HLTH 3100 Week 2 Ethical Principles Brief Example

Four Principles on Paper and Where Two of Them Collide: Mr. Okafor Wants to Go Home Alone

Student Name

Walden University

HLTH 3100: Ethical and Legal Issues in Healthcare

Instructor Name

Month Day, Year

Four Principles on Paper and Where Two of Them Collide: Mr. Okafor Wants to Go Home Alone

Purpose

The four principles approach to health care ethics, developed by Beauchamp and Childress, names respect for autonomy, nonmaleficence, beneficence and justice as general norms that guide decisions in health care (Beauchamp & Childress, 2019). This brief defines each principle in my own words, with an example of what it asks of a health care organization, not only of a clinician. It then runs all four against one scenario until two of them collide, and it explains how the collision can be worked through without simply declaring a winner. The scenario is invented for the assignment.

The Four Principles, Defined

Respect for autonomy. People who are able to make their own decisions have the right to make them about their own bodies and lives, including decisions others think are unwise. For an organization, this means giving patients real information, real choices and enough time to use both, not only a form to sign.

Nonmaleficence. Do not cause harm, or risks of harm, without a good reason. For an organization, this includes harms caused by its own processes, such as discharging a patient into an unsafe situation because a bed is needed.

Beneficence. Act to benefit others, and weigh benefits against risks and costs. Beneficence asks more than avoiding harm: it asks the organization to do something positive, such as arranging services that make a patient safer.

Justice. Distribute benefits, risks and costs fairly, and treat similar cases similarly. For an organization, justice raises questions such as whether patients with fewer resources receive the same discharge planning as patients with family support.

The principles are presented as equal in weight. None automatically overrides the others; each must be balanced against the rest in a particular case (Beauchamp & Childress, 2019). That is what makes collisions possible, and also what makes them interesting.

The Scenario

Mr. Okafor is 81, a retired machinist, and lives alone in a two-story house. He was admitted after a fall at home with a broken wrist and a mild concussion. After three days, he is medically ready for discharge. The physical therapist recommends a short stay in a skilled nursing facility for rehabilitation, because he is unsteady on stairs and cannot use his right arm. Mr. Okafor refuses. He says he has lived in his house for 45 years, his bedroom is upstairs and he will manage. He understands that he could fall again, says so clearly and repeats the risks back accurately. His daughter lives two hours away and is worried. The hospital needs the bed.

Running the Principles Against the Scenario

Respect for autonomy supports Mr. Okafor's choice. He appears to understand the situation, appreciate the risks and reason about them in light of his own values, and he communicates a clear choice, which are the four abilities commonly used to judge decision-making capacity (Appelbaum, 2007). Nothing in the scenario suggests he lacks capacity. His decision is risky, but risky decisions are exactly what autonomy protects.

Beneficence points toward the skilled nursing facility. Rehabilitation would likely improve his strength and balance and reduce the chance of another fall. The physical therapist's recommendation is an expression of beneficence.

Nonmaleficence points in two directions. Sending him home without support risks a second fall, which could be far worse than the first. But overriding his choice, or pressuring him until he gives in, would harm him too, by taking away control at a vulnerable moment.

Justice is less central here but not absent. The hospital's need for the bed is real, and justice requires attention to other patients waiting. But justice also requires that Mr. Okafor's discharge be planned as carefully as it would be for a patient who accepted the therapist's advice.

The Collision and How to Work Through It

The clear collision is between respect for autonomy and beneficence. The patient's choice and the patient's good, as the clinical team sees it, point different ways. One easy answer is to say autonomy wins because he has capacity, and discharge him home. Another is to say beneficence wins because the risk is serious, and keep pressing until he agrees. Both answers treat the principles as rivals where one must lose.

A better approach looks for the action that honors autonomy while doing as much good as possible within his choice. Gillon (1994) described the principles as a framework that requires attention to the scope of each and to the particular case, not a formula for picking winners. Here, that means accepting that Mr. Okafor will go home and then using beneficence to make home as safe as possible: a home health referral for physical therapy, a temporary bed set up on the ground floor, a medical alert device, a call from the daughter each evening for the first week and a follow-up appointment within days. The organization owes him this extra planning because he declined the safer option, not in spite of it.

This resolution does not make the collision disappear. Mr. Okafor will still be at higher risk at home than in a facility, and the team must accept that risk as the cost of respecting his choice. What changes is that beneficence is not abandoned; it is redirected.

What the Exercise Shows

Running the principles against a scenario shows that they work less like rules and more like questions. Each asks something different: what does the patient want, what would help, what could harm and is this fair? The answers often disagree, and the work of ethics is balancing them in a specific case. For a health care administrator, the lesson is practical: when a patient refuses a recommendation, the organization's job does not end with documenting the refusal. It shifts to making the patient's chosen path as safe as it can be, which may require resources, such as home health and equipment, that a policy focused only on bed turnover would not provide.

The scenario would change if one fact changed. If Mr. Okafor could not repeat the risks back, or if his reasons shifted each time he was asked, his capacity would be in doubt and beneficence would carry more weight. That sensitivity to facts is a strength of the framework, not a weakness.

References

Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. BMJ, 309(6948), 184-188. https://doi.org/10.1136/bmj.309.6948.184