Branch William T
Emory University School of Medicine, 1525 Clifton Road, Atlanta, Georgia 30322, USA.
Trans Am Clin Climatol Assoc. 2006;117:257-71; discussion 271.
Principlism, the predominate approach to bioethics, has no foundational principles. This absence of foundations reflects the general intellectual climate of postmodern relativism. Even America's foremost public philosopher, Richard Rorty, whose pragmatism might suggest a philosophy of commonsense, seems to be swimming in the postmodern swamp. 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. The flaw in their approach is failure to conform to real doctors' and patients' experiences. Real doctors adopt a scientific paradigm that assumes an objective reality. Patients experience real suffering and seek effective cures, treatments, palliation and solace. The foundation of medical ethics should be that doctors altruistically respond to their patients' suffering using scientifically acceptable modalities. Compassion, caring, and respect for human dignity are needed as guides in addition to justice, beneficence, nonmaleficence and respect for autonomy.
原则主义作为生物伦理学的主流方法，并没有基本原理。这种缺乏原理的情况反映了后现代相对主义的总体思想氛围。就连美国最杰出的公共哲学家理查德·罗蒂，其实用主义或许暗示着一种常识哲学，但他似乎也深陷后现代的泥沼之中。另外，原则主义的创立者博尚和奇尔德雷斯提出一种不断演进的反思平衡，以某种共同道德为基础，作为21世纪生物伦理学的可行框架。他们方法的缺陷在于不符合真正的医生和患者的经历。真正的医生采用一种假定客观现实的科学范式。患者经历着真实的痛苦，寻求有效的治愈、治疗、缓解和慰藉。医学伦理的基础应该是医生以科学可接受的方式无私地回应患者的痛苦。除了公正、行善、不伤害和尊重自主权之外，还需要同情、关怀和对人类尊严的尊重作为指导。
