Nonmaleficence Exam Prep Document 2026/2027 | Bioethics,
Patient Safety & Ethical Healthcare Decision-Making | 50
Verified Questions with Detailed Rationales
50 Verified Questions with Detailed Rationales
This examination contains verified questions drawn from actual clinical ethics consultations, patient
safety event analyses, and policy decision-making contexts encountered in healthcare. It addresses the
principle of nonmaleficence, bioethical frameworks, patient safety science, and ethical decision-making
models as they apply to real patient care situations and organizational governance.
Section 1: Bioethical Principles & Nonmaleficence – Questions 1–17
Q1: A fourth-year medical student is shadowing in the ICU and overhears a resident say, "We need to do
everything possible for this patient—it's our duty to benefit them." The attending later clarifies that
while beneficence is important, nonmaleficence is actually the older and more fundamental principle in
medical ethics. Which of the following best captures the key distinction between nonmaleficence and
beneficence?
A. Nonmaleficence requires active intervention to improve patient outcomes, while beneficence only
requires avoiding harm.
B. Beneficence obligates healthcare providers to act in the patient's best interest, whereas
nonmaleficence is the duty to refrain from causing harm or allowing harm to occur. [CORRECT]
C. Nonmaleficence applies only to surgical procedures, while beneficence governs all other aspects of
clinical care.
D. Beneficence is a legal requirement enforced by state medical boards, while nonmaleficence is merely
an ethical guideline without legal force.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because beneficence is about actively promoting
good and acting in the patient's best interest, while nonmaleficence is the foundational duty to do no
harm or prevent harm from happening. The phrase "primum non nocere"—first, do no harm—predates
,modern bioethics and reflects that avoiding harm is often considered the baseline obligation before any
positive intervention is attempted.
Q2: During a palliative care ethics rounds, a nurse asks about the principle of double effect and when it
applies in end-of-life care. Which scenario below is the clearest example of an action that meets all
criteria for the principle of double effect?
A. A physician administers a high dose of morphine to a terminally ill patient with the primary intention
of relieving severe pain, knowing that respiratory depression may occur as a foreseen but unintended
side effect. [CORRECT]
B. A family requests that all nutrition and hydration be stopped for a patient in a persistent vegetative
state, with the explicit goal of hastening death.
C. A hospital discontinues ventilator support for a brain-dead patient because the family cannot afford
continued care.
D. A physician prescribes a placebo to a patient experiencing anxiety, believing the deception is justified
because it will reduce the patient's distress.
Correct Answer: A
Rationale: The best answer is A. This choice is correct because the principle of double effect requires
that the action itself be morally good or neutral, the good effect is intended while the harmful effect is
merely foreseen, the good effect is not achieved through the harmful effect, and there is a
proportionate reason for allowing the harmful effect. Administering morphine for pain relief with
respiratory depression as an unintended consequence fits all four criteria precisely.
Q3: A hospital ethics committee is reviewing a case involving a patient with advanced COPD who refuses
intubation. The committee discusses how the four principles of principlism interact. Which of the
following statements about the relationship between autonomy and nonmaleficence is most accurate?
A. Autonomy always overrides nonmaleficence when a competent patient makes a decision that may
result in self-harm.
B. Nonmaleficence and autonomy are frequently in tension, and ethical resolution requires balancing
respect for patient self-determination against the duty to prevent harm. [CORRECT]
C. Nonmaleficence requires healthcare providers to override patient autonomy whenever a treatment
refusal could lead to a bad outcome.
D. Autonomy and nonmaleficence are essentially the same principle, since respecting a patient's choices
never causes harm.
, Correct Answer: B
Rationale: The best answer is B. This choice is correct because in clinical ethics, autonomy and
nonmaleficence are often in genuine tension—respecting a competent patient's right to refuse
treatment may mean allowing harm that could have been prevented. The ethical task isn't to pick one
principle over the other automatically but to carefully weigh and balance them in context, which is
exactly what ethics committees and clinicians do in cases like this.
Q4: A nursing instructor is teaching students about veracity and its relationship to nonmaleficence. A
student asks, "If telling the truth about a diagnosis might cause a patient significant psychological
distress, isn't it better to withhold some information to avoid harming them?" Which response best
reflects the ethical reasoning a clinician should use?
A. Withholding a diagnosis is always the right choice when the truth might cause emotional harm,
because nonmaleficence takes priority over veracity.
B. Veracity and nonmaleficence must be balanced, but lying or withholding material information
typically violates patient autonomy and trust, which are themselves forms of harm. [CORRECT]
C. The principle of nonmaleficence means clinicians should only disclose information that the patient
specifically asks for.
D. Truth-telling is a legal requirement, but ethical practice allows clinicians to decide what information is
"too harmful" to share based on their own judgment.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because while it might seem kind to shield a
patient from distress, lying or withholding a material diagnosis actually causes a different kind of harm—
it erodes trust, undermines autonomy, and prevents the patient from making informed decisions about
their care. The ethical approach is to deliver difficult truth with compassion and support, not to avoid
truth-telling altogether.
Q5: In the landmark case of Karen Ann Quinlan (1976), the New Jersey Supreme Court addressed which
of the following ethical and legal issues?
A. The right of a competent patient to refuse life-sustaining treatment and the role of surrogate
decision-making when a patient is in a persistent vegetative state. [CORRECT]
B. The constitutionality of physician-assisted suicide under the Fourteenth Amendment.
C. The requirement that all hospitals maintain institutional ethics committees with mandatory
consultation authority.
