Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”

TLDR

The four‑principle framework is compatible with a wide range of mutually incompatible moral theories. The study hypothesises that the four principles of medical ethics can account for all substantive claims and calls for falsification of this hypothesis. The authors argue that the four principles can explain all claims and justify prioritising respect for autonomy as the foremost principle. The approach offers a way forward between moral relativism and imperialism, urging bioethicists to adopt it as a basis for global moral ecumenism.

Abstract

It is hypothesised and argued that "the four principles of medical ethics" can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can't be explained by one or some combination of the four principles. This approach is argued to be compatible with a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as "first among equals", not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism.