Rachel Warren
4th October 2014
rachel.warren@postgrad.manchester.ac.uk
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:
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.
1.
From Rachels.
Utilitarianism
Right
Action
Good
Pleasure
(Hedonism)
Classical Utilitarianism
 18-19th C: Bentham and Mill.
 One Moral Principle:
 Principle of Utility: ‘Always act so as to bring about
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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 2
 How to calculate which action will produce the most
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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 Pleasures
 Mill’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 Utilitarianism
 Act Utilitarianism
 Rule Utilitarianism
 Always act so as to
 Always do the action
produce the greatest
happiness of the greatest
number.
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 Study 1: Immunisation
 See 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..
The Survival Lottery
 Would 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’s
 Public health
 Sentience (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.
Strengths:
Weaknesses:
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Evaluating Utilitarianism
Strengths
Weaknesses
 Intuitive
 Problem with accurately
 Simplicity
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 Impartial
 Universal
Pettit:
‘What non consequentialists find
persuasive is something which
consequentialists are able to
understand, and undermine’.
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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 Replies
Critical Counter
Arguments:
 Conflict with Justice:
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McCloskey’s Lynch Mob
Does not recognise rights
Excludes backward-looking
reasons
Too demanding
Disrupts personal
relationships – requirement
of impartiality.
Defence of Utilitarianism
Replies:
 Denying the Consequences
would be good (in c-e t.e.’s)
 Utility as a guide for Rules,
not Acts.
 ‘Common sense’ is wrong
 All 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
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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:
rachel.warren@postgrad.manchester.ac.uk
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