Patient Safety & Ethical Healthcare Decision-Making | 50
Verified Questions with Detailed Rationales
50 Verified Questions with Detailed Rationales
This examination contains verified questions drawn from actual clinical ethics consultations, patient
safety event analyses, and policy decision-making contexts encountered in healthcare. It addresses the
principle of nonmaleficence, bioethical frameworks, patient safety science, and ethical decision-making
models as they apply to real patient care situations and organizational governance.
Section 1: Bioethical Principles & Nonmaleficence – Questions 1–17
Q1: A fourth-year medical student is shadowing in the ICU and overhears a resident say, "We need to do
everything possible for this patient—it's our duty to benefit them." The attending later clarifies that
while beneficence is important, nonmaleficence is actually the older and more fundamental principle in
medical ethics. Which of the following best captures the key distinction between nonmaleficence and
beneficence?
A. Nonmaleficence requires active intervention to improve patient outcomes, while beneficence only
requires avoiding harm.
B. Beneficence obligates healthcare providers to act in the patient's best interest, whereas
nonmaleficence is the duty to refrain from causing harm or allowing harm to occur. [CORRECT]
C. Nonmaleficence applies only to surgical procedures, while beneficence governs all other aspects of
clinical care.
D. Beneficence is a legal requirement enforced by state medical boards, while nonmaleficence is merely
an ethical guideline without legal force.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because beneficence is about actively promoting
good and acting in the patient's best interest, while nonmaleficence is the foundational duty to do no
harm or prevent harm from happening. The phrase "primum non nocere"—first, do no harm—predates
,modern bioethics and reflects that avoiding harm is often considered the baseline obligation before any
positive intervention is attempted.
Q2: During a palliative care ethics rounds, a nurse asks about the principle of double effect and when it
applies in end-of-life care. Which scenario below is the clearest example of an action that meets all
criteria for the principle of double effect?
A. A physician administers a high dose of morphine to a terminally ill patient with the primary intention
of relieving severe pain, knowing that respiratory depression may occur as a foreseen but unintended
side effect. [CORRECT]
B. A family requests that all nutrition and hydration be stopped for a patient in a persistent vegetative
state, with the explicit goal of hastening death.
C. A hospital discontinues ventilator support for a brain-dead patient because the family cannot afford
continued care.
D. A physician prescribes a placebo to a patient experiencing anxiety, believing the deception is justified
because it will reduce the patient's distress.
Correct Answer: A
Rationale: The best answer is A. This choice is correct because the principle of double effect requires
that the action itself be morally good or neutral, the good effect is intended while the harmful effect is
merely foreseen, the good effect is not achieved through the harmful effect, and there is a
proportionate reason for allowing the harmful effect. Administering morphine for pain relief with
respiratory depression as an unintended consequence fits all four criteria precisely.
Q3: A hospital ethics committee is reviewing a case involving a patient with advanced COPD who refuses
intubation. The committee discusses how the four principles of principlism interact. Which of the
following statements about the relationship between autonomy and nonmaleficence is most accurate?
A. Autonomy always overrides nonmaleficence when a competent patient makes a decision that may
result in self-harm.
B. Nonmaleficence and autonomy are frequently in tension, and ethical resolution requires balancing
respect for patient self-determination against the duty to prevent harm. [CORRECT]
C. Nonmaleficence requires healthcare providers to override patient autonomy whenever a treatment
refusal could lead to a bad outcome.
D. Autonomy and nonmaleficence are essentially the same principle, since respecting a patient's choices
never causes harm.
, Correct Answer: B
Rationale: The best answer is B. This choice is correct because in clinical ethics, autonomy and
nonmaleficence are often in genuine tension—respecting a competent patient's right to refuse
treatment may mean allowing harm that could have been prevented. The ethical task isn't to pick one
principle over the other automatically but to carefully weigh and balance them in context, which is
exactly what ethics committees and clinicians do in cases like this.
Q4: A nursing instructor is teaching students about veracity and its relationship to nonmaleficence. A
student asks, "If telling the truth about a diagnosis might cause a patient significant psychological
distress, isn't it better to withhold some information to avoid harming them?" Which response best
reflects the ethical reasoning a clinician should use?
A. Withholding a diagnosis is always the right choice when the truth might cause emotional harm,
because nonmaleficence takes priority over veracity.
B. Veracity and nonmaleficence must be balanced, but lying or withholding material information
typically violates patient autonomy and trust, which are themselves forms of harm. [CORRECT]
C. The principle of nonmaleficence means clinicians should only disclose information that the patient
specifically asks for.
D. Truth-telling is a legal requirement, but ethical practice allows clinicians to decide what information is
"too harmful" to share based on their own judgment.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because while it might seem kind to shield a
patient from distress, lying or withholding a material diagnosis actually causes a different kind of harm—
it erodes trust, undermines autonomy, and prevents the patient from making informed decisions about
their care. The ethical approach is to deliver difficult truth with compassion and support, not to avoid
truth-telling altogether.
Q5: In the landmark case of Karen Ann Quinlan (1976), the New Jersey Supreme Court addressed which
of the following ethical and legal issues?
A. The right of a competent patient to refuse life-sustaining treatment and the role of surrogate
decision-making when a patient is in a persistent vegetative state. [CORRECT]
B. The constitutionality of physician-assisted suicide under the Fourteenth Amendment.
C. The requirement that all hospitals maintain institutional ethics committees with mandatory
consultation authority.
