Case Study Applying the Four Principles Assignment

Case Study Applying the Four Principles Assignment

Case Study Applying the Four Principles Assignment

The concept of principalism implores healthcare providers like nurses and physicians to make decisions by considering the four biomedical principles of beneficence, autonomy, non-maleficence and justice. Physicians and nurses encounter ethical dilemmas when their decisions require observance of these principles at the expense of offering life-saving interventions for patients, especially minors and those incapacitated. Principalism legitimizes moral thinking and decisions that providers can make regarding the provision of care to patients (Beauchamp et al., 2019). Based on the case study, “Healing and Autonomy,” this paper evaluates the application of these principles using the four-quadrant approach.

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Part 1: Chart

The four-quadrant approach is a critical method that allows healthcare providers to make ethical decisions when they encounter ethical issues and dilemmas. Through the four-quadrants, providers can collect information as much as they can to understand a patient’s condition and aspects that impact any suggested interventions. The four-quadrant box includes medical indications, patient preferences, quality of life and contextual issues or features. This framework focuses on ethical issues based on the four moral principles of respect for autonomy, beneficence, non-maleficence, and justice. The framework provides a practical approach to analysis of ethical challenges and issues that may hamper effective decision-making and provision of quality services by practitioners (Teven et al., 2018). The implication is that providers leverage this model to arrive at the most logical approaches and strategies that enable them to offer quality care to patients in diverse care situations and settings as illustrated in the case study of “Healing and Autonomy.”

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Medical Indications

Beneficence and Nonmaleficence

Patient Preferences


Medical indications focus on aspects like the patient’s diagnosis, their prognosis based on the proposed measures for assessment, treatment and evaluation. In all clinical situations, providers start by describing what they know about medical facts of each unique case (Teven et al., 2018). Based on the collected information, the providers develop interventions with the best interest of the patient and overall quality of care and prognosis. These interventions and actions rely on the two critical ethical principles; beneficence and non-maleficence. Beneficence implores physicians and other providers to confer medical and health benefits based on the interests and needs of a patient (Beauchamp et al., 2019). Non-maleficence means that any action by healthcare providers should not cause harm to patients and even their families. Therefore, based on medical indications, a provider must focus on conferring benefits to a patient and ensuring that no harm happens in the process of administering treatment interventions.

In this case, James requires interventions based on his diagnosis as suffering acute glomerulonephritis caused by strep infection and a dialysis can alleviate the condition. The decision by the physician is based on the principle of beneficence as he wants to ensure that James gets well. However, the parents forego a dialysis and opt for a miracle healing service in their church. The family returns after two days and James is placed on dialysis because his condition got worse. The medical indications show that James now needs an immediate dialysis and later on a kidney transplant due to his situation. The implication is that the physician was keen on ensuring that there was minimal harm on James before his condition worsened when the parents opted for the healing session in their church.

Patient preferences are essential from both a medical and ethical perspective. Patient preferences denote the desires and aspirations as well as needs that a patient wish to have accomplished through the medical and healthcare processes. Patients demonstrate their preferences through their abilities to make fundamental decisions and choices (Teven et al., 2018). When patients have decision-making capacity, their preferences should be respected and used to guide the medical and health care processes and interventions. Respect for autonomy is a critical component of complying with patient preferences as it means that physicians and other providers should adhere to the decisions and aspirations of their patients. In this case, James is a minor and his parents make the decisions and show his preferences. Mike and Joanne prefer the healing service when the physician recommends a dialysis upon them presenting James at the facility. Based on the principle of autonomy, the physician cannot make any decision regarding care without the express authority of the parents. Further, the principle of autonomy bars physicians and other providers from making decisions on behalf of patients. The implication is that the physician allows Mike and Joanne to take James to the healing service because of respect for autonomy. James’s condition gets worse and they decide to bring him back because it is their preferences and exercise their autonomy on behalf of the boy.

