Toward a Global Bioethics: Principlism and the Problem of Political Legitimacy

Tom Beauchamp and James Childress's Principles of Biomedical Ethics introduced principlism-or the "four principles approach"-which has since become one of the most influential frameworks in contemporary bioethics. However, its potential to serve as a foundation for shared transcultural bioethical norms has elicited both substantial support and considerable critique. In this article, I analyze two notable attempts that utilize, or appear to be modeled after, principlism as a basis for global bioethics: Beauchamp and Childress's original formulation and the recently revised International Code of Medical Ethics by the World Medical Association. I argue that each model fails, but for different reasons. Beauchamp and Childress's account is rooted in particular moralities, making it suitable for guiding action in specific clinical contexts but ill-equipped to handle global ethical pluralism. Conversely, the WMA's approach is deficient due to its undefined moral foundation and lack of political legitimacy. To address these shortcomings, I outline a third approach designed to make explicit the connection between principlism, global bioethics, and the problem of political legitimacy.