TY - JOUR T1 - When four principles are too many: bloodgate, integrity and an action-guiding model of ethical decision making in clinical practice JF - Journal of Medical Ethics JO - J Med Ethics SP - 195 LP - 196 DO - 10.1136/medethics-2011-100136 VL - 38 IS - 4 AU - William Muirhead Y1 - 2012/04/01 UR - http://jme.bmj.com/content/38/4/195.abstract N2 - Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ethics. It is argued that principlism is an inappropriate model for clinical ethics as it is neither sufficiently action-guiding nor does it emphasise the professional integrity of the clinician. An alternative model is proposed for decision making in the realm of clinical ethics. ER -