Ranking the four principles of biomedical ethics is a controversial and multidimensional task, one that is both personal and interdependent upon one’s worldview. According to the lecture, “they do not have enough moral or concrete content on their own apart from prior assumptions and worldview considerations” (GCU, 2018). It further explains that the principles themselves do not represent a ‘common morality’ which would directly evoke the right choice in any given ethical dilemma. The choice will never be truly unbiased. An example is given of a Buddhist, Islamic, and atheist worldview, proposing that using the principalist methodology each of these individuals would come to a differing conclusion (GCU, 2018)
When taking a rudimentary look at how these principles should be ranked, it is assumed that beneficence should rank as first priority. Beneficence is the principle which states that the actions being considered should contribute to the individuals welfare and generate the best result. However, Lawrence argues that beneficence is dependent upon true autonomy, stating “It is not possible to act without the permission of a free moral agent without that agent’s consent” (Lawrence, 2007). One cannot truly assess what is in the best interest of the patient unless their true wishes are heard and those wishes are met. Additionally, the patient’s wishes may conflict with the provider’s perspective on what is beneficial and in the provider’s opinion, cause harm to the patient’s health or welfare. Is then nonmaleficence a priority over both autonomy and beneficence? Today, the right to universal healthcare is a tumultuous topic. Justice is the consideration of resources available for all in light how much care an individual will require. If a balanced withdrawal from these resources is most ethical, is Justice the top priority? Lawrence argues if it is not a right then how shall we care for those who cannot afford health insurance? If healthcare is a human right, then how can we delineate between what level care people can receive and who pays for that care?
I agree with Lawrence’s closing arguments. He reflects on an paper published in the British Medical Journal stating the principles “are not designed to provide a method for choosing, but rather provide a set of moral commitments, common language and a common set of moral issues. It is necessary to view these in the context of scope in order to properly utilize the principles” (Lawrence, 2007). He goes on to several other authors who explain that ethical dilemmas should be approached with these principles as a guide through each unique situation.
Lawrence DJ. (2007). The four principles of biomedical ethics: a foundation for current bioethical debate. Journal of Chiropractic Humanities, (14), 34–40. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105887311&site=ehost-live&scope=site
GCU. (2018). Biomedical ethics in the Christian narrative
Principalism is a framework for bioethics which can be applied in all areas in our lives and can be incorporated into our morals and values. Ethical decision making can be achieved by considering four principles: Respect for autonomy, nonmaleficence, beneficence, and justice. In the healthcare setting it is important to apply these principles when advocating for our patients and caring for them. The order of importance can change based on the circumstances and factors that are presented. In most cases I would rank the importance of the four principles in the following order: Nonmaleficence, beneficence, autonomy, and justice. I place nonmaleficence as a priority principal because I feel it is our primary job as human beings to not cause another person harm. As a nurse my primary job is to not cause any harm to my patients when I am caring for them. I would place beneficence as my second priority because it is also a principal in which requires preventing harm while keeping a person’s best interest in mind by being my patients advocate. In nursing we always have our patients’ best interest in mind while caring for them and guiding them through the healthcare process. Thirdly, autonomy would be a principal that provides importance in bioethics because respecting a person’s autonomy and independence regarding their own healthcare decisions is an important ethical component in healthcare. Lastly, justice is a principal to consider in bioethics because treating people equally and fairly and distributing resources fairly is important in ethics (GCU, 2015).
In consideration of the Christian biblical narrative, a Christian vision is deontological because it considers principles of right and wrong. The narrative gives us an idea of the big picture or Gods mission for the way in which he wants us to lead our lives. I believe the narrative speaks in this order regarding the four principles of bioethics: Creation according to Christianity relates to the principal of beneficence in which everything exists and is the way it is supposed to be on purpose and is good. This benefits all and brings a sense of peace to all things. The Fall is related to autonomy in that God gave us free will and the opportunity to make our decisions regarding how we choose to live our lives. Redemption relates to the principle of justice. The death of Jesus Christ saves humanity and God is able to forgive our sins. Salivation is able to restore our relationship with God by bringing us together in unity. Lastly, restoration in the Christian story connects with nonmaleficence because God does not want to bring harm to humanity rather, he made salvation available to all man, so we could return to a perfect state of shalom (GCU, 2015).
Grand Canyon University. (2015).Biomedical ethics in the christian narrative. [Lecture 3]. In Ethical and spiritual decision making in health care. Retrieved from