J Med Ethics 32:200-204 doi:10.1136/jme.2005.012591
  • Global medical ethics

In defence of moral imperialism: four equal and universal prima facie principles

  1. A Dawson,
  2. E Garrard
  1. Centre for Professional Ethics, Keele Hall, Keele University, Staffordshire, UK
  1. Correspondence to:
 Dr Angus Dawson
 Centre for Professional Ethics, Keele Hall, Keele University, Staffordshire, ST5 5BG, UK; a.j.dawson{at}
  • Received 25 April 2005
  • Accepted 12 July 2005


Raanan Gillon is a noted defender of the four principles approach to healthcare ethics. His general position has always been that these principles are to be considered to be both universal and prima facie in nature. In recent work, however, he has made two claims that seem to present difficulties for this view. His first claim is that one of these four principles, respect for autonomy, has a special position in relation to the others: he holds that it is first among equals. We argue that this claim makes little sense if the principles are to retain their prima facie nature. His second claim is that cultural variation can play an independent normative role in the construction of our moral judgments. This, he argues, enables us to occupy a middle ground between what he sees as the twin pitfalls of moral relativism and (what he calls) moral imperialism. We argue that there is no such middle ground, and while Gillon ultimately seems committed to relativism, it is some form of moral imperialism (in the form of moral objectivism) that will provide the only satisfactory construal of the four principles as prima facie universal moral principles.