The pillars of principalism represent the four areas of consideration that must be weighed when faced with an ethical dilemma. I would rank the four ethical principles in the following order:
3.) Respect for autonomy
I believe that nonmaleficence, or the principle of not causing harm or purposeful wrongdoing onto others should be the highest ranking ethical principle (Grand Canyon University, 2015). Nonmaleficence is a core medical ethical standard but can also be applied on a broader spectrum throughout society. In a Christian, biblical narrative I believe nonmaleficence to be one of the strongest ethical pillars as well. Numerous biblical teachings and several the 10 commandments of Christian faith relate to the core concept of nonmaleficence (“Bible List Of The Ten Commandments,” 2017). Any consideration of nonmaleficence is likely to involve an examination of beneficence since they can often be considered inseparable. Beneficence is the principle of providing benefits to others. Respect for autonomy is the patient’s right to choose what happens to their body. Though this seems pretty straight forward, there is possibility for dilemma in cases where an individual is unable to make autonomous decisions. Autonomy can be seen as the limiter on how far a clinician can medically intervene for a patient. Justice is the principle of fair and equal benefits and treatment among all people. Justice may require an analyzed approach and comparison and is therefore in the lowest ranking but nonetheless a significant and crucial pillar.
Similar to how the U.S. has placed the respect for autonomy as the highest of the four principles, I too rank autonomy as the most important biomedical ethics principle. I believe that first and foremost, what happens to the body of an individual is the decision of that individual, assuming that those decisions do not cause harm to anyone else.
I rank nonmaleficence as my second most important principle of ethics because I don’t believe anyone should intentionally cause harm to others.
The ranking of the last two principles, for me, is slightly less clear. Beneficence and justice are tied in third. When I see the term “prevent” as in prevent harm, I want to rank beneficence higher on my list, but I need further consideration. In consideration of justice, the fair distribution of benefits is of extreme importance and is no small issue. It is of huge importance, but it is not what I think of when I initially think of ethics.
In relation to the Christian biblical narrative, I believe the order of importance for the principles would be: beneficence, justice, nonmaleficence, and respect for autonomy. I believe this would be the order because in the beginning, God provided benefits that were balanced and distributed fairly to all (beneficence and justice). This resulted in Shalom, a peaceful and orderly state. Nonmaleficence I believe would be ranked third because we were (are) not to cause harm to others. Finally, I believe respect for autonomy would be last in the Christian biblical narrative because all living things had what they needed, and they believed and trusted in God to provide all their needs.
Writing that autonomy would be ranked last in the Christian biblical narrative when I ranked it first really surprised me and is making me think about how these principles of ethics can be interpreted and determined to be more or less important based on the approach.