Principles of Biomedical Ethics, 6. ed. – Nearing perfection?

It is rare to be able to review a book long before it is published. But my copy bears the publication year of 2009, even though I bought it in July 2008.

Be that as it may, seven is the number of perfection so it is relevant to ask whether the 6th edition of Tom Beauchamp & James Childress  (B&C) “Principles of Biomedical Ethics” is moving towards or away from perfection. This question is even more pressing since we are here dealing with one of the classics in bioethics and undoubtedly the bioethics book that has sold most copies worldwide (with the possible exceptions of the Bible and the Quran, books that play a major role in theological bioethics).


Let me first put your mind at rest. B&C are still believers in the four principles and their account of these principles have not changed much.


What is new in the 6th edition? As usual all chapters have been re-written and there is a new chapter on “Moral status” and a new major section on global justice issues. The authors have furthermore modified their account of the link between the famous four principles and common morality, probably to respond to criticism that the common morality used and the principles derived were too American.


The new moral status chapter illustrates the books strengths and weaknesses in equal measure. It gives a short and reasonably accurate account of a number of theories about what it is that gives an entity moral status, but claims in fairly typical B&C style that none of these give the correct answer and that we cannot sort out which of them is correct or reach a more consistent theoretical account. This is very similar to their treatment of theories of justice and in both cases the authors steadfastly refuse to nail their flag(s) to any mast(s). But this leaves the reader dissatisfied and the specific conclusions that B&C never the less reach dangling perilously in the air.


Over the years many of us have argued that what really needed improvement was the account of moral justification and the account of specification and balancing of principles. Very little has happened regarding specification and balancing and the account of justification which is presented in this edition is in my view even less plausible than the ones presented in previous editions.


So, perfection has not been reached in the 6th edition, but then the number six does have quite different connotations than the number seven.


Let me finally try to answer the question “Who should buy the new edition?” I think there are three groups for whom it might be rational to buy the book:

  1. Those who have never read any of the previous editions
  2. Those who uses the book in teaching
  3. Those who are engaged in critical work relating to principlism or common morality theories 

For most people who have the 3th,  4th or 5th edition there is probably not enough new material to warrant the purchase.


Søren Holm


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