"If you are at all familiar with the dominant vocabulary of American bioethics, you are undoubtedly aware that it is an ethics based on principles, most notably the principles of autonomy, beneficence, justice and nonmaleficence People involved in health care, especially physicians and nurses, are expected to observe rules and rights derived from these general principles to determine what they are morally obliged to do in particular situations. If the principles clash, as they often do, then they must be balanced against each other to determine which one obliged or they must be adjusted to preserve coherence in the system. In the minds of many, making moral decisions and judgments in health care ethics remains a process of guiding our actions in accord with the obligations and rights established by the general principles and the more specific rules derived from them."