ETHICS MIDTERMS REVIEWER
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UTILITARIANISM
- Utilitarianism is an ethical theory that argues for
the goodness of pleasure and the determination
of right behavior based on the usefulness of the
actions consequences. This means that
pleasure is good and that the goodness of action
is determined by its usefulness. Putting these
ideas together, utilitarianism claims that one’s
action and behavior are good in as much as they
are directed toward the experience of which
refers to the usefulness of the consequences of
one’s action and behavior. When we argue that
the drug war program of the present government
is permissible because doing so results in better
public safety , then we are arguing in a utilitarian
way. It is utilitarian because we argue that some
individual rights can be sacrificed for the sake of
the greater happiness of the many.
Their system of ethics emphasizes the
consequences of actions:
- This means that the goodness or the badness of
an action is based on whether it is useful in
contributing to a specific purpose for the greatest
number of people.
Utilitarianism is consequentialist:
- This means that the moral value of actions and
decisions is based solely or greatly on the
usefulness of their consequences; it is the
usefulness of results that determines whether
the action or behavior is good or bad.
The utilitarian value pleasure and happiness:
- This means that the usefulness of actions is
based on its promotion of happiness as the
experience of pleasure for the greatest number
of persons, even at the expense of some
individual rights.
JEREMY BENTHAM UTILITARIANISM
- Born on february 15,1748 in london, england.
Died on June 6, 1832.
- He was the teacher of James Mill, father of John
Stuart Mill.
- Bentham first wrote about the greatest
happiness principle of ethics and was known for
a system of penal management called
PANOPTICON.
- Intellectual inheritor of David Hume
- Recognized as ‘Act Utilitarian’
- Right actions result in ‘good or pleasure,’ wrong
actions result in pain or absence of pleasure.
- The Principle of Utility
- Law and Social Hedonism
- Felicific Calculus
THE PRINCIPLE OF UTILITY (JEREMY BENTHAM)
- In the book An Introduction to the Principles of
Morals and Legislation (1789), Jeremy Bentham
begins by arguing that our actions are governed
by two “sovereign masters”--which he calls
pleasure and pain. These “masters” are given to
us by nature to help us determine what is good
or bad and what ought to be done and not; they
fasten our choices to their throne.
- The principle of utility is about our subjection to
these sovereign masters: PLEASURE and PAIN.
- On one hand, the principle refers to the
motivation of our actions as guided by our
avoidance of pain and our desire for pleasure.
is like saying that in our everyday actions, we do
what is pleasure as good if, and only if, they
produce more happiness than unhappiness. This
means that it is not enough to experience
pleasure, but to also inquire whether the things
we do make us happier. Having identified the
tendency for pleasure and the avoidance of pain
as the principle of utility, Bentham equates
happiness with pleasure.
- Actions that lead to PLEASURE ARE RIGHT,
ones that produce PAIN ARE WRONG.
LAW AND SOCIAL HEDONISM (JEREMY BENTHAM)
LAW
- Government should not pass laws that protect
tradition, customs or rights.
- Government should base all laws on the
happiness principle The greatest happiness for
the greatest number.
- Bentham’s theory is both empirical (how much
pain or pleasure is caused by the act or policy)
and democratic (each individual’s happiness is
as important as another’s).
SOCIAL HEDONISM
Ethics as Greatest Happiness
- Moral worth judged by presumed effect.
- Action guided by pleasure/pain.
FELICIFIC CALCULUS (JEREMY BENTHAM)
FELICIFIC CALCULUS
- common currency framework that calculates the
pleasure that some actions can produce.
In this framework, an action can be evaluated on the
basis of intensity or strength of pleasure.
- DURATION or length of the experience of
pleasure.
- CERTAINTY, UNCERTAINTY, or the likelihood
that pleasure will occur; and
- PROPINQUITY, REMOTENESS, or how soon
there will be pleasure.
These indicators allow us to measure and pain in
actions, we need to consider THREE MORE
DIMENSIONS:
- FECUNDITY or the chance it has of being
followed by sensations of the same kind.
- PURITY or the chance it has of not being
followed by sensations of the opposite kind.
- Lastly, when considering the number of persons
who are affected by pleasure or pain, another
dimension is to be considered --EXTENT.
