Applying the Four Principles: Case Study

Part 1: Chart (60 points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible.


Medical Indications

Beneficence and Nonmaleficence

Patient Preferences


James has acute glomerulonephritis, a product of strep throat infection. His condition is made severe by high blood pressure and fluid build-up, thereby necessitating temporal dialysis. The doctor sees the dialysis as what is best for James, but the parents opt for prayers to save their son from the ‘uncomfortable’ dialysis. The delay aggravates the condition so that James now needs a kidney transplant. As a minor, James does not participate in decisions regarding his health. The parents make the decision without considering his input. The physician respects the autonomy of the parents.
Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

The hospital has improved James’s quality of life after his parents brought him back from prayers. The regular dialysis keeps him stable and from more harm, but he still needs a kidney transplant. However, the failure by parents to at least consult him begs the question of whether he feels valued. James’ parents use their faith/religion to make medical decisions. Even the question of letting the brother donates involves faith. Nonetheless, there is also a question of whether it is fair/just to let non-relatives give their kidneys while at the same time preventing the twin brother from doing so.



Part 2: Evaluation

Answer each of the following questions about how principlism would be applied:

  1. In 200-250 words, answer the following: According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)
Christianity regards the four ethical principles as crucial to decisions involving dilemma. While deciding the best course of action, Christians should evaluate the situation and apply the principles. However, depending on the situation, some of the ethical principles tend to be more pressing as compared to others. In James’ case, beneficence ranks first, according to the Christian worldview. Although James is stable, he will die if he does not get a kidney transplant within a year. This dire situation calls for all parties involved to do what can save James’ life. The Bible regards life as sacred, and as such, Christians must do everything they can to save a life (Orr, 2015). Apart from saving James’ life, there is also a need to bolster his quality of life. This goal is only achievable through beneficence. The health practitioners and the parents must act in ways that ‘promote good’ to James. From a Christian perspective, people must demonstrate love to other people. One way of fulfilling this chief commandment is by performing actions that promote the wellbeing of others. For this reason, the primacy of beneficence stands out in James’ case. Any action taken must put the principle of “doing good’ at the center of the whole situation.


  1. In 200-250 words, answer the following: According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points)
As expected, people always attempt to rank the four principles according to priorities. However, this ranking largely depends on the worldview of the individual making the evaluation. As such, a ranking done by a Christian might be different from the one by a Hindu. In the Christian perspective, beneficence takes the top spot. The primacy of the commandment of love obliges every Christian to aspire to do good actions no matter the circumstances. Due to its close association with beneficence, nonmaleficence takes the second position. This principle requires individuals not to harm others. From a Christian worldview, it is sinful to cause harm to others. Christians must be ‘healers,’ not destroyers. The third principle in order of priority is justice. Typically, justice addresses issues such as equality, fairness in the distribution of resources, and compliance to morally acceptable laws (Lozano, 2004). In Christianity, the scriptures teach people to be fair and just in everything they do. Their actions ought to uphold justice and fairness. The last principle is autonomy. During the decision-making process, Christians should allow others to give their opinions or ideas. More importantly, they should respect other people’s positions, even when there is a disagreement. Doing so upholds autonomy.



Lozano, A. J. (2004). Principles of Bioethics for Christian Physicians: Autonomy and

Respect. The Linacre Quarterly71(2), 104-113.

Orr, R. D. (2015). Incorporating spirituality into patient care. AMA journal of ethics17(5),