Dr Pittrof's response1 to our review of recent studies on the association of oral contraceptive use and the risk of venous thromboembolism (VTE)2 discusses the ethical implications of the study results on clinical decision making. His arguments are based on four principles of bioethics, as outlined in the sixth edition of Beauchamp and Childress' landmark textbook on biomedical ethics.3

One of us (JD) remembers with great pleasure Beauchamp's and Childress' lectures at the Kennedy Institute of Ethics at Georgetown University. Their undogmatic and brilliant intellectual contributions have influenced several generations of bioethicists since the late 1970s. Their approach to the establishment of principles that provide general normative frameworks in bioethics (‘principlism’) has been criticised since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes (such as Impartial Rule Theory, Casuistry and Virtue Ethics). However, these new approaches are, in fact, not inconsistent with an undogmatic and broad interpretation …