The Ethical Theory of Principlism in Biomedical Ethics in the Christian Narrative Context: A Case Study
The ethical theory of Principlism introduced by Beauchamp and Childress in the Principles of Biomedical Ethics is also sometimes referred to as the “Georgetown Approach.” It comprises of four main principles namely respect for (patient) autonomy, nonmaleficence, beneficence, and fairness or justice. Nonmaleficence refers to the act of healthcare workers not intentionally causing harm to their patients, while beneficence calls for healthcare workers to always work and do everything for the benefit of the patient (Encyclopedia.com, 2016; Page, 2012; McCarthy, 2003). The four major ethical principles above happen to be common to almost all the available ethical theories, aside from Principlism. They strive to harmonize ethical principles with socio-cultural and religious beliefs (Advanced Practice Toolkit, 2018).
The principle of respect for autonomy dictates that the healthcare professional should respect the decision of care taken by a mentally competent and adult patient or relative of patient. The professional must not object to the decision even if it appears unsound and irrational. This means no healthcare professional has the moral authority to overrule the decision taken by a mentally sound patient or a competent relative concerning their care. Moreover, they must also first obtain consent for any procedure on the patient after thorough explanation of consequences (Encyclopedia.com, 2016; McCarthy, 2003). The ethical principle of fairness or justice on its part dictates that the health professional and the health institution have a distributive and criminal responsibility in so far as the patient’s condition and conduct are concerned. This is in relation to the patient’s condition and its interaction with other members of the society. Resources must be shared fairly (like available organs for transplantation), and matters like a patient intentionally attempting to infect another with a deadly disease (a criminal act) must be reported by the health worker to the relevant authorities (Encyclopedia.com, 2016; McCarthy, 2003).
Applying the Four Principles: Case Study Part 1 (Chart)
Beneficence and Nonmaleficence
|Beneficence dictates that the physician do the best for James who now has kidney failure and not allow harm to befall him (nonmaleficence). Hence the decision to put him on immediate dialysis. Also, the suggestion by the physician to consider Samuel as a potential donor after failure to get a suitable one is an act of beneficence. However, the physician must also assess the potential risks to Samuel in donating a kidney to James, as required by the principle of nonmaleficence (Encyclopedia.com, 2016; Page, 2012; McCarthy, 2003).||The principle of autonomy states that Mike and Joanne as the parents of the minors have the last say in deciding what happens to them. It is them who must not only agree to the physician’s suggestions, but also give informed consent for any procedure (including dialysis) to be done. It is for this reason that Mike and Joanne’s decision to forego dialysis for James and take him to a faith healing crusade has to be respected by the physician. Additionally, the suggestion by the physician that Samuel be the organ donor to his twin brother is subject to approval and consent by both parents; as required by respect for autonomy (Encyclopedia.com, 2016; McCarthy, 2003). This means that the decision as to whether James will get one kidney from his brother or wait for God to perform his miracle on him is the parents’.|
|Quality of Life
Beneficence, Nonmaleficence, Autonomy
Justice and Fairness
|To save James (nonmaleficence) and improve his quality of life (beneficence) the physician has suggested immediate dialysis. However, the parents must first give their consent for that to happen (autonomy). This is the same case with the suggestion of transplantation by the physician.||The principle of justice and fairness requires that the physician and the health institution consider James with priority in the list of those waiting for transplantation based on the urgency of the situation.|
Applying the Four Principles: Case Study Part 2 (Evaluation)
From a Christian standpoint, of the four ethical principles of Principlism the most pressing one in this case study is nonmaleficence. As stated above, this is the principle that states that no harm should be brought upon the patient by the actions of those taking care of him (Encyclopedia.com, 2016; McCarthy, 2003). This is consistent with a study that was conducted by Page (2012). In the survey conducted by the use of a questionnaire, it was found that student healthcare workers actually ranked nonmaleficence highest among the four principles. Conversely, they ranked beneficence or “truth-telling” as the least important (Page, 2012). Arguably, this is also the same factor that is motivating the religious parents of James and Samuel. As such, their refusal to immediately allow James to undergo dialysis and opt for faith healing is informed partly by fear that the procedure (dialysis) might also harm James. Equally, the parents’ reluctance to buy into the idea that Samuel donates one of his kidneys to James is also a result of fear that Samuel may remain in a precarious health situation after donating his kidney. In all this, the general Christian view therefore is that God cannot allow harm to befall any of his creation.
From a Christian point of view, again, a Christian person might rank the four principles in order of priority from the highest to the lowest as follows: nonmaleficence, beneficence, justice, and autonomy. As explained above, a Christian will most likely view nonmaleficence as the most important of the four. This is because it is very unChristian to want to cause harm to another human being. Beneficence should come second for the simple reason that it is the opposite of nonmaleficence. Beneficence is the act of doing good to the other person and carrying out all activities with the intention of ultimate benefit to them, in the context of a patient and care giver (Encyclopedia.com, 2016; Page, 2012; McCarthy, 2003). For a Christian person, the act of not intending to do harm to the patient (nonmaleficence) is automatically supported by a need and wish to do what benefits the patient (beneficence). The third principle from the top in this hierarchy would be justice. For a Christian, after refusing to harm their “neighbor” and deciding to only do what benefits the said “neighbor,” the next thing they would want for this person is nothing but justice and fairness. He would want this person to be treated justly and fairly in terms of not only sharing available resources, but also preventing harm to them by those with criminal intent for instance. Lastly and at the bottom of the list would be respect for autonomy of decision by the patient or relatives.
The biomedical ethical theory of Principlism with its four principles of respect for autonomy, beneficence, nonmaleficence, and justice closely conforms to and agrees with common socio-cultural and religious preferences and beliefs. This makes it better placed to be a reference point in ethical decision-making in clinical practice.
Advanced Practice Toolkit (1 May 2018). Ethical Principles. Retrieved from https://www.advancedpractice.scot.nhs.uk/law-ethics/ethics/ethical-principles.aspx
Encyclopedia.com (2016). Principlism. Retrieved from https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/principlism
McCarthy, J. (2003). Principlism or narrative ethics: Must we choose between them? Journal of Med Ethics; Medical Humanities, 29(2), 65-71. Doi: 10.1136/mh.29.2.65
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision making? BMC Medical Ethics, 13(10). Doi: 10.1186/1472-6939-13-10