Beauchamp: sentido original do principalismo

Prior to the early 1970s, there was no firm ground in which a commitment to principles or even ethical theory could take root in biomedical ethics. This is not   to say that physicians and researchers had no principled commitments to patients and research subjects. They did, but moral   principles, practices, and virtues were rarely discussed. The health care ethics outlook in Europe and America was largely that of maximizing medical benefits and minimizing risks of harm and disease. The Hippocratic tradition   had neglected many problems of truthfulness, privacy, justice, communal responsibility, the vulnerability of research subjects, and the like. Views about ethics had been confined largely to the perspectives of those in the professions of medicine, public health, and nursing. No sustained work combined concerns in ethical theory and the health care fields.

[36] Principles that could be understood with relative ease by the members of various disciplines figured prominently in the development of biomedical ethics during the 1970s and early 1980s. Principles were used to present frameworks of evaluative assumptions so that they could be used by, and readily understood by, people with many different forms of professional training. The distilled morality found in principles gave people a shared and serviceable group of general norms for analyzing many types of moral problems. In some respects, it could even be claimed that principles gave the embryonic field of bioethics a shared method for attacking its problems, and this gave some minimal coherence and uniformity to bioethics.

There were two primary sources of the early interest in principles in biomedical ethics. The first was the Belmont Report (and related documents) of the National Commission for the Protection of Human Subjects, and the second was the book entitled Principles of Biomedical Ethics, which I coauthored with James F. Childress. I here confine discussion to the latter.

Childress and I began our search for the principles of biomedical ethics in 1975. In early 1976, we drafted the main ideas for the book, although only later would the title Principles of Biomedical Ethics be placed on it [1]. Our goal was to develop a set of principles suitable for biomedical ethics. One of our proposals was that health care’s traditional preoccupation with a beneficence-based model of health care ethics be augmented by an autonomy model, while also incorporating a wider set of social concerns, particularly those focused on social justice. The principles are understood as standards of conduct on which many other moral claims and judgments depend. A principle, then, is an essential norm   in a system   of moral thought and one that is basic for moral reasoning. More specific rules for health care ethics can be formulated by reference to these four principles, but neither rules nor practical judgments can be straightforwardly deduced from the principles.

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The principles in our framework have always been grouped under four general categories: (1) respect for autonomy (a principle requiring respect for the decision-making capacities of autonomous persons), (2) nonmaleficence (a principle requiring not causing harm to others), (3) beneficence (a group of principles requiring that we prevent harm, provide benefits, and balance benefits against risks and costs), and (4) justice (a group of principles requiring appropriate distribution of benefits, risks, and costs fairly). (p. 35-36)