Tom Beauchamp

This autobiographical sketch is being published 50 years after I started as an assistant professor at Georgetown University in 1970. In this presentation, I cannot tell the full story of these 50 years. I write only about the formative years both before and after I was hired at Georgetown, and I emphasize two subjects. The first is the importance of the individuals who were massive influences on my intellectual development and aspirations. The second is the great importance of multidisciplinary work. I came from philosophy, a discipline that generally did not emphasize or particularly value multidisciplinary work, but I was transformed by individuals in other disciplines who directed me to this style of work. Almost sheer luck brought each of these influences into my life.

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement with our commentators and respond to their critical evaluations.

This volume presents a framework of general principles for animal research ethics together with an analysis of the principles' meaning and moral requirements. Tom L. Beauchamp and David DeGrazia's comprehensive framework addresses ethical requirements pertaining to societal benefit and features a thorough, ethically defensible program of animal welfare. The book also features commentaries on the framework of principles by eminent figures in animal research ethics from an array of relevant disciplines: veterinary medicine, biomedical research, biology, zoology, comparative psychology, primatology, law, and bioethics.

Two positions that Rosamund Rhodes puts forward are the proper starting point for this commentary: 1. Medical ethics based on the common morality that uses a body of abstract principles or rules are not ‘an adequate and appropriate guide for physicians’ actions’. 2. We need, but do not have, a true professional medical ethics for physicians, which must be ‘distinctly different’ from ethics based on common morality. I will argue that both positions are mistaken. Rhodes does not analyse what she means by a professional ‘medical ethics’ and does not supply content for what she calls ‘medical professionalism’. ‘Common morality‘ is also not given a precise meaning. However, I set aside these problems of conceptual clarity and concentrate on a paradigm case of professional ethics for physicians (and others) in interactions with patients. My example is The Belmont Report. Belmont is almost certainly a document that, in the USA, has for four decades been highly influential on physicians, especially physicians engaged in clinical research. It is not merely research ethics. In full satisfaction of the American Board of Medical Specialties’ ‘definition of medical professionalism’, The Belmont Report puts forward a system of ethical principles showing that physicians and other health professionals must conduct research in the service of the public interest and the well-being of patient–subjects. The Belmont Report also satisfies the earlier delineated conditions of medical professionalism in the American Board of Internal Medicine’s ‘Physician Charter’, which are stated in terms of the ‘fundamental principles’ of the primacy of patient welfare, patient autonomy and social justice.1,1–3 Belmont more than satisfies these conditions of medical professionalism. Indeed Belmont may well be the source of the principles …

The four principles of biomedical ethics are widely used in the world for bioethical deliberation. These theoretical guides are useful for the analysis and resolution of particularly complex ethical controversies arising in clinical and biomedical fields. This chapter develops an analysis of the basic universal principles, the common universal morality, and some characteristics of each principle. Then it discusses some problems posed by critics who have provided alternative frameworks of principles that are nonuniversal. Finally, it shows how universal moral principles are connected to human rights, how rules and rights are specified to become detailed and practical for certain moralities, and how these ideas are connected with problems of justification in bioethics and biolaw.

Book reviewed in this article: Ethical Issues in Social Research. Edited by Tom L. Beauchamp, Ruth R. Faden, R. Jay Wallace, Jr., and LeRoy Walters. Baltimore: The Johns Hopkins University Press, 1982. xii + 436 pp. $25.00 (hardcover); $8.95 (paper). Ethics of Human Subject Research. Edited by Allan J. Kimmel, Jr. San Francisco: Jossey‐Bass, 1981. 106 pp. $6.95 (paper). Social Research Ethics. Edited by Martin Bulmer. New York: Holmes & Meier, 1982. xiv + 284 pp. $39.50 (hardcover); $14.50 (paper). The Ethics of Social Research: Field‐work, Regulation and Publication. Edited by Joan E. Sieber. New York: Springer‐Verlag, 1982. x + 187 pp. $23.50 (hardcover). The Ethics of Social Research: Surveys and Experiments. Edited by Joan E. Sieber. New York: Springer‐Verlag, 1982. xii + 249 pp. $23.50 (hardcover).

