What is known as the ‘principlist’ approach to bioethical decision-making has dominated practical and professional ethics in recent years. In brief, principlism involves weighing general principles such as autonomy, beneficence and justice and applying them to situations which give rise to ethical dilemmas. In health care, principlism focuses, primarily, on the professional responsibilities of doctors, nurses, midwives etc. and is viewed as a means of supporting them to act in ethically appropriate ways.
My paper argues that, whatever its merits, principlism falls far short of what is needed to negotiate the difficult ethical terrain that is health care. I claim that its focus on general concepts and its privileging of the analytic skills involved in their deployment is too narrow and rigid. I support this claim by examining the application of principlism to a case study, titled ‘The Forgetful Mourner’. My suggested remedy for the ills of this approach is to appeal to narrative theory, a contemporary philosophical position, which pays attention to the everyday world and to the unique, personal and relational nature of human life.
Finally, my paper considers whether, given its shortcomings, nurses should, nevertheless, adopt the principlist approach. I am particularly concerned that nurses will lose out if they do not deploy it in their practice. My fear is that nurses will continue to be excluded from key decision-making processes if they do not share a common moral language with their health care colleagues. My solution to this dilemma is to suggest that nurses take what is best from both principlist and narrative approaches to inform their professional lives.