Which ethical decision-making framework can help resolve conflicts when principles diverge, and how is it applied?

• A. Utilitarianism; weigh overall good.
• B. Deontology; apply universal duties.
• C. Principlism; weigh autonomy, beneficence, nonmaleficence, and justice to reach a balanced, patient-centered decision.
• D. Relativism; adapt to cultural norms.

Answer: (C)

Principlism provides a flexible framework for ethical decision-making in contests where principles pull in different directions. It centers on four guiding claims: respect for autonomy (honoring the patient’s informed choices and values), beneficence (acting in the patient’s best interests), nonmaleficence (avoiding harm), and justice (fairness in distribution of benefits, burdens, and resources). When principles diverge, this approach doesn’t lock you into a single rule; instead, you analyze how each principle applies to the situation and consider their relative weight in that context.

In practice, you start by clarifying the ethical issue and identifying which principles are most implicated. Then you examine how autonomy, beneficence, nonmaleficence, and justice support or conflict with one another given the patient’s wishes, prognosis, risks and benefits of options, and considerations of fairness or resource constraints. The aim is to reach a balanced, patient-centered decision that respects the patient’s preferences while promoting well-being, minimizing harm, and ensuring fair treatment. When conflicts remain, you seek a thoughtful compromise that honors all four principles as much as possible, often engaging the patient and other stakeholders in the deliberation. Finally, you reflect on the outcome to determine if the balance was appropriate and how it might be adjusted in the future.

Other approaches tend to emphasize a single aim—like overall good, universal duties, or cultural norms—which can sidestep the nuanced balancing of competing claims in real clinical scenarios. Principlism, by contrast, guides you to weigh and harmonize multiple ethical considerations to arrive at a patient-centered resolution.