Chris Durante’s comments on my article about the compatibility of universal morality, particular moralities and multiculturalism indicate that we have very different approaches to and understandings of these three notions. Durante investigates multiculturalism from the perspective of political philosophy, whereas my approach is grounded in moral rather than political philosophy. Since he refers to his framework as an ‘ethico-political theory’, he may regard his account as a synthesis of moral and political philosophy, but this representation seems incorrect. He repeatedly refers to his discussions of multiculturalism using the language of ‘political ethics’, ‘political theory’, ‘political philosophy’, ‘political system’, ‘political ramifications’, ‘political order’, ‘political liberalism’, ‘political community’, ‘political society’, ‘political principles’ and related concepts. He bluntly states his view about the centrality of political theory: ‘Multiculturalism…is primarily concerned with establishing a political system with moral undertones rather than a moral system with political ramifications’. I take the reverse view. Durante assumes without argument that multiculturalism finds its origins and home in political philosophy; by contrast, I envision multiculturalism as primarily a moral theory about obligations to tolerate moral differences in the face of conflicts between cultural groups. I do not deny that political philosophy is relevant to the resolution of various problems of multicultural …

Business ethics raises many important philosophical issues. A first set of issues concerns the methodology of business ethics. What is the role of ethical theory in business ethics? To what extent, if at all, can thinking in business ethics be enhanced by philosophy, so as to provide real moral guidance? Another set of issues involves questions regarding markets, capitalism, and economic justice. There are related concerns about the nature of business organizations and the responsibilities they have to their members, owners, and society.The Oxford Handbook of Business Ethics is a comprehensive treatment of the field of business ethics as seen from a philosophical approach. The volume consists of 24 essays that survey the field of business ethics in a broad and accessible manner, covering all major topics about the relationship between ethical theory and business ethics. The chapters are written by accomplished philosophers who offer a systematic interpretation of their topics and discuss various moral controversies and dilemmas that plague business relationships and government-business relationships. Readers are thus presented with the major views that define the topic of the essay with critical discussions of those views, as well as topical bibliographies that identify key works in the field. In addition to philosophers who work in this area, the volume will be of interest to those in business and society seeking an up-to-date resource on this vital field. "This book is intended to provide an overview of the state of the field of philosophical business ethics. And Brenkert and Beauchamp are to be commended for having put together a collection of contributors and topics that is well-suited for this goal. The contributors are all first-rate scholars who have made important contributions to business ethics or cognate fields. They are also admirably diverse in age, ideology, and methodological approach, thus providing readers with a good glimpse into the wide range of scholarship that characterizes the field. The book will obviously be of interest to those for whom philosophical business ethics is a main area of interest. But the entries are clear and accessible enough to make the book of special value to at least two other groups: those whose approach to business ethics is not primarily philosophical will find here a useful 'crash course' in an alternative methodological approach to their own subject, and those philosophers who are not primarily interested in business ethics will be treated to a volume that makes clear the connection between business ethics and more standard philosophical subjects, and that will almost certainly provide them with new ways of thinking about both business ethics and other topics in value theory and political philosophy that are connected with business ethics in ways they might not have previously recognized. The selection of topics is also admirably comprehensive." - Notre Dame Philosophical Reviews.

In Unfit for the Future, Ingmar Persson and Julian Savulescu take up intriguing questions about whether human moral capacities should be improved to steer us in paths of improved decision making in confronting global crises. They assess the sufficiency of traditional moral practices and human nature as we confront ever more daunting moral and policy challenges. They start from the position that ‘human beings are not by nature equipped with a moral psychology that empowers them to cope with the moral problems that these new conditions of life create. Nor could the currently favoured political system of liberal democracy overcome these moral deficiencies’ (p. 1).1 The authors defend their starting point by presenting a variety of scenarios and conditions under which humans commonly fail to pursue a morally proper course of action even when aware that it is the proper course. Critical weaknesses include failed political will, biases to the near future, partiality to family and friends, insufficient sympathy, low levels of non-parochial altruism, underdeveloped conceptions of responsibility and a relatively weak sense of justice. The authors assess human nature as so morally deficient that it will be unable to successfully address impending and catastrophic problems at the global level: ‘Human beings now have at their disposal means by which they could undermine the conditions of worthwhile life on Earth forever ’ through their failures to deal with the depletion of essential natural resources, overpopulation, poverty, terrorism, anthropogenic climate change, nuclear weapons and use of biological weapons (p. 1, 2, 5, 37–39, 47–49, 60–63, 66–68, 75, 76, 83, 108, 109, 123, 127, 133, 134).1 This book's most convincing and sobering arguments are in its many passages on the depth and continuously increasing character of these catastrophic problems. It is the most persuasive presentation of the threats these …

