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HCE Week 1
HCE Week 1
A form of ethical theory that is concerned Utilitarianism applied in health care ethics:
with the outcomes of actions.
Claims that it is the action itself that is right or Originally, utilitarian theories were designed
wrong, not the person performing the action. for and applied to legislative matter. It is easy to see
As such, it is a form of a more general theory how this theory can be applied to other realms of
called “consequentialisms”. moral life and why it has become particularly
attractive in the realm of health care ethics,
bioethics.
1. Many of the ethical problems we face in However, there are some goods that can be
medicine are directly about people’s achieved only through means that most of us
happiness. would consider wrong.
The very term “quality of life” acknowledges For instance, there may be times when a
that pleasure and pain are variables in life patient asks that her family not be informed
of her diagnosis or prognosis because the
and need to be assessed as other life
patient does not want to worry them and
conditions change.
fears the disruption in their lives that such
It is in the forefront of decisions about
information would bring. Yet it may seem that
withdrawing or withholding treatment as a the family could provide valuable support for
means to end suffering. the patient. In fact, you may know this
One reason to respect autonomy is the idea particular family well enough to know that
that only the patient can make an accurate telling them about the patient’s illness would
determination about what course of action bring more support and hence greater well-
will bring him or her the greatest happiness, being to the patient than not telling.
and we should therefore accept that By utilitarian reasoning, it would be not just
determination as reflective of the greatest acceptable, but required, that you disclose
good. this information to the family.
2. In medical ethics we are inevitably However, respecting patient confidentiality is
concerned with the distribution of medical an important element of patient care.
resources. Although we do not generally Even if you were right in your assessment of
have to make these decisions at the the situation, most clinicians would agree
patient’s bedside, we do need to be that it is absolutely wrong to disclose patient
prepared to address these issues in a larger information without the patient’s consent.
context and understand their implications for
patient care. Distributing resources so that Thus, following utilitarian reasoning could put
the greatest number of people can get the one in a situation in which breaking ethical standards
most benefit from them is a direct is required. This is a strong indictment of utilitarianism
application of utilitarian theory.
2. True calculations of happiness are impossible
Utilitarianism has been criticized as being too Another criticism of utilitarianism is that in
simplistic and unable to adequately cope with the practice it is impossible for an individual or
complexities of real-life situations. We will examine even a group to accurately calculate all the
three of these claims. pleasure and freedom from pain that any
1. Utilitarianism requires us to do whatever act specific act will entail.
will bring about the greatest good, even if For one thing, we can never be completely
that means doing something we would sure that our actions will produce their
otherwise consider immoral. intended results.
2. True calculations of happiness are Second, even if they do produce the desired
impossible. outcome, how can we foresee all the
3. Utilitarianism does not consider issues of implications of these actions and assess the
distributive justice. effects they will have on all people, however
remotely connected to the act or its
outcome?
1. Utilitarianism requires us to do whatever act will
In considering the total calculation of
bring about the greatest good, even if that
pleasure and pain, it is imperative to account
means doing something we would otherwise
for all people who will be affected by the
consider immoral.
action both now and in the future.
If we can bring about a good, then,
according to utilitarian theory, we are
required to do that action.
Solution: Supporters of utilitarianism generally realize that they are practicing “divine
reply to this criticism by pointing out that even command deontology.” Rather, they are
though not all consequences are foreseeable, the upholding and following the dictates of their
major ones are. For most situations, most of the time, religion.
a reasonable enough calculation can be made. An example of deontology is the belief that
killing someone is wrong, even if it was in self-
3. Utilitarianism does not consider issues of defense. (ethics) The ethical study of duties,
distributive justice. obligations, and rights, with an approach
Utilitarianism only requires that happiness be focusing on the rightness or wrongness of
maximized, not that there be any sense of actions themselves and not on the goodness
fairness regarding who gets to be happy. or badness of the consequences of those
In the general formulation of utilitarianism, it is actions.
equally as legitimate to make rich people
happy by buying them yachts as it is to make Natural Law & Man’s Law
poor people happy by buying them homes.
In health care, this would mean there is no
rationale for distributing resources other than
to make sure that the resources do some
good.
Utilitarian would argue that if this is the case,
if fairness or justice is generally a method of
increasing happiness, then this is a suitable
goal and can be made a criterion for
distributing health care resources, not
because justice or fairness is good in and of
itself, but because promoting it will promote
happiness in general.
