Tom Walker has launched a double attack on the Four Principles approach to biomedical ethics (henceforth “principlism”).1 He questions both the descriptive comprehensiveness of principlism (ie, the framework needs more principles to capture what morally serious people are, as a matter of empirical fact, committed to) and its normative comprehensiveness (ie, without additional principles, the framework offers only a normatively partial account of morality). Is this a devastating blow for principlism?

Beauchamp and Childress define common morality as “the set of norms shared by all persons committed to morality” (p3).2 The “all” denotes the universal scope of the claim, so whether in China, Sweden or Papua New Guinea, the common morality forms the core of people’s moral belief systems. In the 6th edition of their Principles of biomedical ethics, in which Beauchamp and Childress present an expanded account of common morality, they list shared features of common-morality theories, namely their reliance on “ordinary, shared moral beliefs” as their foundation, their suspicion of any ethical theories that clash with these basic moral beliefs and their reliance on several normative principles rather than one. Different common-morality theories might have varying numbers of principles; thus WD Ross, whose intuitionist theory influenced the development of principlism, had eight prima facie duties, and Bernard Gert’s more recent common morality theory has 10 general moral rules.3 4

As a common-morality theory, principlism is sparse, proposing only four overarching principles: respect for autonomy, beneficence, non-maleficence and justice. Acknowledging the indeterminacy of the principles, Beauchamp and Childress add that the action-guiding content in specific situations is derived from the twin methods of specification (which involves the creation of more specific, context-sensitive norms) and balancing (which involves determining which moral norms or values should dominate in a particular situation), and that these are regulated by …