Jeffrey Blustein

As medical technology becomes more sophisticate the ability to manipulate nature and manage disease forces the dilemma of when can becomes ought. Indeed, most bioethical discourse is framed in terms of balancing the values and interests and the benefits and burdens that inform principled decisions about how, when, and whether interventions should occur. Yet, despite advances in science and technology, one caregiver mandate remains as constant and compelling as it was for the earliest shaman—the relief of pain. Even when cure is impossible, the physician's duty of care includes palliation. Moreover, the centrality of this obligation is both unquestioned and universal, transcending time and cultural boundaries.Although universally acknowledged, pain is a complex phenomenon for both the patient and the caregiver, influenced as much by personal values and cultural traditions as by physiological injury and disease.

This paper is a response to particularist critics of the normative force of moral principles. The particularist critique, as I understand it, is a rejection not only of principle‐based accounts of moral deliberation and justification, but also of accounts of character in which principles play a central role. I focus on the latter challenge and counter it with a view I call character‐principlism. I begin by discussing in a general way what motivates the particularity objection to principles and then contrast two views – both of which insist on the importance of attentiveness to particularity – about the relative normative status of principles and particular cases. I present some reasons for believing that we need a more normatively robust conception of the role of moral principles than the particularists provide. In the main portion of the paper, I discuss how character‐principlism sees principles functioning in our lives and the lives we lead with others. I contrast this with some other accounts of desirable character that particularists can embrace, and argue that these are seriously flawed because, unlike character‐principlism, they cannot satisfactorily explain how a person could possess the constancy of character that moral integrity requires.