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Comment 1
Principalism has really evolved into a practical approach for ethical decision-making which concentrates on common ground moral principles for autonomy, justice, beneficence, as well as non-maleficence (Döring, 2011). Principalism is also referred to as four-principal approach because of the four ethical principles which entail bioethics.  Let us look at these four principals.
The first one is respect for autonomy. This involves respect for what happens to person’s own bodies. This implies that patients may decide the kind of treatment one want as well as their right to refuse medications, treatment, and surgeries and this decision must be respected by caregivers (Döring, 2011). A good example is blood transfusion in a patient who is a Jehovah Witness believer. Even though the patient totally in need of blood, we must respect the fact that Jehovah Witness followers refuse blood transfusions. The other principle is nonmaleficence. This means doing no harm (Döring, 2011). It implies making of best medical decision as well as abiding by rules and regulations to ensure that patients are safe. This can even be small assignments such as hand hygiene as a way of preventing various infections. The other ethical principle beneficence which involves promoting all that is good (Döring, 2011). It involves striving to improve patient’s health based on the situation. The last principle is justice. This means that fairness within treatment and patient care need to be practiced to carry out justice. Distribution of resources should also be given equally.
These principles should be ranked the way I have written them, i.e., respect for autonomy, nonmaleficence, beneficence, and justice with the first one being the most important. Allowing patients to participate in their treatment and making their medical decisions is very important (CİVANER, 2016). This allows for an equal diplomatic approach to healthcare where both parties are involved. Even when we bring in Christian biblical narrative of creation, redemption, fall, and restoration, autonomy is important because it allows patients to choose what they want (CİVANER, 2016). Eve when God brought a human into the world, He enabled them to choose what is right for them and what is wrong for them.
Comment 2
The four principal approaches consist of four universal ethical principles, it consists of respect of autonomy which states to make autonomous decision that people can take and that should be respected. The other principal is non-maleficence states about an obligation to not harm anyone; beneficence is the action to benefit others and to simply improve any situation. Lastly, justice is the principle that works on the distribution of benefits which also engage risks and costs (Page, 2012). Thus, the principle of biomedical ethics claims that no one principal is more important than the other.  Above all it is the justice that should be given to all. We should be just towards others and always respect others, their decision and autonomy. 
It is first the justice, and then respect after that comes non-maleficence and then beneficence. On the biomedical ethical grounds in the United State, it merges all the other grounds in one sphere and also differentiates one from the other in certain aspects. Justice trumps over all other values or principals and it is the one above all. Therefore, in the case study autonomy has been held above all. The doctor did not pressurize the family to take any decision instead gave Mike and his wife full autonomy to decide the right path and take the call.         

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