Principalism is a system of ethics based on the four moral principles of autonomy, beneficence, nonmaleficence, and justice (Childress, 2001). This is a set of rules that are presumptively binding, and is uses for the balance of ethical challenges in the medical field when faced with such challenges, and to be used when appropriate.

The question seems to be how to balance the four and which principle takes precedence over the other principles. Principalism is to be used in context with the doctor or nurses scope of practice to those in which we hold obligations to serve (Meilaender, 2013). Autonomy is respect of person, and free will or agency along with one's autonomous choices including informed consent, and having permission (Childress, 2001). This is ranked highest because without permission the other principles would have a hard time to follow.

Beneficence is the "golden rule" it means to do good, it is taking the good vs. the bad, it is the benefit vs. the risk (Childress, 2001). Nonmaleficence is the negative side of beneficence and is the risk side, and means to do no harm (Childress, 2001). Justice is to act fairly, and is a social distribution of benefits and burdens, and would help to consider how to provide healthcare to those that cannot afford (Childress, 2001).

It is extremely hard to rank the principles, because they all seem to help to try to answer the ethical questions that can arise in the medical profession, and with so many different worldviews how do one ask the right question, or apply the correct principle? I feel the remaining three principles hold the same value with again autonomy being the strongest principle, because without permission what do we have to go on.

In Christian Biblical narrative, it has been said that Christians should reflect God's image by following the 10 commandments, and embody the character of Jesus (Grand Canyon University, 2017). In applying a biblical principle when faced with ethical or other dilemmas it will allow one to allow the Holy Spirit to guide you and do good for all in trusted in your care (Grand Canyon University, 2017).

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