 Finally, Beauchamp and Childress themselves recently acknowledge two misunderstandings of their four principles framework. The first misunderstanding is that the framework represents American individualism, with the principle of autonomy taking priority. Their response is, first, to contest any connection between American individualism and a respect for autonomy. Further, they emphasize that their framework’s principles are all only prima facie binding. The second misunderstanding is that the framework downplays the virtues. It has been argued that medical ethics should be underwritten by virtue-based ethics rather than by principle-based ethics, and that that approach has a better chance of restoring humanity to health care (de Zulueta 2015). Here, Beauchamp and Childress point to various discussions of virtue theory and moral character appearing in various editions of PBE, including a discussion in the eighth edition of how virtues and principles might work together in certain practical scenarios (Beauchamp &amp; Childress 2019b: 11).