Bioethical Dilemmas

Why This Matters

Bioethics sits at the intersection of philosophy's biggest questions: What gives life value? Who gets to make decisions about bodies and health? How do we balance individual freedom against collective welfare? When you encounter bioethical dilemmas on an exam, you're being tested on your ability to apply core ethical frameworks—utilitarianism, deontology, virtue ethics, and care ethics—to real-world scenarios where these theories often conflict. These aren't abstract puzzles; they're the exact situations doctors, policymakers, and families face every day.

What makes bioethics particularly challenging is that reasonable people using sound ethical reasoning can reach opposite conclusions. An FRQ might ask you to defend both sides of an abortion debate or explain why a utilitarian and a Kantian would disagree about genetic enhancement. The key is understanding which principles are in tension—autonomy vs. beneficence, individual rights vs. social good, sanctity of life vs. quality of life. Don't just memorize positions; know what ethical concept each dilemma illustrates and be ready to argue multiple perspectives.

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Autonomy and Bodily Self-Determination

These dilemmas center on a foundational question: Who has the right to make decisions about a person's own body? The principle of autonomy holds that competent individuals should control what happens to them, but this right frequently collides with other moral claims—the interests of potential life, family members, or society at large.

Abortion and Reproductive Rights

• Personhood and moral status—the central philosophical question is when a fetus acquires rights that might override maternal autonomy
• Bodily autonomy arguments draw on Judith Jarvis Thomson's famous violinist thought experiment to separate the question of fetal personhood from the question of mandatory pregnancy
• Legal and ethical divergence—what's legally permitted varies enormously across jurisdictions, demonstrating how societies weigh competing values differently

Euthanasia and Assisted Suicide

• Voluntary euthanasia (physician administers death) versus assisted suicide (physician provides means) represent distinct moral categories with different implications for medical ethics
• Right to die with dignity arguments invoke autonomy, while opponents cite the sanctity of life and concerns about vulnerable populations being pressured
• Slippery slope concerns—critics worry that permitting assisted death could erode protections for disabled or elderly individuals who feel they're "burdens"

Informed Consent in Medical Procedures

• Respect for persons requires that patients understand risks, benefits, and alternatives before agreeing to treatment—this is autonomy in action
• Capacity and competence create complications when patients are minors, cognitively impaired, or in emergency situations where consent isn't possible
• Cultural and structural barriers—language differences, power imbalances, and time pressures can undermine genuine informed consent even when forms are signed

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Beginning and End of Life

These dilemmas force us to confront the boundaries of moral consideration: When does a human life begin to matter morally? When, if ever, does it stop mattering? Different ethical frameworks draw these lines in radically different places.

Stem Cell Research

• Embryonic vs. adult stem cells—embryonic sources have greater therapeutic potential but require destroying embryos, while adult stem cells avoid this but are more limited
• Moral status of embryos is the crux: are they full persons, potential persons, or biological material with no independent moral claims?
• Consequentialist defense emphasizes the millions who could benefit from regenerative medicine, weighing aggregate welfare against embryo destruction

Human Cloning

• Reproductive vs. therapeutic cloning distinction matters ethically—creating a child raises different concerns than creating tissue for medical treatment
• Identity and individuality concerns ask whether clones would be psychologically harmed or treated as means rather than ends
• Near-universal legal prohibition reflects broad societal consensus that some biotechnologies cross moral boundaries, even if we can't fully articulate why

End-of-Life Care and Decision-Making

• Advance directives allow individuals to extend their autonomous choices into periods when they can no longer communicate, respecting precedent autonomy
• Quality vs. quantity of life—utilitarian calculations about suffering must be weighed against deontological commitments to preserving life
• Surrogate decision-making raises questions about whose values should guide choices when patients cannot speak for themselves

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Justice and Resource Allocation

When resources are scarce, bioethics becomes explicitly political. Who gets access to life-saving treatments? How do we distribute the benefits and burdens of medical progress fairly? These dilemmas test your understanding of distributive justice theories.