The physician also suggests that Samuel, James’ twin brother, donates a kidney as it is the only one matching. However, the preferences of the parents are that Samuel should not be the donor as they are worried about the outcome and would like others to be donors. All these affect the treatment and the physician cannot do anything based on the autonomy of patients and preferences.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

Diseases and injuries can have negative effects on the quality of life. The primary goal of medicine and health care processes is to preserve restore, and enhance the quality of life (QOL) (Teven et al., 2018). Therefore, it is essential to discuss the effects of treatment interventions and even care plans on the quality of life, especially for a chronic or acute condition as demonstrated in the case. While the quality of life is subjective by nature, individuals seeking treatment must develop effective interventions based on the three principles of beneficence, non-maleficence, and respect for autonomy.

The case study shows the deterioration in James’ condition because of the kidney failure that requires immediate dialysis and later on, a kidney transplant as the long-term solution. The physician and his team are categorical that only a kidney transplant can help James attain a better quality of life due to his condition (Beauchamp et al., 2019). The dialysis is only a temporary solution that is not sustainable. The physician urges Mike and Joanne to make sound decisions to help their son get well. However, his interest is based on the principles of beneficence and non-maleficence while Mike and Joanne exercise respect for autonomy as biomedical principle to make the decisions and the choices that they are making (Toh et al., 2019). Therefore, James’ quality of life depends on the decisions that his parents make concerning the donation of a kidney by Samuel.

Health care issues do not happen in isolation but illustrate a larger situation that may require ethical evaluation before making decisions. Contextual features impact decisions that people make concerning medical interventions. These features emanate from ethical, legal, religious, and family dynamics and aspects that impact decision-making by providers in diverse settings (Teven et al., 2018). Patient-centered issues like family dynamics, financial situation and resources as well as religious and cultural identities and factors, and environment matters like the possible legal ramifications affect the provision of care and decision-making by those involved (Beauchamp et al., 2019). Imperatively, these contextual factors have a significant impact on justice and fairness. For instance, Mike and Joanne’s religious life and faith is affecting the decisions that they make concerning James’ treatment. The parents are not fair since they believe that taking James to church for a healing service will improve his healing. However, they are not doing this in his interest but only to fulfill their interests and demonstrate if they have sufficient faith in God. The recommendation by the physician to have Samuel donate his kidney does not augur well with them and further show unfairness on their part. However, actions by the parents are within justice realm since they are parents to James who is a minor (van Bruchem-Visser et al., 2020). The implication is that contextual features have a significant impact on the decisions that stakeholders make in care provision as demonstrated in this case.

Part 2: Evaluation

Answer each of the following questions about how the four principles and four boxes approach would be applied:

  1. In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)
The Christian worldview advances diverse sets of principles which agree with the actions and decisions that Mike and Joanne make in the case study. The four principles can be specified and weighted in the case based on the diverse approach to issues by Christians as demonstrated by Mike. Christianity advances the creation of man as free and independent based on God’s image (Superdock et al., 2018). Consequently, as a free being, individuals exercise autonomy and have the capacity to make independent choices and decisions. James parents make independent decisions in this case when they opt for healing service as an illustration of their faith as opposed to treatment interventions and plane. The weight of the decision by Mike has devastating effects as James’ condition gets worse necessitating his return. Health providers offer sufficient and relevant information but respect the decisions and preferences that patients and their families have as illustrated in this case.

The healthcare team and the physician specify the principles of beneficence and non-maleficence by recommending treatment interventions to improve James’ condition. The physician makes a clear diagnosis and action plan on different occasions when James’s parents present him in the facility (Harvey & Gardiner, 2019). As they weigh the two recommendations, it is clear that they would offer more benefits to James and cause no harm. All the decisions are positive and would lead to improved quality of life. The principle of justice is clearly specified by the physician by recommending a kidney transplant and Samuel as the matching donor. The parents weigh the recommendation based on Christian belief and opt for a miracle healing as a way of addressing the issue. However, this does not work as the boy returns in a worse situation than before, necessitating the need for immediate dialysis.


