Questions: Bioethics

Question 1

A competent adult Jehovah's Witness refuses a life-saving blood transfusion on religious grounds, having been fully informed of the consequences. Should the physician administer the transfusion anyway?

• A. Yes — beneficence and non-maleficence together outweigh autonomy when a life is at stake
• B. No — respecting the informed refusal of a competent patient is required by the principle of autonomy, even when the physician disagrees
• C. Yes — justice requires using available resources when they can save a life
• D. It depends on whether the patient has signed a legally binding advance directive

Answer: (B)

The four-principles approach does not automatically rank beneficence above autonomy. A competent, informed, voluntary refusal is the paradigm case of autonomous decision-making that bioethics was developed to protect. Strong paternalism — overriding a competent refusal 'for the patient's own good' — is deeply contested precisely because it treats the patient as a means to an outcome they have rejected. Option A restates paternalism without engaging the philosophical challenge. Option C introduces justice in a way that is irrelevant here. The legal question in D is distinct from the ethical one.

Question 2

The Tuskegee syphilis study is paradigmatic in bioethics because it illustrates that:

• A. Research ethics violations only occur when studies lack proper control groups
• B. Medical authority without ethical constraint can systematically exploit vulnerable populations, destroying the trust that medicine depends on
• C. The Belmont principles were already in place but were simply ignored by researchers
• D. Consent requirements should be stricter for experimental treatments than for standard ones

Answer: (B)

The Tuskegee study (1932–72) withheld treatment from Black men with syphilis without their knowledge or consent, and continued even after penicillin became available. It illustrates what happens when medical authority operates without ethical constraint — particularly on a population that was already vulnerable and distrustful of medical institutions. The study directly motivated the Belmont Report (1979), so Option C has the causation backwards: the Belmont principles were developed *in response to* Tuskegee. The lesson is about systemic power and the necessity of principled ethical oversight.

Question 3

Under the four-principles approach, the principle of autonomy does not automatically override beneficence — each case requires weighing which principle applies with greater force given the specific circumstances.

• T. True
• F. False

Answer: True

This is the foundational feature of Beauchamp and Childress's framework: the four principles (autonomy, beneficence, non-maleficence, justice) are *prima facie* obligations, meaning each has genuine weight but none has absolute priority. They can conflict, and resolving conflicts requires contextual judgment about which principle is most weighty in this type of case. For a competent patient's refusal, autonomy typically prevails; for a patient lacking decision-making capacity, beneficence may take precedence. The framework provides vocabulary for identifying the conflict, not an algorithm for resolving it.

Question 4

Informed consent is satisfied as long as the patient signs a consent form and has received written information about the relevant procedure.

• T. True
• F. False

Answer: False

This is explicitly flagged in the Common Misconceptions: informed consent requires three conditions — that the patient has *understood* the relevant information (not merely received it), that they are *competent* to make decisions, and that their choice is *voluntary* (free from coercion or undue influence). Signing a form documents consent but does not constitute it. A patient can sign without understanding; a coerced patient can sign voluntarily-appearing forms. The philosophical content of consent is about genuinely autonomous decision-making, not the bureaucratic record of it.

Question 5

Explain why the four principles of bioethics cannot simply be ranked in a fixed hierarchy, and what happens when they conflict in practice.

Model answer: The four principles — autonomy, beneficence, non-maleficence, justice — are prima facie obligations: each has genuine moral weight, but none is lexically prior to the others in all cases. They conflict in structurally different ways in different situations. Respecting a patient's informed refusal (autonomy) may conflict with preventing serious harm (non-maleficence). Allocating scarce ICU beds by likelihood of survival (justice) may conflict with giving every patient the maximum possible benefit (beneficence). A fixed ranking would resolve these conflicts mechanically, but different cases call for different weightings. A paternalistic override of a competent refusal treats autonomy as subordinate to beneficence; most contemporary bioethics rejects this. But for an incompetent patient, beneficence may appropriately override what the patient once expressed. The framework requires judgment about the type of case, not application of a priority rule.

The absence of a fixed hierarchy is sometimes criticized as leaving bioethics without action-guiding force. But defenders argue that this flexibility is a feature: it acknowledges that moral life involves genuine, context-dependent tradeoffs, and that any fixed ranking would produce clearly wrong verdicts in the cases that fall outside the paradigm the ranking was designed for.