Covenantal Ethics for Health Care: Alternative to Principles-Based Ethics and Convergence with Normative Practices

Abstract

Biomedical ethics has been dominated by principles-based ethics (PBE). PBE focuses on the process of moral problem-solving by rational consensus but suffers from minimal ethical content and inattentiveness to relational aspects that constitute the core of medical care. Grounded in a Reformational philosophical view of the created order, the Normative Reflective Practitioner (NRP) model acknowledges constitutive (structural and aspectual) as well as regulative (directional) dimensions of medical practice. Medical practice is qualified by the ethical principle of care for relational activities in medicine, which are most meaningfully expressed within a biblical covenantal ethical framework (CEF). CEF helps to transform the disparity in knowledge and power between caregiver and patient toward a covenantal disposition of caring for the vulnerable and needy. This model acknowledges creationally ordered individuality structures of medical practice, provides dynamic and normative direction to changes in the expression of those structures, and maintains focus on patient needs in light of techno-formative advances. Both the NRP model and the CEF help to reinterpret the principle of beneficence within medicine as the ethical core aspect of all medical encounters, providing overarching moral force for maintaining relational cohesion in patient care.