rachel warren 4 th october 2014 [email protected]
TRANSCRIPT
Session Aims:To introduce the distinct features of
utilitarianism as a form of consequentialism. To examine the application of utilitarian
thinking to some ethical problems in health care.
To identify some key strengths and weaknesses of utilitarianism in this context.
Issues:The ‘classical’ utilitarianism of Bentham and
J.S. Mill.Principle strengths and weaknesses of
utilitarianism.The difference between act and rule
utilitarianism.Are there limits to what utilitarians would do
– how far can the ends justify the means?
Key claims of Utilitarianism:1. An action is to be judged right or wrong
solely by virtue of its consequences.2. In assessing consequences, only the balance
of happiness/unhappiness (of all) matters.3. Each person’s happiness counts equally.
From Rachels.
Right Action Good Pleasure
Utilitarianism
(Hedonism)
Classical Utilitarianism18-19th C: Bentham and Mill.One Moral Principle:Principle of Utility: ‘Always act so as to bring
about the greatest happiness of the greatest number’.
Utility as happiness.Morally, only the consequences of an action matter.Maximise happiness.Happiness as pleasure(Bentham).20th C: Desire satisfaction/Preference Satisfaction
accounts of happiness.
Key Definition:Mill:
‘Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure, and the absence of pain; by unhappiness, pain, and the privation of pleasure’.
p.210
Classical Utilitarianism 2How to calculate which action will produce the
most happiness? -> Felicific Calculus.Calculate net happiness of consequences, including
unhappiness (suffering) which may occur.The demands of Utilitarianism:Too much? Impartiality over moral proximity.‘Each counts for one and no one for more than one’‘The question is not can they reason? Nor can they
talk? But, can they suffer?’Too little? Conflict with justice?Morally counter-intuitive conclusions?
Questions:Are consequences all that matters?How is the notion of happiness to be defined?Is pleasure the only thing that matters?Should we be equally concerned for
everyone?
How to weigh theory vs. intuitions? Begin to think about evaluation...
Higher and Lower PleasuresMill’s development of Bentham’s theory: a reply
to the charge that utilitarianism is ‘a doctrine worthy only of swine’.
Preference for ‘higher’ pleasures over ‘lower’ pleasures by competent judges:
“It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied
than a fool satisfied”.How could this idea affect treatment choices?
Refining UtilitarianismAct Utilitarianism
Always act so as to produce the greatest happiness of the greatest number.
Rule Utilitarianism
Always do the action which conforms to a rule, the general acceptance of which would produce greater happiness than any other alternative.
Q: Does Act utilitarianism really need to be modified, even if it challenges common sense
assumptions?
Case Studies
Case Study 1: ImmunisationSee Pippa handout. Discuss in small groups and feed back.
Johnston, C and Bradbury P 2008: 100 Cases in Clinical Ethics and Law. London, Hodder Arnold. PP. 5-6..
Case Study 2: The Survival Lottery
The Survival LotteryWould the SL be a better
proposal if:a) suicidal people were
permitted to volunteer as organ donors?
b) it worked on an ‘opt-out’ basis (those that opt out of donating cannot receive organs).
c) the scheme was purely ‘opt-in’ (so only those that opt in to donate can receive organs).
Other Applications to Medicine:E.g:QALY’sPublic healthSentience (ability to feel pleasure and pain)
and Moral Status: implications for the treatment of foetuses, PVS patients, anencephalic babies.
Impartiality, future generations and resource allocation.
Medical Goal to minimise pain and suffering.
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Strengths: Weaknesses:
Evaluating UtilitarianismStrengths WeaknessesIntuitiveSimplicityImpartialUniversalPettit: ‘What non consequentialists
find persuasive is something which
consequentialists are able to understand, and
undermine’.
Problem with accurately ascertaining consequences.
Gap between foreseen, predicted consequences and actual consequences.
Does not allow for moral proximity
May justify atrocities in the name of the greater good.
Moral paralysis – lack of spontaneity.
Consequences are not the only morally relevant thing.Q: Are there limits to what Utilitarians would do? How far
can the ends justify the means?
Objections and RepliesCritical Counter Arguments:
Defence of Utilitarianism Replies:
Conflict with Justice: McCloskey’s Lynch Mob
Does not recognise rights
Excludes backward-looking reasons
Too demandingDisrupts personal
relationships – requirement of impartiality.
Denying the Consequences would be good (in c-e t.e.’s)
Utility as a guide for Rules, not Acts.
‘Common sense’ is wrongAll values have a util. basis.
Crit. view that some values are independent of utility
Q. Gut reaction to exceptional cases
Focus on all conseqs.
Summary:Key Concepts in utilitarianism.Application to cases in medicine.Evaluation: strengths and weaknesses of
utilitarianism.
Summary:• The morally correct thing to do is that that results in the best
overall outcome; irrespective of the means used to achieve those consequences.
• The principle of utility: the greatest happiness principle.• Right: “the greatest happiness for the greatest number”
(Bentham).• Good: Happiness: maximising pleasure and minimising
pain.• Difficulties with accurately ascertaining consequences, hence
appeal to Rules.• No absolute prohibitions: ‘nothing unthinkable’ if it creates
the most happiness for the majority.• Mill’s distinction between Higher and Lower order pleasures.
Further Reading:
