Does American bioethics speak with one voice?

Many international organizations and countries have adopted the principles of American bioethics as their own principles. However, further analysis of what is going on in the United States shows that what we have come to call principlism is only one expression among many other health care ethics approaches that are found in the U.S. The first section of the text presents American bioethics from the point of view of principlism, the main focus being the creation of this vision, and its meaning. The second section examines, first of all, the critiques that from the beginning have been addressed to this approach; and secondly, other visions developed as much in response to the limits intrinsic to principlism as to the major changes that drive the American health system. In the third section, I will attempt to indicate that the real challenge of American bioethics is not a consequence of the tension existing between principlism and the other approaches, but that it arises in the political domain: the polarization between liberals and conservatives.