A Sociological Account of the Growth of Principlism

Bibliographic Data

ID20335209
AuthorsJohn H Evans (0000-0002-1351-0953)
Year2000
Volume30
Issue5
Pages31
Publication date2000-09-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueThe Hastings Center Report (JOURNAL)
Journal identifiersISSN: 0093-0334 • E-ISSN: 1552-146X
PublisherJSTOR (PUBLISHER)
DOI10.2307/3527886
PMID11057386
OpenAlexW2170037227
LanguageEN
Citations received30
References cited3

Bioethicists' attraction to principlism is rooted in a Western view of how matters that affect public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from circumstances of problem. That view of deliberation, itself fostered by Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of bioethics discourse. The three principles of respect for persons, beneficence, and justice first articulated in Belmont Report and four similar principles published in Beauchamp and Childress's Principles of Biomedical Ethics have structured decisionmaking in bioethics.[1] In this paper I do not address whether these principles are or apply them to problems. Nor do I explain why certain principles have become institutionalized rather than others. Rather, I engage in an investigation of principlism from perspective of sociology of knowledge: Why has use of a small set of principles--whichever they may be--become common in bioethics? The sociology of knowledge assumes that decisionmaking systems, such as principlism, do not become influential because they are the best or correct, but rather because social conditions are right for those promoting system to defeat champions of competing ideas. That an idea is most coherent, for example, is important in this competition only if people in authority to judge legitimacy of ideas agree that coherence is important. Everyone recognizes that to understand dominance of principlism we must go back in history, perhaps to Nuremberg trial. I propose that to understand social determinants of principlism we must go back much farther, to 1494, when first textbook for double-entry bookkeeping was written. This form of bookkeeping is tabulation that any department chair is familiar with: What are our costs for next year; what is our income? And more specifically, are costs associated with this component of business generating returns that justify costs? This process is taken so much for granted it is hard to imagine an alternative. Before invention of this system, however, accounts from businesses were basically a rambling story with that served to assist memory of businessman, but not help with evaluation of businessman's actions.[2] For example, an account from early 14th century England stated: Account of Maurice Hunter and Fynlay Sutor, balies of burgh of Stivelyn, given up at Dunbretan on twenty-fifth day of January, ... of fermes of said burgh for two terms of this account. They charge themselves with .36 [pounds sterling] received on account of fermes of said burgh for year of their account. Whereof, for their superexpenses made in preceding account 40 s. 1 d halfpenny. And in duties to abbot of Cambuskyneth and Dunfermelyn, ... during time of account, 23 [pounds sterling]., 5 s. 4 d. And to Friars Preachers of Stivelyn. .. (p. 40) Double-entry bookkeeping was a major innovation in economic history. Two changes in accounts system also transformed it into a procedure that allowed for calculability, efficiency, and predictability in human action, paving way for modern capitalism. The first change was that new system was a means of discarding information deemed to be extraneous to decisionmaking. After all, does it matter to calculation of profit that Hunter and Sutor live in burgh of Stivelyn? This could be put in an address book. The new accounting just had numbers, with all other information removed. The second change was that these numbers took on a new degree of calculability. Instead of putting proceeds on one list (the account above) and costs on another, these two were translated into a common metric called profit, making an evaluation of each action much more precise

Economics · Environmental ethics · Positive economics · Social science · Sociology · Ethics in Clinical Research · Ethics in medical practice · Pharmaceutical industry and healthcare · Philosophy

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