here defined : "Autonomy is a form of personal liberty of action where the individual determines his or her own course of action in accordance with a plan chosen by himself or herself". Autonomy is not antinomian. It can coexist with authority and the authority of moral traditions. " The legitimacy of any command is regarded as contingent upon...