Department of Philosophy and Pedagogy, Medical University of Silesia, Katowice, Poland.
Eur J Med Res. 2010 Nov 4;15 Suppl 2(Suppl 2):98-101. doi: 10.1186/2047-783x-15-s2-98.
In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called ?moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds.
This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings.
Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy.
The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as "hard core" and "protective belt" of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of moral norms not only respects the objectivity of the good, but also can be seen as a condition sine qua non of such objectivity in the changing socio-historical context of doctor-patient relationship.
The life program approach to bioethics and clinical ethics in particular, can be seen as a form of widening of principlism. This new approach, being non-relativistic, is at the same time sensitive to moral pluralism experienced in everyday medical practice.
在日益全球化的世界中，道德多元化（通常与宗教多元化相关或基于宗教多元化）的体验已成为一个不可忽视的重要问题。患者和治疗团队的道德观点之间以及团队中特定成员的道德信仰之间的潜在冲突，是根据生物伦理理论来解决的，其中原则主义仍然是生物医学伦理的主流方法。然而，问题在于，这种方法本身是否应该被视为所谓的“道德帝国主义”的工具，因为它严格地受到美国特定哲学传统的限制。此外，原则主义的架构，特别是通过阐述共同道德的概念，为其理论在多元化环境中的适用性辩护，应该强调的是，一些道德规范和标准被认为是所有文化中所有有道德的人都共同拥有的，这种观点不仅受到经验主义的批评，也受到理论背景的批评。
本文旨在重新考虑原则主义，以便使其更适合解决伦理多元化临床环境中的道德困境。
拉卡托斯的复杂方法论证伪被用于两种不同的方式：（1）构建“生命计划”的概念；（2）用新阐述的伦理理论来对抗原则主义。这种反思仅限于与临床伦理中的关键问题相关的规范，即尊重患者的自主权。
共同道德和特殊道德的概念分别被解释为生命计划的“硬核”和“保护带”（根据拉卡托斯的科学哲学）。接受研究计划的多样性，拉卡托斯维护了真理客观性的理念。类似地，生命计划的多样性并没有质疑道德价值观的客观性。道德规范的多样性不仅尊重善的客观性，而且可以被视为在医生-患者关系不断变化的社会历史背景下这种客观性的必要条件。
生命计划方法，特别是生物伦理学和临床伦理学，可以被视为原则主义的一种扩展形式。这种新方法，是非相对主义的，同时对日常医疗实践中所经历的道德多元化具有敏感性。
