Per Beauchamp & Childress, (1994) Principalism is the framework for analyzing and comparing the moral foundations of the ethical statements of these health-related professional associations. This framework includes four core behavioural norms of importance in guiding ethical decisions involving work with patients, other clients, and human research subjects.

At the core of principalism, is the idea that ethical justification rests primarily, if not exclusively, in appeals to more general or higher level moral norms under which any more particular ethical claim can be subsumed (Beauchamp, & Childress, 1994). The four tenants of principalism elaborated below are:

-Autonomy: Recognizes a person's right to make choices, to hold views, and to take actions based on personal values and beliefs. Support of independent decision making.

-Non-maleficence: Do no harm.

-Beneficence: do good Take actions to help others and contribute to their welfare. Refers to an action done for the benefit of others.

-Justice: social distribution of benefits and burdens and treat everybody fairly (Beauchamp, & Childress, 1994).

These principles have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. We can test whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision-making process when individuals are faced with ethical dilemmas (GCU, 2015). The four principles referred to here are not prioritized, meaning no one principle routinely is more important than the other.

. Each situation and the circumstances surrounding it should be considered. While autonomy should be of importance, there are situations in which it is not the priority, specifically if others will be directly impacted. Because there may be conflicts among the principles, other methods of resolving concerns should be established.

One example of Autonomy that is practiced: There are times that we teach the patient about the importance of turning or the importance of a medication that they need to take and for the patients' rights which is autonomy, they have the right to refuse. You can accept that answer, or you can try again later because you know that the patient needs that medication especially if it must deal with cardiovascular system, or respiratory system, or neurological system.

All we can do is educate and remind, other than that, the patient has their right to their decisions and their body. These methods may include utilizing a moral code or a just process for making decisions. In the clinical setting, these principles should serve as guidelines and not be considered absolutes due to the complexity of medical situations (McCormick, 2013).

If was to prioritize these four principles, it would be influenced by ethical concepts which are not specifically taught in Scripture but can be derived from principles which are found in God's word. Also, with alignment in the Nightingale Pledge which has a Christian influence on nursing and embraces the roles of myself as a Christian and a nurse. . I believe the hierarchy of principles would be:

1) Justice- (Everyone should be treated equally, as God sees each of us that way).
"I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling."

2) Nonmaleficence-(No individual should ever intentionally cause harm to another- Do unto others as you would have done to you).
I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug."

3) Beneficence- (God calls us to serve one another and I feel that this should frequently occur before we serve ourselves).
"I shall be loyal to my work and devoted towards the welfare of those committed to my care."

4) Autonomy- (Although autonomy may be used in the context of each of the above principles, it lends to the suggestion that one is only considering what is right for them and their personal beliefs without considering others).

"I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully."

References

Grand Canyon University. (2015). Biomedical ethics in the Christian Narrative.

Beauchamp, T. L. and Childress, J. F. (1994). Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press.

McCormick, T. R (2013). Principles of bioethics.