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Bioethics details the guidelines and structure for addressing the ethical problems and concerns surrounding the life sciences that entails all living things and nature. Principalism is denoted and defined as a moral structure that involves ethical principles that are used in addressing ethical issues in medicine. The word is coined by the opponents of the principles who denounce the limited usage of it and its functionality. It includes various applications regarding moral values, guidelines, and numbers them according to their significance. The approach of principalism must include some moral reasoning. This rule of addressing ethical issues entails four principles.

These group of principles is dynamic and changes depending on the case or issue that is being addressed medically. The approach in addressing these ethical or moral issues are not significant according to critics of the principles so should not be termed an ethical framework. The four principles known as principalism, entails four general ethical concepts. These four general principles of guidelines and ethical qualities are known as beginning and obliging structure of moral perception and judgement. These principles are Beneficence which is vital in medical practice and healthcare in general, non-malfeasance which is mandatory in healthcare practice and test the healthcare giver’s moral values by doing no harm to individuals that are at their most vulnerable state of life; autonomy is comparative because it depends on what is being evaluated and lastly is justice which is controversial and divisive.

Beneficence and non-malfeasance are critical in healthcare because it addresses the ethical basis of healthcare and is in line with the Christian biblical narrative and concept of caring. Christianity provides a foundation for medical ethics because ethics entails moral judgement when doing things by barring harmful and sinful behavior by being righteous in agreement with one’s and God’s purposes. Christians believe, according to the scripture, that human beings are formed in God’s image, and God respects and honors every being irrespective of their social, physiological, psychological or financial situation. This entails caring for people to the best of your ability and causing them no harm. According to “Beneficence can never be forsaken, non-malfeasance is built into beneficence. Non-malfeasance assumes greater importance in research, beneficence in therapy, but beneficence cannot exclude non-malfeasance”. The core aspect of medical or healthcare practice is to care for the patients to the best of our ability and knowledge causing the least possible hurt while creating comfort and doing no harm.

 Autonomy is known as the first principle but may be negotiated in some cases or circumstances. This principle involves healthcare practitioners to have the ability to determine and evaluate a patient’s identified outcome and to plan interventions accordingly. Sometimes this can be complicated in the healthcare delivery system regarding how to determine who needs care first especially in dire situations where the practitioner for instance has to determine who needs an organ transplant first; a mental health patient, a prisoner or a 4-month old child? It is also a bigger problem in the clinical study for cancer drugs where it relates to setting up informed consent regarding fitness, revelation of knowledge and ability to participate in the trial. According to Shelly & Miller (2006), “Human autonomy may seem good at first, but it is a deception from the enemy, and eventually everything goes wrong. In truth, unless we give our loyalty to God and his kingdom we remain as prisoners in what Scripture calls the power of darkness (Col 1:13). The Bible calls rebellion against God sin”.

Justice is complicated especially in the delivery of limited healthcare resources because patient’s rights and providers’ moral values come into play. It is one of the most complicated issues in the United States judicial and political system. The answers are not as obvious as they seem. Even in the Christian biblical narrative, the world is created by God with moral values such as in justice, compassion and truth. “God created us in his likeness, and our moral calling is to express God’s character. The law of God for our behavior corresponds with the way we are made and with the world in which he asks us to be moral agents. Those who advocate a natural law ethic are right when they argue for a moral creation. Paul writes about those who do instinctively what God’s law requires because it is written on their hearts (Rom 2:14-15).Reflecting on our general sense of morality, however, leaves us perplexed” (Shelly & Miller, 2006, p.157)

The process of assessment to meet identified outcomes by evaluation and judgements is a delicate process that entails and is guided by one’s moral values. The above mentioned principles should be balanced seeking direction from God allowing his moral values to reign, denouncing prejudice, and following ethical guidance. Principalism is not without questions and challenges in society today, but it remains the key guideline in bioethics and healthcare today.