Deontology
The major contender to consequentialist
theory is deontological theory.
“Deontology” is derived from the Greek word Aristotle wrote that nature is organized for
“deon” meaning “duty”. good purpose.
The defining difference between It claims to provide an objective and
consequentialism and deontology is that universal foundation. Moral rules based on
deontologists believe that actions are right or natural law, like the dictates of science, are
wrong insofar as they satisfy a moral portrayed as objective and existing
obligation or duty, regardless of whether that independent of personal, social, or cultural
maximizes the good. beliefs. Typically, they argue that moral
There are many forms of deontological behaviors such as kin altruism, reciprocal
theory, but what they have in common is the altruism, feelings of sympathy, and
determination that the action is morally right consolation are evolutionary traits that have
if and only if it conforms to one’s moral duties contributed to human survival.
and obligations. The use of the natural law theory can either
One of the earliest and most prevalent forms be right or wrong. The use of natural law is
of deontology is known as “divine dependent on person’s intention.
command” theory. In this theory, the duties E.g., of mis-use of natural law: man is for
and obligations that are to be followed are procreation, therefore any man can
those that have been given to people by procreate to any woman as long as they will
God. Most adherents to this theory do not bear offspring.
Examples of why natural law is rightfully used: Examples of Divine Command Theory
Drunkenness is wrong because it injures the
health and worse, destroys one's ability to 1. Orthodox Church has a very strong pro-
reason, which is fundamental to man as a life stand. Orthodox Jewish patients often
rational being. taking a more stringent interpretation of
Theft is wrong because it destroys social God’s command to respect and
relations, and man is by nature a social preserve life.
animal. 2. Jehovah’s Witnesses, although agreeing
with the duty to respect and preserve life,
Kantian Ethics claim that there is a higher duty, given by
divine command, not to ingest blood,
Morality is only possible in a community of and therefore refuse blood transfusions
beings that possess the natural attributes of 3. Even people who do not identify with a
rationality and free will. Thus, we cannot justly particular religious’ tradition may have
hold someone responsible for his/her actions their own sense of what God requires of
unless that person can know right from them.
wrong; and unless that person is capable of
doing right and avoiding wrong. Knowing Reflecting on the work of Immanuel Kant:
what’s right or wrong is different from doing o Kant believed that all moral duties and
what’s right or wrong. obligations could be determined through the
For Kant, and all deontological theorists, the application of practical reason
morality of human action cannot be o Kant’s view, apply our powers of reason to
separated from intent. Morally good actions ascertain which rules of obligation we should
arise out of good intentions and morally bad act on.
actions arise out of bad intentions. o according to Kant, we must act in
E.g., The head hunters: since they are accordance with our obligations, which are
capable of knowing right from wrong governed by rules.
therefore they are ethically wrong. But if a o Kant provides us with a formula for
special child commits something bad, then determining which rules (or maxims, as he
he is not liable of his/her action. calls them) are a valid reflection of our duties
Immanuel Kant (1724–1804) is the central and obligations
figure in modern philosophy. He argues that o This formula, or test, is called the “categorical
the human understanding is the source of the imperative.” It is also known as the
universalizability criterion: “Act only on that
general laws of nature that structure all our
maxim by which you can at the same time
experience; and that human reason gives
will that it should become a universal law.” In
itself the moral law, which is our basis for colloquial terminology, “We should act only if
belief in God, freedom, and immortality. we can desire that all others act in the same
Therefore, scientific knowledge, morality, way”.
and religious belief are mutually consistent
and secure because they all rest on the same Application of Immanuel Kant’s formula,
foundation of human autonomy, which is “Categorical imperative or universalizability
also the final end of nature according to the criterion” in the health care and medical settings:
teleological worldview of reflecting
judgment that Kant introduces to unify the o First criterion, the categorical imperative
theoretical and practical parts of his requires us to test this action to see whether,
philosophical system. in doing so, we would be appropriately
discharging our obligation to the patient.
Communitarianism
All people and principles owe their
existence to and are partly constituted
by a community or group of
communities. Thus a community, or
nested set of communities, is integral to
the identity of all people.
In medical ethics, communitarians
emphasize the importance of taking
seriously the community that we