Should the death penalty be legal? View point of Utilitarianism and Deontology.

BIO-MEDICAL ETHICS Utilitarianism

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UTILITARIANISM Utilitarianism originated in the late 18th and early 19th century England as a sec-ular replacement for Christian ethics. Jeremy Bentham (1748-1832) and John Stuart Mill (1806- 1873) were its two chief theorists. The essential idea of utilitari-anism is that right acts should produce the greatest amount of good for the great-est number of people, which is called "utility."

Utilitarianism was a reform movement intended to humanize outmoded institu-tions. Utilitarianism did not urge people to turn the other cheek and hope for justice in another life, nor did it exalt those virtues so cherished by England's aristocracy: stylish dress and manners, personal honor, literacy, scientific and artistic accom-plishment, and patriotism.

Utilitarianism's essence can be summed up in four basic tenets:

1. Consequentialism: The consequences of actions count, not motives or intentions. 2. The maximization principle: The number of people affected by consequences matters;

the more people, the more important the effect. 3. Good Consequences: A good consequence is the effect of an action that brings people

pleasure, or, if not please, at least what people prefer (like removing suffering). 4. People count as one and no more: Each being's happiness is to count as one and no

more.

For utilitarians, right acts produce the greatest amount of good conse-quences for the greatest number of beings.

Utilitarianism also seems to imply that every being's happiness on the planet matters, not just beings of my society. John Stuart Mill says that the drowning man doesn't care why the lifeguard is swimming out to sea to rescue him, just that the lifeguard is coming. Utilitarians think motives only count insofar as they tend to produce the greatest good.

In medicine, it makes a difference whether a physician listens because she really cares about patients or because she's found that having satisfied patients is an effective way to maximize income. A utilitarian might argue that if the physician's techniques are good enough, whether she really cares about her pa-tients matters very little; in either case, the behavior produces good consequences to real people.

Utilitarians believe that happiness (pleasure or eliminating pain) for the greatest number of people should be maximized. This belief can also cause trouble for Utilitarians. Wouldn't utilitarian-ism be willing to violate the traditional sanctity-of-life principle to save many people? Utilitarians think that if an FBI sniper saw a terrorist about to detonate a bomb in a skyscraper full of inno-cent people, the sniper should shoot the terrorist. On the other hand, if it were a matter of killing those innocent people to keep a city worth of people safe, the Utilitarian would sacrifice those people.

These are the easy cases. The hard ones come in population policy. If more happiness is better than less, why shouldn't we create the maximal number of people on the planet? So long as

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each new life has more happiness than misery, and so long as everyone else's life has at least the same, shouldn't we produce more?

More specifically to medical ethics, wouldn't utilitarianism permit the sacrifice of an innocent, healthy person to transfer his organs to four patients who needed them to live? Aren't four people alive better than one? If consequences and num-ber of lives define morality, what's morally wrong with doing so? Yet it certainly seems morally wrong to chop up an innocent patient this way.

In medicine, the two areas where utilitarianism applies most powerfully are public health and triage situations. It is likely that improvements in public health have helped more people live longer (created more "utility") than all the drugs and surgeries ever invented. The English physician John Snow might have agreed: In 1849 he advocated clean water to prevent cholera epidemics, which were spread by contaminated water. (It took 40 years and many more cholera epidemics for Snow's ideas to prevail.) It doesn't matter why Snow improved the water supply, only that he did and that many millions of people now live decades longer.

Triage involves the apportionment of scarce resources during emergencies when circumstances preordain that not all victims will live. Because consequences count, utilitarianism says a physician should not treat each patient equally, but should focus only on those whom he can actually benefit. Rigorous application of this principle gives utilitarianism its famous hard edge: A physician should abandon those who will die even if he helps them and, just as ruthlessly, he should abandon those who will live without his help. He should help only those who waver between life and death and for whom he can make the difference. The goal is to save the maximal number of lives.

This point illustrates an ambiguity in sanctity-of-life ethics. Traditionally, sanctity-of-life ethics emphasize the absolute value of each individ-ual, implying that the physician should at least comfort those who are beyond his help. But utilitarian-triage ethics maximizes the value of life in saving the maximal number of people who will eventually live.