Book and media reviewRadiographic Atlas of Skeletal Maturation, S.L. Kahn, C.M. Gaskin, V.L. Sharp, et al., Thieme (2011), 620 pages, $249.99, ISBN: 978-1-604-06571-8

TOM BEAUCHAMP, AUTHOR OF STANDING ON PRINCIPLES, IS ALSO the coauthor of Principles of Biomedical Ethics, often referred to simply as “Beauchamp and Childress”—the most widely taught and most frequently cited bioethics book. Beauchamp is likewise an internationally renowned scholar of the philosophical work of David Hume (1711-1776), the most influential ethicist of the Scottish Enlightenment. Standing on Principles begins with 2 chapters providing a scholarly account of the 1978 Belmont Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, for which Beauchamp served as staff philosopher. This presidential commission created momentum for effective, enduring change in public policy: current federal regulation of research involving human participants. The Belmont Report became and has remained the intellectual touchstone in the work of clinical investigators and institutional review boards. The national commission also shaped the distinctive character of bioethics as scholarly, applicable to clinical and research questions in medicine, and critically appraising and improving health policy. Beauchamp’s historical account of the origins of the Belmont Report situates it in the context of the codes and statements of ethics. The remaining 13 chapters take up theoretical aspects of bioethics and explore their implications for such topics as informed consent, medical paternalism, setting limits on lifesustaining treatment, and the exploitation of economically disadvantaged individuals and groups in pharmaceutical research. From beginning to end, the book presents bioethics at its best, providing thorough and even-handed scholarship, especially in presenting the views of Beauchamp’s critics; clarity and precision of analysis of key concepts and rigorous tracing of their implications; solid grounding in the scientific and clinical literature; and accessibility to readers not expert in bioethics. In his dialogues, Plato portrays Socrates as providing instruction on the difference between philosophical reasoning—persuasively on display in Standing on Principles— and “mere opinion,” ie, conclusions asserted with confidence but without reasons. Beauchamp’s magnificent book provides an important counterweight to bioethics as “mere” or subjective opinion and gently but powerfully explicates and deploys conceptual tools that will equip the reader to leave subjective opinion behind and experience the discipline of philosophical reasoning about the ethical dimensions of clinical practice, research involving human participants, and health policy. The reader expecting a lucid and compelling account of ethical principles will not be disappointed. The familiar quartet of beneficence, nonmaleficence, respect for autonomy, and justice expresses “distilled morality” (p 36)—“the most general and basic norms of the common morality” (p 44). Each of these norms is prima facie in character. This means that no one principle automatically or always overrides the others; the implications of all principles relevant to clinical, research, or health policy questions and their implications for how such questions should be answered must be taken into account. One does so by “specification” of principles—making principles moreconcrete in response to specific clinical, research,orhealth policy matters, resulting in prima facie rules or practical, concrete guides to action, such as “do not coerce for his or her own good an adult patient with decision-making capacity who expresses informed refusal of clinical intervention.” Differences among rules are to be managed by reasoned argument. The results are either consensus or well-reasoned disagreement (the definition of ethical controversy). Principles distill or express “common morality,” which is “applicable to all persons in all places” (p 43). The principles of common morality are discovered when individuals are “morally serious,” ie, when they commit themselves to the objective of morality, the improvement of the human condition. This commitment requires individuals to “lessen human misery and preventable death” and thus “promote human flourishing” (p 43). “Centuries of human experience” (p 43) have taught the value of this commitment. Hume wrote words very like these, indicating his deep influence on Beauchamp’s account of common morality. Physicians will immediately recognize this commitment: it shapes professionalism in medicine and has done so since the late 18th century when, deeply under Hume’s influence, John Gregory (1743-1772) and Thomas Percival (1740-1804) invented the ethical concept of medicine as a profession. Readers should add Standing on Principles to their professional libraries as one of the “essentials.” They will find themselves experiencing the splendid rewards of turning to it again and again.