When health care reform makes purchasing insurance an obligatory choice, which ethical tension is most directly involved?

• A. Autonomy versus Beneficence.
• B. Veracity versus Justice.
• C. Nonmaleficence versus Fidelity.
• D. Confidentiality versus Justice.

Answer: (A)

The central tension here is autonomy versus beneficence. Respect for autonomy means individuals have the right to make their own health-related decisions, including whether to purchase insurance. Beneficence focuses on promoting welfare and preventing harm, which a health reform aims to do by expanding coverage and improving access to care. When insurance becomes mandatory, the policy limits personal choice in order to achieve broader health benefits for individuals and society, creating a direct clash between honoring individual decision-making and pursuing the greater good. The other ethical tensions—truth-telling, justice in distribution, privacy, or keeping promises—are not the primary conflict in a mandate to buy insurance.