Which of the following explains how health care reform is an ethical issue?

• A. Reforms promote the principle of beneficence.
• B. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence.
• C. Lack of access to affordable health care causes harm, invoking nonmaleficence as a basic principle of health care ethics.
• D. All of the above.

Answer: (D)

Health care reform raises ethical questions because it touches beneficence, autonomy, and nonmaleficence. Reforms aim to promote the well-being of patients and reduce suffering, which reflects beneficence by expanding access and improving outcomes. At the same time, decision-making about insurance or mandates can constrain personal choice, creating tension between autonomy and beneficence as efforts to maximize overall good may limit individual freedom. Finally, when affordable care isn’t available, harm occurs—delayed or foregone treatment and financial distress—illustrating nonmaleficence, the obligation to avoid causing harm. Because each statement highlights a valid ethical dimension of reform, all of the above best explains why health care reform is an ethical issue.