Principalism is a one of the approaches used in biomedical ethics to aid in ethical decision making.

The 4 principles of Principalism are:

Respect for autonomy − A principle that requires respect for the decision making capacities of autonomous persons.

Nonmaleficence − A principle requiring that people not cause harm to others.

Beneficence − A group of principles requiring that people prevent harm, provide benefits, and balance benefits against risks and costs.

Justice − A group of principles requiring fair distribution of benefits, risks and costs.

The specific context or ethical dilemma will weigh into the ranking of these principles however generally speaking I would rank nonmaleficence as the #1 consideration or importance to ethical decision making followed by beneficence, respect for autonomy and then justice. I believe that doing no harm should be the primary concern however the risks and costs associated with a particular ethical decision must be examined closely and promptly (beneficence principle). These two are very close in level of importance to me and really go hand in hand. To not do harm, one should and must balance the benefits with risk and cost. One can even say that the level of harm trying to do the “right” or “best” thing must be considered. For example, a decision to end life sustaining care may be the “best” decision as it creates the least harm and the most benefit in that the patient is no longer suffering from pain etc.

It is easy to see how respect for autonomy is put to a high place as it is a fundamental right for a human being to give consent or not and that decision being respected. It could be seen as the starting point. The gray area for me is the not autonomous individual like a child or a dependent adult who has not had capacity or has lost capacity.

Generally I would say in the context of the biblical narrative, the order would be the same recognizing the context of each situation is different.


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