Consequentialism

The first ethical theory we will look at more closely is consequentialism. Consequentialism claims that whether an action is right or wrong depends on the consequences that it brings about. Any consequentialist ethical theory has to provide a justification of how we decide which consequences are good or bad. The most famous form of consequentialist ethics is utilitarianism which was first proposed by Jeremy Bentham and then furthered by John Stuart Mill in the 19th century. 

Utilitarians claim that actions are “right in proportion as they tend to promote happiness; wrong as they tend to produce the reverse of happiness” and that what is desirable is “pleasure and the freedom from pain”. In other words, the morally right action is the one that produces the greatest amount of happiness or welfare. This is not the greatest amount of happiness for the moral agent but the greatest amount of happiness overall - this is known as the ‘greatest happiness principle’. Finally, Mill also claims that happiness is the only thing that is desirable in itself as an end.

Now we will look at an example of how utilitarianism may be used in a medical context. To do so, let’s look at a current example of limited resources, such as ventilators, in hospitals during the Covid-19 outbreak and how we may decide which patients should be allocated these resources. 

In this example: A hospital has limited capacity to deal with Covid-19 patients and is having to decide between admitting a 20 year old patient, who is fit and well, and a 75 year old patient, who has a history of heart disease, to their last available ventilator.

When deciding on questions of what is ethically right or wrong utilitarians want to maximise the overall amount of happiness or welfare. In this case, they would argue that welfare would be maximised by giving the last ventilator to the 20 year old. This is because all things being equal they will live longer and may contribute more to society over a longer period of time. 

In many hospitals and healthcare trusts across the world this is the thought process that is guiding their policies regarding who should be treated in hospitals. Particularly in Italy, where the death toll and strain on hospitals has reached a critical point, there is a policy now to prioritise treating younger patients and healthcare workers. One doctor speaking to the Business Insider claimed:

"If you had, let's say, an ICU that was overwhelmed, you're probably going to try and give some extra attention to healthcare workers because you need them to deliver care," he said. "The rationale isn't that they're more worthy; it's that they can contribute in the longer run to saving more lives."

Certainly, the use of utilitarian ethics in medical contexts is not without controversy and this is something which we shall next by looking at a well-known objection to utilitarianism using a thought experiment: 

The objection is that by only focusing on objectively promoting the greatest good, utilitarians can permit and indeed claim that certain actions, which appear morally wrong, are in fact the right action. To demonstrate this I will use an adapted version of John Harris’ ‘Survival Lottery’ thought experiment (this thought experiment is a theoretical example used to highlight the objection and is not to be taken literally):

‘Let us imagine we have five patients who require organ transplants. On the next ward is  Patient A who has a curable disease and also is a suitable donor for the other patients. Utilitarianism would permit a doctor to allow Patient A to die and for their organs to be used to save the lives of the other five patients. Their justification is that this action would produce the most overall welfare.’

Clearly it is an abhorrent thought that an individual would be sacrificed simply to promote overall welfare in complete disregard for their life. Utilitarianism in this instance appears to give the morally incorrect answer. 

The Survival Lottery thought experiment highlights that there are actions which we consider morally right or wrong regardless of the amount of happiness or welfare produced. These can be thought of as rules or duties that we have to ourselves and to others regardless of their consequences. This is the basis of duty based ethics, also known as deontology, which we will turn our attention to in the next post. 

For a summary of consequentialist ethics check out the videos below:

For more information on consequentialism and utilitarianism follow the links below:

https://plato.stanford.edu/entries/consequentialism/

https://plato.stanford.edu/entries/utilitarianism-history/

https://plato.stanford.edu/entries/mill-moral-political/

https://www.iep.utm.edu/util-a-r/

https://ethics.org.au/ethics-explainer-consequentialism/