Since these assumptions favored the traditionally privileged classes over those less privileged, such as women, minorities and third world citizens, postmodernism’s exposure of previously uncritically held assumptions is often applauded by intellectuals. Foucault, Derrida, Lyotard and other Continental philosophers deconstructed well-accepted modern texts to unearth hidden power-laden cultural assumptions ( 4). With devastating effects, postmodernism targeted a previously held confidence in human progress through science dubbed modernism ( 3). The Postmodern Reaction: Relativism, Neopragmatism and Antifoundationism Before exploring their means of escape and its consequences, let me look at the relativists themselves, specifically, at Richard Rorty, father of neopragmatism, perhaps the least strident, most eloquent and convincing form of postmodern-though Rorty denies that categorization-antifoundationalism. They seek, if you will, an escape from relativism, but in a world where relativism seems to hold the philosophical trump cards.
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I think Beauchamp and Childress chart their particular course, built largely but far from exclusively on “mid-level”, some might consider free floating, principles precisely to escape from having a “thin” as opposed to a “thick” moral philosophy. Relativists have so effectively undermined the foundations of normative values that one philosopher said he could propose only a “thin” foundation for human morality, one that has few if any real applications, in contradistinction to a “thick” foundation that could actually guide doctors in rationing of scarce resources, addressing inequalities in access to care, use of human stem cells for research, assisted death and suicide, and similar real-life issues ( 2). I am referring to postmodern relativism, a philosophy that seems capable of undermining any meaningful basis for belief, yet incapable in moral philosophy of providing a workable substitute.
One might ask, then, what is the basis for using four principles to guide ethical decisions? Perhaps the two authors are seeking to escape what is, I think, the bane of useful decision-making in fields like medicine, fields that require real decisions affecting the lives of real people. Beauchamp and Childress refer to mid-level principles.
This is not at all the underlying method of the purveyors of “principlism,” however. Physicians who invoke the four principles presume that theirs is a deontological approach grounded in universal values. Such has been the case since Beauchamp and Childress published the first edition of their classic text, Principles of Biomedical Ethics, in 1979 ( 1). Compassion, caring, and respect for human dignity are needed as guides in addition to justice, beneficence, nonmaleficence and respect for autonomy.īeneficence, nonmaleficence, justice and respect for autonomy, these four principles are widely accepted by the medical community to underlie medical ethics. The foundation of medical ethics should be that doctors altruistically respond to their patients’ suffering using scientifically acceptable modalities. Patients experience real suffering and seek effective cures, treatments, palliation and solace.
Real doctors adopt a scientific paradigm that assumes an objective reality. The flaw in their approach is failure to conform to real doctors’ and patients’ experiences. Alternatively, principlism’s architects, Beauchamp and Childress, suggest a constantly evolving reflective equilibrium with some basis in common morality as a workable framework for twenty-first century bioethics. Even America’s foremost public philosopher, Richard Rorty, whose pragmatism might suggest a philosophy of commonsense, seems to be swimming in the postmodern swamp. This absence of foundations reflects the general intellectual climate of postmodern relativism. Principlism, the predominate approach to bioethics, has no foundational principles.
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