Jenkins, Simon (2019) Is the four quadrant approach to military medical ethics a cargo cult? A call for more unity between philosophers and practitioners. Journal of the Royal Army Medical Corps . doi:10.1136/jramc-2019-001183 (In Press)

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Abstract

Moral theory should be practically useful, but without oversight from the philosophical community, the practical application of ethics by other institutions such as the military may drift into forms that are not theoretically robust. Ethical approaches that drift in this way run the risk of becoming “cargo cults”: simulations that will never properly fulfil their intended purpose. The four quadrant approach, a systematic method of ethical analysis that applies moral principles to clinical cases, has gained popularity in the last ten years in a variety of medical contexts, especially the military. This paper considers whether the four quadrant approach is a cargo cult, or whether it has theoretical value, with particular reference to the more popular four principles approach. This analysis concludes that the four quadrant approach has theoretical advantages over the four principles approach, if used in the right way (namely, with all four quadrants being used).The principal advantage is that the four quadrant approach leaves more room for clinical judgement, and thus avoids the charge of being too algorithmic, which has been levelled at the four principles approach. I suggest that it is the fourth quadrant, which invites the user to consider wider, contextual features of the case, which gives the approach this key advantage. Finally, I make a more general proposal that theoretical ethicists should work closely with those practitioners who apply ethics in the world, and I call for a symbiotic relationship between these two camps.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) U Military Science > U Military Science (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Military ethics, Medical ethics
Journal or Publication Title:	Journal of the Royal Army Medical Corps
Publisher:	Royal Army Medical Corps
ISSN:	0035-8665
Official Date:	7 March 2019
Dates:	Date Event 7 March 2019 Available 5 February 2019 Accepted
Date of first compliant deposit:	13 February 2019
DOI:	10.1136/jramc-2019-001183
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	This article has been accepted for publication in Journal of the Royal Army Medical Corps 2019 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/jramc-2019-001183 © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
Access rights to Published version:	Restricted or Subscription Access
Related URLs:	Publisher

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