Healthcare Resource Allocation

• Triage principles force explicit choices about whose life to prioritize—utilitarian approaches maximize lives saved, while egalitarian approaches emphasize equal moral worth
• QALYs (Quality-Adjusted Life Years) attempt to quantify health outcomes but face criticism for potentially devaluing disabled lives
• Socioeconomic determinants mean that "neutral" allocation criteria often reproduce existing inequalities, raising questions about structural justice

Organ Donation and Transplantation

• Opt-in vs. opt-out systems reflect different assumptions about default consent and have dramatically different donation rates
• Allocation criteria must balance medical urgency, likelihood of success, time on waiting list, and geographic factors—each choice embeds ethical assumptions
• Living donation introduces questions about acceptable risk to healthy donors and whether financial incentives would help or corrupt the system

Vaccination and Public Health

• Herd immunity creates a collective action problem where individual choices affect community protection, especially for those who cannot be vaccinated
• Mandatory vaccination pits public health beneficence against individual liberty, a classic tension in political philosophy
• Global vaccine equity exposes how national borders complicate utilitarian calculations about maximizing worldwide welfare

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Technology and Human Enhancement

As biotechnology advances, we face unprecedented questions: Should we use technology only to restore "normal" function, or is enhancement permissible? Who decides what counts as "normal"? These dilemmas test whether traditional ethical categories can handle radical technological change.

Genetic Engineering and Gene Therapy

• Somatic vs. germline editing—somatic changes affect only one individual, while germline modifications pass to future generations who cannot consent
• Therapy vs. enhancement distinction is philosophically unstable: is correcting genetic deafness "therapy" while enhancing memory is "enhancement"?
• Playing God objections invoke concerns about human hubris, though critics note we already intervene in nature constantly through medicine

Human Enhancement Technologies

• Positional goods problem—if enhancements provide competitive advantages, non-enhanced individuals may be disadvantaged, potentially creating coercive pressure to enhance
• Authenticity concerns ask whether enhanced achievements are truly "ours" or whether enhancement undermines the meaning of human accomplishment
• Transhumanist arguments embrace enhancement as continuous with medicine's traditional goals of reducing suffering and expanding human flourishing

Artificial Intelligence in Healthcare

• Algorithmic bias can encode and amplify existing healthcare disparities if AI systems are trained on unrepresentative data
• Accountability gaps emerge when AI makes diagnostic errors—who is responsible: the physician, the hospital, or the algorithm's developers?
• Epistemic concerns arise when AI "black boxes" make recommendations that even experts cannot fully explain to patients

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Privacy, Trust, and Professional Obligations

Healthcare depends on trust between patients and providers. These dilemmas explore the boundaries of confidentiality, the ethics of medical research, and how professional obligations sometimes conflict with other values.

Confidentiality and Privacy in Medical Records

• Therapeutic trust requires patients to share sensitive information; breaches can deter people from seeking care or being honest with providers
• Limits to confidentiality exist when third parties face serious harm—Tarasoff-type cases require weighing patient privacy against duty to warn
• Digital health data creates new vulnerabilities as electronic records can be hacked, sold, or subpoenaed in ways paper records could not

Animal Testing in Medical Research

• Moral status of animals is contested—utilitarian approaches weigh animal suffering against human benefits, while rights-based approaches may oppose testing regardless of outcomes
• Three Rs framework (Replace, Reduce, Refine) represents an ethical compromise that accepts some animal research while minimizing harm
• Regulatory requirements often mandate animal testing before human trials, creating institutional pressure that individual researchers cannot easily escape

Surrogacy and Reproductive Technologies

• Commodification concerns ask whether paying surrogates inappropriately treats reproduction as a market transaction rather than a gift relationship
• Exploitation vs. autonomy—critics worry surrogates (often from lower socioeconomic backgrounds) face economic coercion, while defenders emphasize women's right to make their own reproductive choices
• Parentage and rights become legally complex when genetic, gestational, and intended parents are all different people

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Quick Reference Table

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Self-Check Questions

1. Both abortion and euthanasia invoke autonomy—what key difference makes the abortion debate more complex regarding third-party interests?

2. Identify two bioethical dilemmas where the therapy vs. enhancement distinction is central to the ethical debate. Why is this distinction philosophically unstable?

3. Compare and contrast how a utilitarian and a Kantian deontologist would approach mandatory vaccination policies. Which principles does each prioritize?

4. Healthcare resource allocation and organ donation both involve distributing scarce medical resources. What unique ethical consideration does organ donation add that allocation decisions during a pandemic do not?

5. If an FRQ asked you to evaluate whether genetic engineering represents "playing God," what ethical framework would you use to defend the practice, and what framework would best support opposition? Explain the key principles each side would invoke.