- Felicific calculus allows the evaluation of all
actions and their resultant pleasure. This means
that actions are evaluated on this single scale
regardless of preferences and values. In this
sense, pleasure and pain can only quantitatively
differ but not qualitatively differ from other
experiences of pleasure and pain accordingly.
JOHN STUART MILL
- His ethical theory and his defense of utilitarian
views are found in his long essay entitled
UTILITARANISM (1861).
- He studied Greek at the age of three and Latin
at the age of eight. He wrote a history of Roman
Law age eleven. He was married to Harriet
Taylor after 21 years of friendship.
 - Was born on May 20, 1806, in Pentonville,
London, United Kingdom. Died on May 8, 1873,
in Avignon, France from Erysipelas.
- A more sophisticated form of Utilitarianism.
- Concerned with quality of pleasure and quantity
of people who enjoy it.
- Recognized higher and lower types of human
pleasure.
- PRINCIPLE OF GREATEST NUMBER
- JUSTICE AND MORAL RIGHTS
- Mill dissents from Bentham’s single scale of
pleasure. He thinks that the principle of utility
must distinguish pleasures QUALITATIVELY and
not merely quantitatively.
- For Mill, utilitarianism cannot promote the kind of
pleasures appropriate to pigs or to any other
animals. He thinks that there are HIGHER
INTELLECTUAL and LOWER BASE
PLEASURES.
- Lower pleasures: eating, drinking, sexuality, etc.
- Higher pleasures: intellectuality, creativity and
spirituality.
- "It is better to be a human being dissatisfied than
a pig satisfied; better to be Socrates dissatisfied
than a fool satisfied.”
PRINCIPLE OF GREATEST NUMBER (JOHN STUART
MILL)
- Utilitarianism cannot lead to selfish acts. It is
neither about our pleasure nor happiness alone;
it cannot be all about us. If we are the only ones
satisfied by our actions, it does not constitute a
moral good. In this sense, utilitarianism is not
dismissive of sacrifices that procure more
happiness for others.
- Utilitarianism is interested with the best
consequence for the highest number of people.
It is not interested with the intention of the agent.
Moral value cannot discernible in the intention or
motivation of the person doing the act; it is
based solely and exclusively on the difference it
makes on the world’s total amount of pleasure
and pain.
- Utilitarianism is interested with everyone’s
happiness, in fact, the greatest happiness of the
greatest number.
JUSTICE AND MORAL RIGHTS (JOHN STUART
MILL)
- When we call anything a person’s right, we
mean that he has a valid claim on society to
protect him in the possession of it, either by the
force of law , or by that education and opinion. If
he has what we consider a sufficient claim, on
whatever account, to have something
guaranteed to him by society, we say that he has
a right to it.
- The right to due process, the right to free speech
or religion, and others are justified because they
contribute to the general good. This means that
society is made happier if its citizens are able to
live their lives knowing that their interest are
protected, and that society (as a whole) defends
it.
- A right is justifiable on utilitarian principles in as
much as they produce an overall happiness that
is greater than the unhappiness resulting from
their implementation.
- Mill creates a distinction between legal rights
and their justification. He points out that when
legal rights are not morally justified in
accordance to the greatest happiness principle,
then these rights need neither be observed, nor
be respected. This is like saying that there are
instances when the law is not morally justified
and, in this case, even objectionable.
- In short, Mill’s moral rights and considerations of
justice are not absolute but are only justified by
their consequences to promote the greatest
good of the greatest number.
BETHAMITE (DEMOCRATIC UTILITARIANISM)
- No one pleasure is inherently better than any
other.
- If drunken parties make you happy, then go for
it!
- Reading poetry isn’t better than watching The
Bachelor, it’s just different.
MILLSIAN (ELITE UTILITARIANISM)
- Some pleasures are better than others.
- If you party and get drunk every day, then you
won’t be as happy as you otherwise might be.
- Enjoying poetry is better than watching bad TV.
And if you disagree, it is because you don’t
understand quality.
JUSTICE
John Rawls’s principle of justice is directed closer
to reformulating conceptions of justice which can be
primarily based totally upon ideas which can be arbitrary
from an ethical point of view. Moreover, Rawls is in
opposition to all claims of Utilitarianism. He sees it as
unfavorable to the wellness of the people withinside the
society. This is because, for Rawls, Utilitarianism does
now no longer remember the character as inviolable. It
virtually sees the character as sheer mechanism for the
proliferation of welfare-software and, hence, as
expendables for the maximization of software or
happiness of the majority. Thus, Rawls rejects any
ethical claims that invoke the concept of software or the
happiness of the majority. Indeed, for Rawls, people do
own inviolable rights and dignity that can not be
overridden through the society’s venture of the best life.
