The exact point at which the Hippocratic tradition lost its universal appeal and application is hard to establish. However, by the 1970s a secularized ethic began to be articulated that was designed to be devoid of theological language. The Belmont Report: US National Commission for the Protection of Human Subjects (1978), while utilizing some of the intellectual tools of Catholic morality, sought another basis for making medical decisions and used the norms of beneficence, nonmaleficence and social justice to guide such thinking. Not too much later, the principle of autonomy was articulated, so that Tom Beauchamp and James Childress could develop what has become the dominant, secular medico-moral method now known as principlism. Their system, as is their claim, overcame the intractable debate between utilitarianism and deontology by its focus on the notion of mid-level principles or prima facie norms — autonomy, beneficence, nonmaleficence, and justice. As such, the obligations generated by those norms are not seen as absolute. They bind agents unless overridden or outweighed by a competing obligation.

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