 A fairly recent criticism comes from John McMillan, according to whom Beauchamp and Childress’ approach stifles careful reflection about real issues. McMillan claims that principle-centered methods cannot lead to the formulation of what he calls “reasoned convictions about moral problems”, and writes that the four principles approach hinders bringing moral reason to bear upon practical questions. This is because, as McMillan has it, newcomers to bioethics will subsume whatever issues are under consideration under one of the four principles, and then rule that the principle of autonomy should trump the other three principles. While recognizing that such a method is not what Beauchamp and Childress intended, McMillan writes that it is in fact the way the four principles approach is typically employed (McMillan 2018: 51–53).