The Limits of Principlism and Recourse to Theory: The Example of Telecare Tom Sorell Published online: 1 June 2011 # Springer Science+Business Media B.V. 2011 Abstract Principlism is the approach promoted by Beauchamp and Childress for addressing the ethics of medical practice. Instead of evaluating clinical decisions by means of full-scale theories from moral philosophy, Beauchamp and Childress refer people to four principles—of autonomy, beneficence, nonmaleficence, and justice. Now it is one thing for principlism to be invoked in an academic literature dwelling on a stock topic of medical ethical writing: end-of-life decisions, for example. It is another when the topic lies further from the mainstream. In such cases the cost of reaching for the familiar Beauchamp and Childress framework, with its formulaic set of concerns, may be to miss something morally important. After discussing an example of the sort of academic literature I have in mind, I propose to distinguish the uses of the formulaic from the uses of the more unapologetically theoretical in applied ethics, and to suggest that the latter can make up for some of the limitations of the former. This is not to say that the more theoretical literature has no limitations of its own, or that it should take the place of the formulaic. On the contrary, there is room in applied ethics and a use in applied ethics for both. But there is a sense in which there is a greater dependence of principlism on theory than the other way round, and at the end I try to spell out the significance of this fact. Keywords Telecare . Disability . Autonomy . Justice . Ageing . Moral theory There is something to be learned about the value and scope of moral theory from “principlism”. Principlism is the approach promoted by Beauchamp and Childress for addressing the ethics of medical practice (Beauchamp and Childress 2009). Instead of evaluating clinical decisions by means of full-scale theories from moral philosophy, or even codes of practice developed by medical professionals, Beauchamp and Childress refer people to four principles—of autonomy, beneficence, nonmaleficence, and justice. These principles have connections to full scale moral theories, but are usable by people who are not immersed in the theories, or who do not know how to adjudicate conflicts between theories. Medical students can make use of the principles without first taking a degree in philosophy, and members of the public can engage with decisions made on the basis of the principles, without having either medical Ethic Theory Moral Prac (2011) 14:369–382 DOI 10.1007/s10677-011-9292-9 I am grateful to Prof. Heather Draper for discussion of some of the issues taken up here. T. Sorell (*) Dept. of Philosophy, University of Birmingham, Birmingham, UK e-mail: t.sorell@bham.ac.uk