The four principles of biomedical ethics autonomy, beneficence, nonmaleficence, and justice serve as the basis for ethical decision-making in healthcare (Rus et al., 2021). While autonomy is often emphasized in the United States due to its alignment with individual rights and informed consent, its prioritization over the other principles can create ethical dilemmas, especially when there are different populations with different cultural and socioeconomic backgrounds.
From my worldview, justice should be ranked as the highest principle because it ensures that healthcare resources and medical decisions are distributed equally for everyone. Without justice, autonomy may only be accessible to those with financial and social privilege, which can create health disparities.
Next in importance is beneficence, which emphasizes that healthcare providers need to act in the best interest of their patients (Cheraghi et al., 2023). Ensuring that medical care promotes overall well-being is essential in protecting those who may not have the same access to healthcare as others.
To continue, nonmaleficence is similar to beneficence, as the commitment to “do no harm” is essential in preventing medical errors, discrimination, and unintended negative consequences in treatment. Ensuring that interventions do not cause harm is essential in maintaining trust and enhanced patient satisfaction.
Lastly, while autonomy is important, it is the last principle in my ranking. While respecting patient choices is highly important, autonomy should not be more important than the well-being of everyone, especially during outbreaks or vaccination programs where the patient’s health can be at risk (van et al., 2025).
In conclusion, prioritizing justice, beneficence, and nonmaleficence over autonomy ensures a more ethical and equitable healthcare system that protects patients.
References
Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: an integrative review. BMC Nursing, 22(1), 1–9. https://doi-org.lopes.idm.oclc.org/10.1186/s12912-023-01246-4
Rus, M., & Groselj, U. (2021). Ethics of Vaccination in Childhood-A Framework Based on the Four Principles of Biomedical Ethics. VACCINES, 9(2). https://doi-org.lopes.idm.oclc.org/10.3390/vaccines9020113
van der Weide, H., Lovink, M. H., Luijkx, K. G., & Gerritsen, D. L. (2025). How is autonomy supported for people with dementia living in a nursing home, to what extent and under what circumstances? A realist evaluation. BMC Health Services Research, 25(1), 1–14. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-025-12349-w