Discussion

All materials below retrieved from: Sullivan, S. & Peceroni, P. (2002). Ethics: An online textbook. Chapter 6: Utilitarianism. Retrieved from http://www.qcc.cuny.edu/SocialSciences/ppecorino/ETHICS_TEXT/C ONTENTS.htm

The Basic Idea To overcome the obvious defects of using Egoism as a moral guide Utilitarianism approaches the question of the GOOD from an opposing point of view. Instead of that being the GOOD which serves one's own interest and provides for one's own pleasure, the utilitarian’s take that which produces the greatest amount of pleasure (Physical and emotional) for the greatest number of people to be the GOOD. This is the principle of UTILITY. The theory developed from an attempt to direct the lawmakers of England to consider the common good rather than the welfare of their social class when they made laws. The GOOD is that which provides for the happiness of the greatest number of people even if it results in no happiness to the agent at all. In this approach each human being has exactly the same worth as all other human beings. In this view the benefit of the action must be maximized: When confronted by some situation and facing a choice or dilemma and

when considering what would be the correct thing to do, what would be right, what would be good, the utilitarian would: 1. Consider the options available, however many there are. 2. Calculate how much happiness would be produced were each of the options to be acted upon. 3. Determine, which option produces the greatest resulting happiness. 4. Choose that option which does produce the greatest amount of happiness for the greatest number of people, the greatest utility. Note: it is not a matter of making the majority (>50%) happy but the greatest possible number of people. So if there are three options, (a), (b), and (c) and (a) makes 87% happy, (b) makes 76% happy and (c) makes 89% happy the utilitarian must choose to do (c). Choice (c) is the GOOD the others (a) and (b) are not good. ACT and RULE Utilitarianism There is a difference between rule and act utilitarianism. The act utilitarian considers only the results or consequences of the single act while the rule utilitarian considers the consequences that result of following a rule of conduct. Why the two approaches? Consider the following case: Someone goes to the doctor. The person is ill, experiences pain and dysfunction. The doctor performs a series of test and examinations. The person returns to the doctor's office to learn of the results, the diagnosis and prognosis. The doctor is aware that the tests all show that the person has a disease that is incurable and life threatening. In fact even under the most aggressive treatment option there is a survival rate of less than 15% for two years. The doctor is considering what would be GOOD to tell the person. Should the person know the truth or should the person be told something other than the truth? Which is better? Which is the right thing to do? What would be GOOD to do? The act utilitarian might calculate

that in telling the truth there will be a great deal of pain and hardly any pleasure at all. The person will be upset, their family will be upset, the doctor will be upset in informing the ill person that there is nothing that the doctor can do to alter their condition. The doctor's staff will be upset seeing the person come in for whatever treatment there may be. On the other hand if the doctor makes up a story concerning the diagnosis and prognosis that is not true but that gives the ill person more time to enjoy life before the illness makes it obvious that the end is near, well then the results are different. The doctor is not so upset in seeing the person; the doctor's staff is not upset. The family and friends of the person have some more time with that person to enjoy things instead of being morose and depressed. So the ACT utilitarian might calculate that the GOOD is to lie. The rule utilitarian would need to consider what would the long term consequences be if doctors were to lie to those who come to them and have life threatening, incurable illnesses. The rule utilitarian might calculate that people would no longer be able to trust their doctors and this would break down the confidence they need for their therapies to be effective. The RULE utilitarian might calculate that there is far more harm in lying and so the GOOD is to tell the truth. The same result might obtain were there to be a consideration of cheating on an examination. The single act might produce a great deal of happiness for the cheater, teacher, family and friends. The rule of cheating might produce quite the opposite result as society could no longer trust that the doctors, lawyers, engineers, repair people etc.. really know what they are doing and deserve their position. Rule Utilitarianism (RU) has no rule other than UTILITY. Every act is evaluated according to the utility. Does it or doesn't it produce HAPPINESS. Utilitarian’s must Maximize HAPPINESS. They must never accept unhappiness if they can minimize it. Both ACT and RULE utilitarian’s must ASSUME NOTHING. They must actually poll or measure what act will produce the greatest utility. The difference is that the ACT

UTILITARIAN measures the consequences of a SINGLE ACT. The RULE UTILITARIAN measures the consequences of the act repeated over and over again through time as if it were to be followed as a RULE whenever similar circumstances arise. NOTHING is right or wrong in itself for a utilitarian. NOTHING! It all depends on the consequences of the act, the results are what matters not the act. The idea behind Rule Utilitarianism is that whenever you are in a situation and have alternatives you calculate the utility to be produced by adopting a course of action (rule), which would produce the greatest utility in the long run if it were followed every time that situation arose. Let's consider the rule that states you must stop your vehicle at a red traffic light. Situation: Pregnant woman in back seat. She’s about to deliver. Water has broken. Contractions are 2 minutes apart. It is 4am. The vehicle is 2 miles from the hospital. There are no other cars around. The RU would think if you were as a rule to break the law and go through that red light it would produce more utility than not doing so and therefore would be the morally GOOD thing to do. So the RU RULE would be to go through red lights whenever it is 4am and there is a pregnant woman in the back seat that is about to deliver and you are heading to the hospital. The Utilitarian Principle We all know, by now, the difference between an ethical theory, and an ethical principle, right?? The theory defines the basic ethical terms, and provides the most general ways of interpreting ethical experience, obligations, the role of reason, etc. Principles are general rules of conduct that emerge or derive from an ethical theory. Well, you've been reading about Utilitarianism as an ethical theory, and we can state quite

