What is principlism (Beauchamp and Childress), and why are its four principles called "mid-level" and "prima facie"?

Principlism holds that the moral aspects of medical practice can be identified, examined and resolved with four principles: respect for autonomy, non-maleficence, beneficence and justice. They are mid-level because they sit between grand theories and concrete rules and are not tied to any one theory; prima facie because each binds unless it clashes with another, so conflicts must be weighed.

Beauchamp and Childress (1979) proposed the best-known theory of medical ethics:

• Four principles: do good, do no harm, respect autonomy, justice.
• Justified by common morality (Alltagsmoral): the principles are not derived from a theory; their legitimacy comes from their wide distribution and general acceptance.
• Mid-level principles (Prinzipien mittlerer Reichweite): more concrete than "maximise utility" or the categorical imperative, more general than a clinic rule. They don't apply in every context.
• Prima facie ("at first sight"): each is a binding duty, valid independently of further considerations and not bound to any ethical theory, until it collides with another. Since they are only prima facie valid, they can conflict, and conflicts require balancing the demands of both principles.
• Used both to work through ethical problem fields systematically and to judge moral dilemmas in daily clinical practice.

Why this design: people who disagree about Kant vs. utilitarianism can still agree that harming patients is wrong. Principlism builds on that shared middle ground.

Go deeper:

• Wikipedia: Principlism — origin, the four principles and criticism.
• Wikipedia: W. D. Ross — the source of the idea of prima facie duties.