Principles of Biomedical Ethics: Autonomy, Beneficence, Justice

Modern biomedical ethics acquired its dominant working framework in 1979, when the American philosophers Tom L. Beauchamp and James F. Childress published Principles of Biomedical Ethics, now in its 8th edition (2019), proposing four mid-level principles intended to be equally binding and applicable across cultures and clinical contexts without requiring commitment to any single overarching ethical theory: respect for autonomy, non-maleficence, beneficence, and justice. This "principlism" or "Georgetown mantra" — so called because both authors were affiliated with the Kennedy Institute of Ethics at Georgetown University — was designed as a practical middle path between the abstraction of grand normative theories, such as Kantian deontology or utilitarianism, and the case-by-case particularism of traditional casuistry, giving clinicians, ethics committees, and policymakers a shared vocabulary for analyzing dilemmas without first resolving deep metaethical disputes. The framework built on, and helped systematize, the 1979 Belmont Report, issued by the U.S. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the wake of the Tuskegee syphilis study scandal, which had identified respect for persons, beneficence, and justice as the core principles governing ethical human-subjects research.