clearly what principle of behavior it requires: Always act in such a way as to maximize the pleasure of the maximum number of those who can feel pleasure; always act in such a way as to minimize the pain of the maximum number of those who can feel pain. Role and importance of reason in utilitarianism? The task of reason is to CALCULATE the relative amount of pleasure and pain for the most number of people, presently and in the future, which results from the prospective actions. The importance is that nothing else can serve as a guide to moral actions. Not feelings – for feelings does not provide such information. What is required to make a correct moral decision is analysis of the types of pleasures and pains, as well as the informed prediction of the consequences of various actions. We've seen that, according to Bentham anyway, moral decision-making is nothing more than the calculation of the consequences of prospective actions, and the analysis of the contribution toward happiness that such consequences have. The elements to be measured are: 1. intensity 2. duration - if two pleasures are the same in intensity, but one lasts longer, then it's better 3. certainty - if when I am trying to figure out which of two actions I ought to follow, it is only possible that I get much pleasure as a consequence of the first, but it is highly probable that I get pleasure from the second, then I ought to favor the second option. 4. propinquity - Bentham suggests that an action results in immediate pain is worse than an action whose pain is delayed. 5. fecundity - how likely is it that an action will have consequences which themselves will also have pleasurable consequences? An education may not have immediately satisfying consequences, but it may allow for a lifetime of goods.

6. purity - simply put, an action A is more pure than action B if there are, say, 10 pleasures and no pains with action A, while there are 10 pleasures and 3 pains with action B. Action B has mixed results, and thus is less pure. 7. extent -- this refers to the number of people effected by the action. If an action effects 1,000 people, that has a greater "extent" than an action which effects only 10 people.

Objectivity and subjectivity of utilitarian ethics Utilitarianism suggests that ethics is subjective inasmuch as its foundation is human and pleasure. This seems to be the heart of human subjectivity, human consciousness, so in that way it ethics is, according to utilitarianism, very subjective. But it is objective in two senses: first, it takes into consideration the real, empirical effects of one's actions.

It asks such questions as: • What would be the effects of raising taxes of all taxpayers by 2%? • What would the effect of police taking into custody and vigorously investigating all men that look of Arab ethnicity? • What would the effects be if I cheated on my math final exam? And the answers to such questions have very definite, objective answers. Now we may not be able to know ahead of time what the answers are, but we need to use all of our scientific and intellectual tools to make the best predictions that we can. And we can do this. We do it all the time. It is precisely what we do when we take into consideration the effects or consequences that our actions will have on other people. What becomes difficult is prediction of effects of actions that by nature effect lots and lots of people, in many different areas. In other words -- social, political, and economic policies. At this point we need get help from economists, sociologists, politicians, physicians, judges. etc. And this is precisely the sort of debate and research that you see on C-Span! Second, there does seem to be a degree of objectivity in pleasures – we can tell what gives pleasure and pain by folks saying what gives them pleasure and pain. It is pretty easy to figure out what brings pleasure to people -- you ask them! But there are other ways of knowing about what brings people pleasure and pain. We can tell by watching people's behaviors. If a certain type of food is more popular in a restaurant, we can safely say that that gives more people more pleasure than other items on the menu. This, again, is important information to have when setting public policies, for enacting laws, for establishing taxes, for providing social benefits to different segments of the population, etc.

Deontological Theories: The Non-Consequentialist Approach In Normative Ethics the Deontological theories are those that maintain that ethical evaluations are rooted somehow in the action or some feature of the action, which would result in a duty or obligation. In this approach the consequences of the action is not generally considered to be morally relevant. Thus deontological theories often are based on or generate a set of duties. Deon is from the Greek and means a duty or obligation. What is the source of such duty? The various theories answer that question differently. It could be a deity, natural law, reason, a sense of justice or one sense of self. There is a wide range of cases in the area of medical ethics. Some deal with medical research, others with health care and others with social policy concerning access to health care. The general areas or headings include: • Autonomy and Informed Consent • Privacy and Confidentiality • Experimentation on Humans • Experimentation on non-Humans

