Prinzipien und Diskurs – Ein Ansatz theoretischer Rechtfertigung der ethischen Fallbesprechung und Ethikkonsultation

Definition of the Problem Models of decision making in medical ethics have to establish themselves as being able to lead to ethically right or at least “credible” decisions. For this purpose, approaches of theoretical justification stemming from ethics are vital. However, clinical ethics is sometimes criticized for theoretical deficits. In order to address this criticism, we will try to justify ethical case discussion and ethics consultation by principlism and discourse ethics by referring to a clinical ethics project (METAP). Arguments Principlism and discourse ethics can fruitfully complement each other when used in ethical case discussion or consultation. Thereby, some theoretical as well as practical weaknesses of both approaches can be mitigated. Discourse ethics, for example, safeguards the ethical validity of moral decisions and norms for action, respectively, thus mitigating shortcomings of justification when using principlism. Conversely, principlism answers questions concerning ethical adequacy and functions particularly as a safeguard for appropriate decisions in the individual case. Conclusion By using a combination of these two approaches, a broader justification seems possible rather than by relying on principlism or discourse ethics alone. Even if some challenges persist, and even if the combined model cannot always prevent dissent, it may strengthen practical confidence in the ethical decision by its „double“ safeguards (principles and discourse). This could render clinical ethics more „robust“ that have been missing so far.