In lieu of an abstract, here is a brief excerpt of the content:36. A DISCUSSION ON PERSONAL IDENTITY Jane L. Mclntyre's original paper "Is Hume's Self Consistent?" was presented at the MoGiIl Hume Conference; it will be published in the forthcoming volume devoted to those preceedings. Tom Beauchamp" s paper is presented here as delivered. John Biro's paper has been revised since its original presentation. 37. SELF INCONSISTENCY OR MERE SELF PERPLEXITY? Professor Mclntyre's imaginative and constructive paper has three primary parts (despite its division into six sections). First, she offers an interpretation of Hume's view of the self in Book I of the Treatise. Second, she explains why his own reservations in the Appendix create problems not only for this theory of self identity but for other parts of his philosophy as well. Finally, she tries to ease him out of these difficulties with her overlap interpretation of the bundle theory. My comments follow exactly this outline, though my conclusions, for the most part, do not coincide with hers. My reservations do not derive from her attempt to render Hume consistent. Rather, I question the foundations of the entire enterprise in which she, Robison, Nathanson, et. al. are engaged. That is, I remain unconvinced that the alleged problem, as presently framed, is more than a pseudo-problem. I. Hume's Theory in Book I In Book I Hume offers a variety of arguments about the nature of the self, most of which rely on other theories, such as those of causation, the association of ideas, and substance. Whatever the exact arguments and positions he may be advancing, at least the following six propositions are integral to his theory of personal identity: 1)The self is entirely reducible to a collection of perceptions. 2)The self is not characterized by strict identity. 3)There is nothing simple in which the collection of perceptions inheres. 4)Both identity and simplicity are attributed to the self because of relations between perceptions--the relations of causation and resemblance. 5)The relations of resemblance and causation unite these perceptions. 38. 6) There are no real (non-associational) connections or relations among these perceptions which unite them. Half of these six claims are critical denials of other philosophical claims; the other half are constructive philosophical theories. Hume's entire philosophical program in Book I is tied up with these claims. The criticisms are directed at numerous metaphysical theories of mind, substance and causation; and the constructive account of personai identity requires his theories of perception and association of ideas. I mention these obvious points only because it is so important to note that if_ the interpretation is correct which Professor Mclntyre and others give to (roughly) five sentences in the Appendix, where Hume mentions a possible inconsistency, then Hume is not only questioning his theory of personal identity in Book I, he is calling Book I itself into question. To be convinced that this strikingly implausible turnabout occurs in five sentences of the Appendix, we must be given a most compelling argument—one which I doubt is forthcoming. II. Hume's Alleged Inconsistency The alleged problem of inconsistency arises because Hume says in the Appendix that he does not know how to render his own former opinions consistent (T633, 636). However, when he comes to a formal statement of the inconsistency, as everyone is agreed, the propositions said to be inconsistent are not inconsistent. In the attempt to grasp Hume's meaning, a general consensus has emerged in recent Hume scholarship, including Professor Mclntyre in its company, that we ought both to move backward and forward a sentence or two in Hume's text. Hume says in those passages that his hopes for his theory are diminished because he is unable to explain the principles, that unite our successive perceptions in our thought or consciousness (T636) ; and he then indicates that i_f perceptions could be shown to inhere in something simple or to be really connected, these prob- 39. lems would vanish. It is this textual setting which Robison, Nathanson, and Professor Mclntyre turn into the claim that "the concept of a self which is affected by experience, and therefore must persist through experience— is precisely the concept of the self that...

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting...

In recent years, the right of employees to know about health hazards in the workplace has emerged as a major issue in occupational health policy. A general consensus has gradually evolved that there is a right to know, and correlatively that there is a moral obligation to disclose relevant information to workers. For example, the National Institute for Occupational Safety and Health, and several other U.S. federal agencies, informed the U.S. Senate as early as July 1977 that ‘workers have the right to know whether or not they are exposed to hazardous chemical and physical agents regulated by the Federal Government.’ In 1980, the Occupational Safety and Health Adminstration promulgated regulations guaranteeing workers access to medical and exposure records.

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics.

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, these approaches are consistent with and should not be considered adversaries of a principle-based account.