• Abortion • Infanticide • Care of the Dying • Assisted Suicide • Genetics: Intervention, Control and Research • Reproduction: Assistance and Control • The Allocation of Resources and Triage • A Right to Health Care Here is a listing of some sample case studies. Case studies: Medical Field • Autonomy and Informed Consent Dax case- Refusing Medical Treatment and Being Ignored - Issue: Autonomy In 1973, Donald "Dax" Cowart, age 25, was severely burned in a propane gas explosion. Rushed to the Burn Treatment Unit of Parkland Hospital in Dallas, he was found to have severe burns over 65 percent of his body; his face and hands suffered third degree burns and his eyes were severely damaged. Full burn therapy was instituted. After an initial period during which his survival was in doubt, he stabilized and underwent amputation of several fingers and removal of his right eye. During much of his 232 day hospitalization at Parkland, his few weeks at Texas Institute of Rehabilitation and Research at Houston, and his subsequent six-month's stay at University of Texas Medical Branch in Galveston, he repeatedly insisted that treatment be discontinued and that he be allowed to die. Despite this demand, wound care was continued, skin grafts performed and nutritional and fluid support provided. He wanted the treatments to stop so that he could go home and die; either through natural causes or by suicide. The doctors, who frequently hear such complaints from patients receiving painful procedures, did not stop the treatment. By continuing the treatment there was a very high probability of survival, while ending the treatment would result in almost certain

death. He was discharged totally blind, with minimal use of his hands, badly scarred, and dependent on others to assist in personal functions. Perhaps of significance is the fact that the procedure that Dax endured was a very new technology, thus if Dax had the accident ten years earlier he would have certainly died. Dax completed the treatment and regained a high quality of life, however, he has never recanted his belief that the decision to discontinue treatment was his, and his alone, and if he could go back into time, even with knowing the quality of life, which he now possesses, he would still refuse treatment. • Privacy and Confidentiality DeMasi Case: Pedophile- Issue: Confidentiality Doctor should have disclosed colleague's pedophilia, jury says By Denise Lavoie Associated Press Story posted Saturday, 10-Oct- 98 09:40:33 - Online Athens Daily News BRIDGEPORT, Conn. A psychiatrist who failed to warn anyone about another doctor's sexual fantasies about children was held partly responsible by a federal jury Thursday for the molestation of a 10-year-old boy. Dr. Douglas Ingram was found negligent in not warning anyone about by Dr. Joseph DeMasi. The jury will return Friday to decide how much Ingram should pay the boy's family in damages. The verdict's effect on the principle of doctor-patient confidentiality was not immediately clear. One psychiatrist said the case is unusual enough that its effect will not be large. As part of his training in psychiatry, DeMasi underwent psychotherapy with Ingram during the mid-1980s. During the sessions, DeMasi admitted fantasizing about sex with children. He later was charged with molesting three boys, including a 10-year-old boy who was being treated at Danbury Hospital for suicidal tendencies. That child's family sued Ingram and the New York Medical College, where DeMasi was being trained. The jury did not find the medical school at fault. Ingram and lawyers for both sides left the

courthouse without comment. The boy, now 22 and serving a prison sentence for assault, is expected to testify on Friday. During the trial, Ingram said that he had questioned DeMasi about whether he had ever molested a child, intended to molest a child or fantasized about a particular child. In each case, Ingram testified, the answer was no. Ingram also said that he had consulted with five other psychiatrists and was confident that he had no obligation to report DeMasi's disclosure or force him out of the residency program. But the jury concluded Ingram should have known that DeMasi was likely to harm others. DeMasi pleaded guilty to risk of injury to a minor and received a seven-year prison sentence in 1987. In most cases, conversations between a doctor and patient are considered private. But court cases in the past 25 years have gradually established that psychiatrists also have a duty to protect others who may be threatened by patients, especially when specific individuals have been identified. "If patients can't talk to doctors about their fantasies, it's going to destroy treatment," Dr. Walter Borden, a therapist and forensic psychiatrist, told The Hartford Courant. "I see a lot of people who have committed crimes and are potentially dangerous. It's difficult enough to get them to talk. This is not going to help matters." But Dr. Harold Schwartz, director of the Institute of Living in Hartford, said the combination of DeMasi's fantasies, his career and his belief that pedophilia should not be illegal should have set off alarms. • Experimentation on Humans CASE: Cold War Radiation Exposure Experiments Experiments were done on human beings without their knowing about it or without being fully informed. Some of the subjects of these experiments were very young children. Read about the range of experiments and the government investigations and the new criteria and guidelines for such studies. At the University of Cincinnati patients who were being treated for cancer were given massive doses of radiation. The Cincinnati Project told the patients

that they were being treated for their cancer, when in fact the experiments were funded by the Military. The Military was interested in discovering how much radiation a person can absorb and still remain functional. At Vanderbilt University in the late 1940's, eight hundred pregnant women were exposed to radiation to determine the effects of radiation on fetal development. At the Oak Ridge National Laboratory, two hundred cancer patients were exposed to high levels of radiation. The experiments continued up until 1972 when the Atomic Energy Commission discontinued them on the grounds that there was little or no benefit to the patient. In an Oregon State Prison the testicles of inmates were exposed to X rays to determine the effects of radiation on sperm production from 1963 to 1971. The inmates were never told that the exposure to massive doses of radiation could cause cancer. During the late 1950's twelve terminally ill cancer patients at Columbia University and Montefiore Hospital were injected with radioactive calcium and strontium 85 to determine the absorption rate of radioactive substances into a variety of tissues and organs.