Is Principlism unable to guide health public policy?
I think Principlism may be applicable in the relationship between doctors and patients, but are insufficient to conduct public health policies, particularly in developing countries, usually marked by great economic and social inequalities, and where concepts such as justice and autonomy not are so clear.
ıf there is social inequalities, The first principle of deteriorating is justice. the doctor decides according to prejudices, this situation gives rise to discrimination. for example women, children, handicapped and old people are worst affected
Applying Principlism in medical ethics needs to find the best balance considering all the prima facie principles according to the ethical issue in a peculiar context. That is not easy at all, but ethics is not an easy matter too.
This is a question that has evolved along the editions of Beauchamp & Childres - Principles of Biomedical Ethics. Despite the ease of use of this theoretical patchwork, there are many criticisms from Latin America about how the principle of respect for autonomy places the principle of justice out of focus in countries with many social injustices. There is a tendency in these countries to abandon principialism in favor of utilitarian theories in public healthcare.
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