  1. In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why. (45 points)
Healthcare providers ensure that they balance each of the four principles based on the weight or significance that each presents. Christians can use ethical principles enshrined in their belief system to balance each of the principles in this situation. The first principle would be autonomy as demonstrated by James’ parents who are free to make decisions without any interference from the physician and his team. Mike and Joanne are inherently free based on the Christian ethical principles and consider all options at hand without any coercion from even the authority and the hospital (Harvey & Gardiner, 2019). However, they find it delicate to balance this principle with justice principle as it means that they are not fair to James. The decisions that they make do not confer substantial benefits to him and proceeding with it is being unreasonable from a medical perspective. Nonetheless, they proceed but fail to get anything positive and return him to the facility.

From a Christian perspective, one can balance these principles when they appreciate their roles in health and medical decision-making and their degree of application or usage. The case study shows that one must balance beneficence and non-maleficence and autonomy as these impact the quality of life for the patient, James. The physician has an obligation to show the best interventions to deal with the issue and explain the benefits as well as possible harm (Varkey, 2021). His actions, recommendations, and procedures show no harm intended. He focuses on the best possible outcomes based on the current situation. These recommendations and suggestions that he advances show that Christians consider ethical principles based on the Biblical teachings of Jesus Christ and their subsequent application in life. Therefore, a Christian must demonstrate a delicate balance of the three principles of autonomy, justice, and non-maleficence as critical pillars of showing love for one another irrespective of their situations (Superdock et al., 2018). James needs interventions that implores his parents and the team to have a perfect balance of the four principles a this will indicate God’s love through sacrifices and selflessness.


The application of ethical principles based on the four-quadrant method shows that physicians and healthcare providers encounter delicate situations that lead to ethical dilemmas. Effective responses to these issues requires them to apply the most appropriate approaches and develop rapport with patients based on the ethical principles to avoid such dilemmas. James’s case indicates the need for patients and physicians to uphold best practices to discharge positive outcomes based on diverse perspectives, like the Christian worldview.


Beauchamp, T., & Childress, J. (2019). Principles of biomedical ethics: marking its fortieth

 anniversary. The American Journal of Bioethics, 19(11), 9-12.

DOI: 10.1080/15265161.2019.1665402.

Harvey, D. J. R., & Gardiner, D. (2019). ‘MORAL balance’ decision-making in critical care.

            BJA Education, 19(3), 68. DOI:

Teven, C. M., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care.

AMA journal of ethics, 20(6), 595-601.

Toh, H. J., Low, J. A., Lim, Z. Y., Lim, Y., Siddiqui, S., & Tan, L. (2018). Jonsen’s four topics

approach as a framework for clinical ethics consultation. Asian Bioethics Review, 10(1), 37-51. DOI: 10.1007/s41649-018-0047-y

Torry, M. (2018). Ethical religion in primary care. London Journal of Primary Care, 9(4), 49-53.

            DOI: 10.1080/17571472.2017.1317407

Superdock, A. K., Barfield, R. C., Brandon, D. H., & Docherty, S. L. (2018). Exploring the

vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliative Care, 17(1), 1-14. DOI: 10.1186/s12904-018-0360-y.

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical

            Principles and Practice, 30(1), 17-28.

van Bruchem-Visser, R. L., van Dijk, G., de Beaufort, I., & Mattace-Raso, F. (2020). Ethical

frameworks for complex medical decision making in older patients: A narrative review. Archives of Gerontology and Geriatrics, 90, 104160.

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Assessment Description
This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles and four boxes approach.

Based on the “Case Study: Healing and Autonomy” and other required topic Resources, you will complete the “Applying the Four Principles: Case Study” document that includes the following:

Part 1: Chart

This chart will formalize the four principles and four boxes approach and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.

Remember to support your responses with the topic Resources.

APA style is not required, but solid academic writing is expected.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.


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