Bioethics is a new discipline that arose out of a general revulsion for the events of the holocaust and concerns about the rapid progress of modern knowledge that created unique dilemmas. The four principles approach to medical ethics has been widely adopted as a basis for ethical decision making in clinical practice. Although the four principles have succeeded in raising the general awareness of biomedical ethics there are several problems with principlism. This review discusses the criticisms of the four principles and attempts to provide and integrated approach to ethics based on the character of the moral agent.