In his components of his principle of justice,
Rawls gives 3 essential presuppositions. First, he starts
off evolved his principle with a thought of a democratic
society, one this is characterized via way of means of
freedom and equality. This is coupled together along with
his emphasis on different rational people whose
rationality permits them to agree upon ideas of
distribution customary via way of means of all. Second,
he adheres to the concept of the need of a agreement
principle to be able to legitimize any nation movement
withinside the procedure of distribution. Third and last,
Rawls provides ideas of justice that function the
underlying motive for any simply society. According to
Rawls, those ideas must be observed in any respect
charges via way of means of rational people. It is
likewise vital to be aware that for Rawls, the ideas if
justice are meant to insure that the people rights and
liberties are blanketed and that all of them is given same
possibility to realize their perceived dreams no matter
their socio-political and financial status. And ultimately,
those ideas are designed to assure that the terrible are
given veto or strength over inequality.
Etymologically, justice comes from the Latin
word ‘jus’ to mean ‘right’. The etymological meaning of
the word ‘justice’ that connotes ‘right’ is somewhat a bit
different from the word ‘justice’. What then is justice?
The terms fairness, desert (what is deserved) and
entitlement are used by various philosophers in an
attempt to explicate justice. This account interprets
justice as fair, equitable, and appropriate treatment in the
light of what due or owe to others.
The writer of the Hippocratic Oath insists that it
is a part of the doctor’s duty to keep his patients free
from injustice they can do themselves, Justice is
generally thought to be giving others their due. This idea
may be taken into different senses, most narrowly as
fulfilling responsibilities prior to any undertakings, more
widely, as being fair perhaps to others, quite generally,
as acting uprightly in any way of actions bearing on
others, biblically, the scripture would say that justice may
mean goodness and holiness in general. However, most
philosophers use the term justice in a more specific
sense that was referred to as ‘rightness in people’s
interactions and interrelations’. Thus, it is rightfully
correct to say that sometimes the word ‘justice’ overlap
with the word ‘right’.
Formal Principle of Justice
Formally speaking, as Aristotle in Nicomachean
Ethics would say that justice refers to ‘equals must be
treated equally’ and ‘unequals must be treated
unequally’. This is the formal principle of justice, it is
‘formal’ because it identifies no particular respects in
which equals ought to be treated equally and thus
provide no criteria for determining whether two or more
individuals are in fact equal (Beauchamp and Childress,
2001).
Material Principle of Justice
Principles that specify the relevant
characteristics for equal treatment are called ‘material’
because they identify the substantive properties for
distribution. Philosophers like Engelhadrt, Keusch,
Wildes and others have suggested the following material
principles of justice:
1. To each person an equal share. [example: all
members of the society are given equal services
such as the free immunization to all children
below seven years old]
2. To each person according to need. [example:
when there is a shortage of ex. Hepatitis B
vaccine, it is provided only to the high risks
groups. Likewise, only health care workers
assigned in the high risks areas are provided
with free health check-ups, medication, including
treatments and vaccinations to protect them]
3. To each person according to contribution.
[example: only people who are members of the
Philippine Health can avail of its medical
services and privileged]
4. To each person according to free-market
exchanges. [example: the service is provided
only to those who can afford it such as cosmetic
surgery]
5. To each person according to merit. [example:
this principle involves that implementation of set
of rules/criteria that must be met before a
privileged can be granted. Example: Philippine
Charity Sweepstakes service of proving free
health care assistance only to those who meets
the required criteria and that is having no
financial capacity to provide it for themselves
and to their family]
6. To each person according to effort. [example:
this refers to the patient’s efforts to comply or not
to comply with the medical advice. A diabetic
client has the choice to comply or not to comply
with his medication and diet regimen]
Types of justice
1. Distributive justice. It refers to fair, equitable,
and appropriate distribution or responsibilities or
share or rights and roles, resources and
privileges
2. Criminal justice. Refers to the infliction of
punishment or penalty proportionate to the crime
committed. In other words, no exemption in the
merited penalty.
3. Rectificatory justice. Refers to just
compensation for transactional problems such
as breaches of contract and practice based on
civil law. Rectify the person who did not observe
hi/her word of honor.
