Can You Solve This Bioethics Dilemma?

A bust of Hippocrates, who the Hippocratic oath is ascribed to. (Source: Getty)

You’re working in a small clinic that’s involved in a research project, with participants being recruited from the clinic’s regular patients. The work is very simple: each participant has a small amount of blood drawn to be studied, along with the amount taken as part of their usual care. Here’s the problem: the clinic is very busy, and sometimes you’re not able to ask for a patient’s consent before the other doctor does the routine blood draw, necessitating a separate draw for the study.

Then you get an idea: rather than do two blood draws, during the routine blood work, the other doctor will simply take the extra blood needed for the test. If the patient later doesn’t consent to participate, the excess is simply discarded. Do you think this is ethical, or is taking the extra blood without permission wrong? It might sound like a simple enough dilemma, but it’s fraught with questions of informed consent, as the patient has not agreed to have this extra blood taken. This is no simple hypothetical, but a real dilemma submitted to a team of experts.

Questions like this are at the center of bioethics, a branch of ethics concerned with human autonomy in the context of everything from simple medical procedures to sweeping technological advancements. Consider this: should scientists pursue gene-editing technology to rewire human biology to be resilient to disease? It sounds like a simple positive good for the world, but is there an objective model for what’s a “good” human body, or does that inevitably lead to eugenics? Where do we draw the line?

A lab mouse. Beyond humans, animal experimentation is a continued debate in bioethics. (Source: Science Magazine)

Consider the blood test example again. Taking the extra blood without permission isn’t questionable over health reasons, the amount is too small to make a difference. The problem arises out of our belief in an individual’s autonomy and right to know what they’re participating in, even if the procedure in question is hardly perceptible. On the other hand, if the study can benefit the whole of society, does that override an individual’s rights if the infraction is minor? Which is more important to you, the individual or the group? You see how tricky this can get.

As a field, bioethics is a tangle of the scientific, philosophical, and political. It originated out of a tension from two conflicting philosophical principles, both of them originating in two ancient traditions. One is the Hippocratic Oath ascribed to Hippocrates, some version of “First do no harm.” The other is Cicero’s principle of “salus populi suprema lex esto,” or “let the safety of the people be the supreme law.” This is a classic ethical dilemma, two conflicting obligations that don’t cancel each other out. 

This is the central tension that undergirds questions of bioethics, but Hippocrates and Cicero never could have imagined just how dicey these questions could get. Today, bioethics has to contend with questions of everything from stem cell research, animal experimentation, cloning, to euthanasia. The dilemma of the blood draw story is at a small scale, but it raises questions and conflicts that are fundamental to scientific research.

The blood test example is a real dilemma submitted to the Georgia Clinical & Translational Science Alliance. Read what the experts had to say on the issue here. Or you can check out their answers to other dilemmas here. You can also weigh in on the comments below.

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McWhirter RE. The History of Bioethics: Implications for Current Debates in Health Research. Perspectives in biology and medicine. 2012;55(3):329-338. doi:10.1353/pbm.2012.0025