Beauchamp T L, Childress J F. Oxford University Press, 2001, £19.95, pp 454. ISBN 0-19-514332-9

The Principles of Biomedical Ethics by Beauchamp and Childress is a classic in the field of medical ethics. The first edition was published in 1979 and “unleashed” the four principles of respect for autonomy, non-maleficence, beneficence, and justice on the newly emerging field. These principles were argued to be mid-level principles mediating between high-level moral theory and low-level common morality, and they immediately became very popular in writings about medical ethics. Over the years Beauchamp and Childress have developed this approach and vigorously defended it against the various criticisms that have been raised.

The 5th edition of this book is, as all the previous editions, well written and for the most part very persuasively argued. In some places the authors’ intention of being comprehensive does, however, create problems. There are, for instance, places where opposing views are mentioned merely in order to be summarily dismissed as “morally perilous” without further argument.

What is new in the 5th edition? The main theoretical novelty is that the authors now clearly state what they mean by “common morality” and that this definition has changed from previous editions where the common morality was viewed as a set of socially sanctioned norms. The common morality is now defined as “ . . . the set of norms that all morally serious persons share” (3) and it is linked explicitly to human rights discourse. This is a major new theoretical commitment on the part of Beauchamp and Childress and saddles them with the problem of showing that there really are any norms that “all morally serious persons share”. We may agree that there are norms that all morally serious persons ought to share on serious reflection and after exposure to a wide range of views and arguments, but there is quite some distance between this view and the view that Beauchamp and Childress seem to advocate. In order to get a common morality that has some content they are arguably compelled to define “morally serious person” in terms of holding norms that are to some degree congruent with “common morality”, thereby introducing a problematic circularity in their analysis of common morality.

The structure of the book has also been changed. The chapters on moral theory and moral justification are now the last chapters and have swapped places with the chapters on moral norms and moral character. This is presumably to make the book more accessible to health care professionals.

The whole book has been comprehensively rewritten, but the core arguments in the four chapters explicating the four principles are still the same. This also means that the restrictive limits in the scope of the principles of beneficence and justice are still open to the same criticisms that were levelled against the previous editions of the book.

For the person who already has the 4th edition on the bookshelf, and who is not actively using the book for teaching or study there is thus little reason to buy the 5th edition although it is very modestly priced. The underlying arguments have changed to some extent, but the conclusions are pretty much the same.