The discussion of justice will only be limited to
distributive justice for it’s too complex to handle it here.
Theories of distributive justice have been developed to
specify and unite one’s diverse principles, rules and
judgment. Theory attempts to connect the characteristics
of persons with morally justifiable distribution of benefits
and burdens. Nonetheless, systematic theories of justice
have been proposed to determine how social burdens,
including health care goods and services should be
distributed or redistributed. Some influential theories that
go with the discussion of justice are the following:
The Paradigm Approach to Justice
Utilitarian: Justice as whatever brings about the
greatest good of the greatest number (John Stuart Mill)
For a utilitarian, justice is not an independent
moral principle. Rather it is a principle dependent on,
governed by, that sole principle of morality, the principle
of utility. It names the most paramount and stringent form
of obligation created by the principle of utility. Utilitarian
therefore work out all the predictable benefits and all the
predictable losses of some proposed change or state of
affairs, calculate the net sum (or utility) of the proposed
changes and choose that state of affairs which will bring
about the greatest good for the greatest number, which
will in turn maximize utility. Justice in this instance then is
the distributed result of that calculation. Thus, any form
of state of affairs is considered just if it represents the
greatest good for the greatest number and unjust to the
extent that it does not affect that result.
As it is applied in health care, utilitarian used two
principal criteria for working out one’s utility: quality of
life measures and social contribution measures. It is a
fact that some utilitarian may have various emphases yet
they tend to favor the following principles in medicine: a)
prevention is to be preferred to cure and cheaper (less
expensive) therapies are to be preferred to a more
expensive ones, b) expensive or scarce therapies are
only available to the young and those who likely to lead
long productive lives, c) preference should be given to
those likely to receive the greatest benefit in terms of
improved length and quality of life and to those likely to
make the greatest future social contribution, d) short-
term services are to be preferred to long-term care and
institutional care is eliminated as much as possible and
e) healthcare for the terminally ill, dying, elderly,
chronically sick or incapacitated, severely handicapped
and permanently unconscious is to be given the lowest
priority (Anthony Fisher).
Egalitarian: Justice as the equal distribution of good
and services (John Rawls).
Egalitarian argued that justice means is
essentially considered what is due is what is fair, equal,
or perhaps fairness. John Rawls principle of justice is
derived from what people would choose if they were
forced to be impartial, if they had to choose principles on
which to base a social structure that will satisfy them
whenever they turn out to be located in it. John Rawls
continue to say that each person will choose two Communitarian believed that human life will go better if
principles that will lead towards the exercise of fairness, collective and public values guide people’s lives. They
namely, a) each person should have the most extensive have a commitment to facilitate and practice designed to
system of basic liberties compatible with similar liberties help members of the community develop their common
for all and b) social and economic inequalities should be and henceforth personal lives (Honderich, 1995).
arranged so that they are to the greatest benefit of the Modern communitarian writers disagree on the
least advantaged and are open to all under conditions of application of these theories to health care access.
fair equality of opportunity. Simply to say, justice for Some proposes a federation of interlinking community
Rawls therefore consists in fair equality of opportunity. health programs that are democratically administered by
the citizen-members. In this approach to communitarian,
John Rawls himself never applied justice to the
each individual program would determined which
distribution of health care. However, most readers
benefits to provide, which care is most important,
(Daniels, Norman) of John Rawls believed that his theory
whether expensive service will be included or excluded
inspired approaches to health care distribution by
(Beauchamp and Childress, 2001).
insisting that each person irrespective of social condition
such as poor and the wealthy should be provided with
The following table shows a summary of the
equal fair opportunity to health.
different approaches to justice:
Distribution Rawls believed must be on the basis Approaches Propone Principle Description
of need which is understood as what is necessary for to justice nt of Justice
equality of opportunity. For example, better services, utilitarianism Mill Justice as Equality of
such as luxury hospital rooms and expensive but whatever all persons
optional dental work, should be available for purchase at brings and
personal expense by those who are able and wish to do about the impartiality
so. On the other hand, everyone’s basic need of health greatest between
service should be met at an adequate level. By this, it good of persons
ensures decent minimum of health care and equal the
opportunity. greatest
number
Libertarian: Justice as the lack of restraints on
Egalitarian John Justice as Emphasize
individual liberty (Robert Nozick).
