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The difficulty in ranking these principles is that they are all important, and they overlap, hand-in-hand.

I do agree that autonomy is quite important. A patient should be allowed to make their own decisions when they are able. And if they are unable to, then they should be able to have their health care proxy make those decisions.

According to Kinsinger (2009), “beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation” (para. 2). The health care provider should always take into consideration the importance of doing what they believe is in the best interest of the patient, while also taking into consideration autonomy.

Nonmaleficence ties in with these two, as the health care provider should do no harm. I believe that this is an important principle, however, each health care provider may use their own beliefs to determine what nonmaleficence may be. For example, if a doctor does not feel that they agree with abortions, as they feel that it is harmful to the fetus (whom they may consider to be a person), however, if a patient feels that that is something that they want to do, then the doctor may be at conflict, because they feel that they are not using nonmaleficence towards the fetus.

“Justice addresses the questions of distribution of scarce healthcare resources, respect for people’s rights and respect for morally acceptable laws” (Lawrence, 2007, p. 36). This principle can be pretty broad, however, what is important is that each person can feel a sense of justice in the care in which they received. This topic can become even more broad, by taking into consideration various communities, cities, and governments.

If I could, I would place them all of high importance. However, in the context of the Christian biblical narrative, autonomy is not necessarily something that may be seen as important. Shelly and Miller (2006) find that “human autonomy may seem good at first, but it is a deception from the enemy, and eventually everything goes wrong” (p. 154). So autonomy may actually be ranked last as far as the Christian worldview. Otherwise, I feel that according to the Christian worldview, beneficence may be first, followed by nonmaleficence, and justice.

References:

Kinsinger F. S. (2010). Beneficence and the professional’s moral imperative. Journal of chiropractic humanities, 16(1), 44–46. doi:10.1016/j.echu.2010.02.006

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://search-ebscohost-com.lopes.idm.oclc.org/lo…

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: IVP Academic.

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The four principles that make the core of modern bioethics include autonomy, beneficence, nonmaleficence and justice. The creators of the principles state that they are equally important and that none is more important than the other. There has been debate on that theory that some are more important than others. I agree that each of the principles are important and may each have an equal degree of importance depending on the topic. I do however believe beneficence weighs heavily as a nurse. The practice of beneficence is challenged by the respect for autonomy. It is not possible to act without the permission of a free moral agent without that agent’s consent (Lawrence, 2007). Nonmaleficence can be related in healthcare in regard to “do no harm” which is equally important. Justice is applied to everything we do and must also be held as a high standard in which to practice. Each of the principles play their part in moral and ethical decision making and should all be considered important. In the context of the Christian biblical narrative, autonomy is not viewed as important. Shelly and Miller write that autonomy may appear good until something interferes causing it to turn bad (Shelly, Miller 2006). Christians view the four principles in rank beginning with most important; beneficence, then nonmaleficence, justice, and lastly autonomy is seen as not important.

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://search-ebscohost-com.lopes.idm.oclc.org/lo…

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: IVP Academic.

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Principlism is the ethical decision in bioethics that uses four principle approaches f or a theory. The four principles are respect for autonomy, Non-maleficence, beneficence, and justice. I believe all are important but if I had to choose one I believe beneficence. The other would be autonomy. In the article review it discussed how the two overlap in that a person needs to be able to have the choice so that can do good deeds. As a nurse we train and use knowledge learned which used to with my approach on ethical decisions is used in patient care. The Christian Biblical Narrative is the story of creation, fall, redemption, and restorative of human being. Once again, I don’t believe that there is any order to which Principles in the context of Christian Biblical narrative as in article reviewed. The goal in moral decision-making is ultimately to specify and balance each of the four principles, recognizing that there is no set hierarchical order of principles in that one or more moral principle may override one or more other moral principle depending on the circumstances (Bulger, 2009). If I had to choose it would be Beneficence but in article I review it discusses about autonomy of religion. Collective religious autonomy as an instrumental right may be needed for more effective or full protection of individual rights (Kiviorg, 2014).There is importance in all four principles.

References:

Bulger, J. W. (2009). An approach towards applying principlism. Ethics & Medicine: An International Journal of Bioethics, (2), 121. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.311379352&site=eds-live&scope=site

Kiviorg, M. (2014). Collective Religious Autonomy versus Individual Rights: A Challenge for the ECtHR? REVIEW OF CENTRAL AND EAST EUROPEAN LAW, 39(3–4), 315–341. https://doi-org.lopes.idm.oclc.org/10.1163/1573035…

 
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