Healthcare professionals are continually faced with situation where they have to make critical decisions, sometimes with the life of a patient, or public health concerns hanging in the balance. Different theories and concepts have been developed to ease the process of decision-making while others have developed through practice. Among key decision-making concepts include principalism, virtue ethics, and casuistry. Christian doctrine as based on scripture also canvasses right and wrong thus can be applied into decision-making processes based on the theories and concepts indicated above.
The Four Principles of Principalism in Order of Importance
How I Would Rank Them
The four principles of principalism are autonomy, beneficence, Non-maleficence and justice. Based on a careful analysis of the rules and related research, I believe that non-maleficence would be the most important principle. Under ordinary circumstances, healthcare professionals will always seek to do good based on their training, oaths, and ethics. However, when critical decisions come to the fore, lines are blurred and doing the right thing is convoluted (Bucknall et al., 2016). For example, virtue ethics is based on the character of the doer, rather than the nature of the action. What is right and what is supposed to be right become blurred hence the need to focus on not hurting the patient. Seeking to avoid wrong is, therefore, paramount. The second principle in my opinion is autonomy. In modern holistic nursing, the will of the patient is paramount, even when it does not agree with the will of the nursing officer hence the importance of patient autonomy (Stewart, 2018). Benefice takes the third position, based in the concept of always seeking to do good to the patient and the patient’s loved ones. However, in the healthcare profession, doing good is always expected hence not always rewarded while maleficence or breaching patient autonomy can lead to legal or ethical liability (Chua & Pitts, 2015). Seeking to always do good can also lead to warped logical reasoning such as casuistry reasoning which will be detrimental. Finally, there is justice which relates to the fair distribution of burdens and benefits. The nursing profession is all about sacrifice hence justice and fairness will normally come last.
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Ranking as Per Christian Narrative
When reviewed based on the Christian faith, some of the principles will carry more weight than the others. Beneficence would be the most important principle based on scripture (Kadar et al., 2015). According to the Bible, God is love and loving one another is most important commandment. Beneficence is a manifestation of love, thus comes first. Non-maleficence would take the second position. Most of God’s commandments, rules, and laws are against sin which includes doing wrong to others as Christ did (Caldwell & Holloway, 2017). However, avoidance of doing wrong, while paramount cannot be superior to actually doing right. Justice based on the concept of fairness can be considered as the third principle. Several important versus relate to fairness including doing to others as one would want done unto them. Finally, autonomy would rank last, since it is not prioritized in the bible. Whereas Christianity is based on humans having the benefit of choice, Christians are supposed to sacrifice that right in order to obey God explicitly (Majerus & Sandage, 2010).
Conclusion
Making important decisions will never be easy, more so when the stakes are as high as human life. As reflected above, even a singular concept or theory such as principalism becomes vague and complicated when looked at from different perspectives. The reasoning based arrangement above differs from the scriptural-based reasoning that follows soon after. It is also possible that another person might arrange the four principles differently based both on logical reasoning and scriptural interpretation. Even secondary concepts of decision-making, such as virtue ethics and casuistry seem to further complicate rather than ease the process. The determination on whether a decision was right or wrong varies exponentially thus making practice in the healthcare profession more intricate.
References
Bucknall, T. K., Forbes, H., Phillips, N. M., Hewitt, N. A., Cooper, S., Bogossian, F., & First2Act Investigators. (2016). An analysis of nursing students’ decision‐making in teams during simulations of acute patient deterioration. Journal of Advanced Nursing , 72 (10), 2482-2494
Caldwell, C., & Holloway, C. S. (2017). Raising the bar–transformative ethics and the example of Christ. Business and Management Research , 6 (4), 54-63
Chua, S. J., & Pitts, M. (2015). The ethics of prescription of placebos to patients with major depressive disorder. Chinese Medical Journal , 128 (11), 1555-1557
Kadar, J. L., Scott, A. B., Hipp, K., Belavich, T. G., Butfer, E. M., Rye, M. S., ... & Zinnbauer, B. J. (2015). Religion and spirituality: Unfuzzying the fuzzy. In Sociology of Religion (pp. 29-34). New York: Routledge
Majerus, B. D., & Sandage, S. J. (2010). Differentiation of self and Christian spiritual maturity: Social science and theological integration. Journal of Psychology and Theology , 38 (1), 41-51
Stewart, R. S. (2018). Some ethical issues in treating and caring for people with dementia. Online Journal of Health Ethics,14 (1). doi:10.18785/ojhe.1401.05
