Moral Theories in Health Care
A moral theory tries to give a complete answer to the following question:
What is it that determines whether an act is right (we have an obligation to do it) or is
wrong (we have an obligation not to do it)
Answering this question could help us resolve moral dilemmas and disagreements in
Two types of moral theory:
Consequentialism: The rightness of an act depends only on its consequence (the effects
that the act has on others and yourself).
NonConsequentialism: Consequences are not the only thing that affects the morality of
The most prominent form of consequentialism
Accepted by many philosophers today
Leading defenders include the English philosophers Jeremy Bentham (17481832)
and John Stuart Mill (18061873)
Mill: “actions are right in proportion as they tend to promote happiness, wrong as they
tend to produce the reverse of happiness”
The Utilitarian “Theory of Value”: What things in the world are good, and what things
are not good
Instrumentally good – good as a means
Intrinsically good – good for its own sake
Only one thing is intrinsically good: happiness.
Each person’s happiness is of equal value.
Many utilitarians assume further that:
Happiness consists of pleasure and the absence of pain (Hedonism)
Pleasures include intellectual, artistic, and other pleasures, as well as physical and
Pleasure and pain can be roughly quantified
Principle of Utility – a more precise statement
An act is morally permissible only if there is no other act one could have done that would
have produced more overall happiness
Illustration: Supposed I win $1000 in a lottery. What should I do with the money?
Utilitarianism imposes a high standard: “The happiness which forms the utilitarian
standard of what is right in conduct, is not the agent’s own happiness, but that of all
concerned. As between his own happiness and that of others, utilitarianism requires him
to be as strictly impartial as a disinterested and benevolent spectator.” – Mill This poses an extremely high standard for a person. This means that any small
act one doesn’t for himself is wrong, such as going out to dinner, because that money
could have been spend on making more than just oneself happy. This is a main objection
of utilitarianism, and is called the “too demanding objection”.
Utilitarians believe that the principle of utility alone accounts for all right and wrong.
Many utilitarians also believe that this principle underlies our common sense judgments
about right and wrong.
Utilitarianism was very progressive:
Abolition of slavery
Abolition of child labour
Equality for women (Mill was an early feminist)
Animal welfare (Bentham was one of the earliest advocates for animal rights)
Programs for public health and safety
Strong obligation to help the poor
Utilitarianism was used to justify all of these. Whatever criticism the theory is open to,
these are at least positive results of it
Is utilitarianism a plausible moral theory?
We now want to ask whether utilitarianism gives an accurate account of right and wrong.
To test it, we will look for possible counter examples, that is, examples of acts that util
says we should do but which seem to us wrong acts, or acts that util says we should not
do, but which seem to us right acts.
Utilitarianism does NOT take fairness into account. Although it tends towards equality
when things are being divided up, it doesn’t guarantee it.
Main problem: It doesn’t use fairness, justice, and equality as a moral standard.
Utilitarianism can justify the sacrifice of a few people’s happiness in order to increase
other people’s happiness. Utilitarians could justify human medical testing, due to the
greater good it will produce. They don’t always take into account general human rights,
which is a major flaw in this theory.
Summary: Some Problems for Act Utilitarianism
1) Some say the theory is impractical
2) Would sometimes violate people’s rights
3) Would sometimes lead to unfairness
4) Gives weight to pleasures that are bad/immoral
5) Cannot account for special relationships between people, e.g. family, friends
6) Is too demanding, requires too much of people
Another Objection: Is pleasure the only intrinsic good? Suppose there is a machine that can be programmed to give you any imaginable series of
experiences. The experiences are totally realistic and the machine won’t break down.
Now you’re given a choice: you can live out your life in the normal way, or plug yourself
into the machine for the rest of your natural life. Which would you do?
By hypothesis, you will experience more pleasure by plugging in. But surely no sane
person would plug in. So it seems that pleasure is not the only thing we value.
Differences Between Rule and Act Utilitarianism
Act – Applies the principle of utility to individual acts: Always try to do those particular
acts that will produce as much happiness as possible
Rule – Applies the principle of utility to rules: First, determine what rules would
maximize happiness in society, and then follow those rules. They should be the best
possible set of rules you can have. The second step is just to follow those rules in your
How would they lead to different acts?
Consider the case of killing an innocent person and using his organs to save many others.
Act util might require us to do this act
What about rule utilitarianism? Would we maximize happiness in society if we
had a rule that permitted such acts? The answer is clearly no – everyone would be
Therefore, rule and act would lead to different outcomes
What rules would maximize happiness?
We would have to include the familiar rules of common sense morality:
Don’t lie (except in extreme situations)
Don’t steal …
Don’t kill …
Without such rules there would be chaos, and happiness would not be maximized
It coincides with common sense morality
How rule util avoids objections to act util:
The ideal system of rules would
Have to protect human rights Include a realistic rule for charity, e.g. give a small part of your salary to the poor
– so Rule Util is not too demanding
Not say “try to maximize happiness in your actions” since people would make
These rules should promote happiness in society
Possible Objection to Rule Utilitarianism:
Some critics argue that rule utilitarianism involves a kind of rule worship. I.e. not doing
an act just b/c there is a rule against it, even though the act would produce more
happiness than anything else we could do.
Immanuel Kant (17241804)
Born, lived and died in Konigsberg, Prussia
Strict protestant upbringing
Taught as a Privatdozent for many years
Captivating lecturer, great conversationalist, people set their clocks by his walks
Major works: Critique of Pure Reason, Groundwork of Metaphysics of Morals
Contrast between Utilitarianism and Kant:
Consequentialist – only the consequences of an act are relevant to its being right
No act is intrinsically right or wrong
Nonconsequentialist – consequences are not rele