Rawls the equal d on what is
Contemporary libertarian like Robert Nozick distributio owe (as a
believed that it is not the role of the state to impose any n of (at matter of
pattern of distribution of benefits and burdens on its least fairness) by
members since that will violate the rights of individuals. some) the rest of
Nozick believed that individual have rights, such as right goods or us to the
to liberty, life, property and others, which those individual services poorest and
are entitled to enjoy and to exercise so long as it does most
not interfere into the rights of others. Nozick therefore vulnerable
believed that the affair of the state is to protect citizens members of
against any unjust interference such as, theft, fraud, the
violence and others and it is not the business of the state community
to distribute benefits and burdens such as health care Libertarian Robert Justice as Recognizes
since that will turn violate the rights of individuals. Nozick the lack of the
So, as the libertarian suggests, the only just restraints centrality of
system of allocation of health care is the operation of the on individual’s
free-market. It is up to people individually to choose what individual autonomy
health care or service, and from whom, for which they liberty
wish to spend their own resources. It is up to the health Communitaria Alasdair Justice is Consist in
professional as well to decide how, when, for whom, with n MacIntyr what is favoring
whom and for how much they wish to work. Libertarian e due to and
therefore treats autonomy, both the health care individuals fostering
professional and the patient as a central notion of health or groups the
care and allocating resources. Individual then must be depend on common
encouraged to take responsibility for their own health the good of
(Ronald Dworkin, 1981). communit one’s
y-derived communitie
Applying Nozick’s libertarianism to health care, standards s. It
health care professionals are obliged to provide care emphasizes
only that health care in keeping with their own prior on solidarity
undertakings or present choices. Thus, they may with every
legitimately decide for themselves what distribution human
standards to apply to their own practices. Furthermore, being/perso
libertarian, supports generally a health care system, the n
state or any instituted state that does not coerce in
taking one’s own personal property rights, physician Justice underlies the nurse commitment to
have liberty, nurses too, and society is not morally provide services with respect for human dignity and
obligated to provide health care if it is done through render nursing care to the best of their ability to every
coercion. patient regardless of religion, sex, race, economic status
and beliefs.

Communitarian: Justice is what is due to individuals or
groups depend on the community-derived standards
(Alasdair MacIntyre).
Communitarian regards justice as pluralistic
(Beauchamp and Childress, 2001). That means it
derives justice from as many as different conceptions of
the good as there are diverse moral and cultural
communities. Communitarian then placed the community
as the core of a value system than prioritizing an
individual as libertarian proposed. The value of any
public goods are rooted from a communal practices.
Allocation of Scarce and Resource (Triage)
The basic ethical question to allocation of scarce
and resources is not whether there is a need to rationing
or prioritization but how it should do so, given the case
that it is inevitable. Unless there is a systematic ethical
examination and criticism of health care distribution,
there are likely to be inconsistencies, abuses in the way
the goods of the state is allocated.
The first issue on allocation of scarce resources
is on the ‘macro’ level is: how much should be spent on
healthcare? The second would be on meso-allocation
which is: how many healthcare resources should go to
what kind of services? And finally, on the microallocation:
who should get what share of the healthcare resources?
The problem of health care distribution does not
only arise when being addressed directly. Time and
again it rears its head when treating other bioethical
questions such as the appropriate treatment of
newborns, the infertile, the chronically sick and the
terminally ill and the permanently unconscious.
To allocate is to distribute by allotment as
Beauchamp and Childress would argued. And such
distribution does not presuppose either a person or a
system that rations/prioritize resources. A criterion of
one’s ability to pay in a competitive-market for instance
is a form of an example of allocation.
‘Macroallocation’ decisions determine the funds
to be expended and the goods to be made available, as
well as the method of distribution. This emphasize that a
macroallocation deals with how much of the society’s
resources will be used for various needs, including
health-related expenditures. A certain state therefore
decides how much of the national budget goes to the
health care program and what proportion of available
health goes to which program.
On the other hand, ‘Microallocation’ decisions
determine who will receive the particular scarce
resources. This distinction that were mentioned are
useful, but the line between them are not clear and
oftentimes interact.
One’s own moral intuition often drives each one
into two conflicting directions: either to allocate more to
treatment or to allocate more to prevention and
education. Now, determining who among the given
options will receive priority varies due to different
philosophies one is adhering. So, the only recourse
perhaps is to give what is due to ones own.