Which scenario best illustrates a conflict between beneficence and nonmaleficence in clinical decisions?

• A. A treatment with substantial potential benefit carries a significant risk of harm, requiring risk-benefit analysis and patient involvement.
• B. Administering a highly beneficial cancer treatment with manageable side effects without involving the patient.
• C. Withholding a beneficial treatment solely because of cost concerns.
• D. Providing nonbeneficial care to avoid risk.

Answer: (A)

The main idea tested here is balancing doing good with avoiding harm, and recognizing when patient involvement is essential because the benefits and risks must be weighed together.

When a treatment promises substantial benefit but also carries a significant risk of harm, a genuine conflict between beneficence and nonmaleficence arises. Beneficence pushes you to help the patient, while nonmaleficence pushes you to prevent or minimize harm. In this scenario, the clinician must conduct a careful risk-benefit analysis to determine if the potential benefit justifies the risk, and this decision should involve the patient so their values and preferences guide whether to proceed. That shared decision-making honors autonomy while still aiming to promote welfare.

The other options don’t illustrate this specific tension. Administering a highly beneficial treatment without involving the patient slips into disregarding autonomy, rather than a clash between beneficence and nonmaleficence. Withholding a beneficial treatment solely for cost concerns raises questions of justice and resource allocation, not the direct balance of benefit and harm in the patient’s care. Providing nonbeneficial care to avoid risk doesn’t reflect a choice between trying to help and avoiding harm; it’s more about avoiding unnecessary care.