case study about utilitarianism

10 Utilitarianism Examples (Plus Pros and Cons)

The core idea of utilitarianism is that we ought to act in a way that maximizes happiness for the greatest number. So, the morally right action is, according to utilitarians, the action that produces the most good.

Examples of utilitarianism include effective altruism, bulldozing someone’s home for a highway, and redistribution of excess money from the rich to the poor.

It is an ethical theory developed to determine what we morally ought to do. It is a variety of consequentialism . That is, utilitarianism takes the consequences that action produces as the only relevant factor to determining whether that action is or isn’t morally permissible.

Utilitarianism Definition

Utilitarianism is the view that one ought to promote maximal well-being, welfare, or utility. The theory evaluates the moral rightness of actions, rules, policies, motives, virtues, social institutions, etc. in terms of what delivers the most good to the most people.

According to MacAskill, Meissner, and Chappell (2022), all utilitarian theories share four defining characteristics:

Consequentialism: The view that one ought to act in a way that promotes good outcomes.
Welfarism: The view that only the welfare or well-being of individuals determines the value of an outcome.
Impartiality: The view that the identity of individuals is irrelevant to the moral value of an outcome. The interests of all individuals hold equal moral weight.
Aggregationism: The view that the value of the world is the sum of the values of its parts. The parts are experiences, lives, societies, and so on.

Any theory that denies any of the elements above is not utilitarian. For example, a non-consequentialist might hold that actions can be inherently right or wrong regardless of the outcomes they produce.

Utilitarian Case study: Jeremy Bentham

A key feature of utilitarianism has always been its focus on practical action. Jeremy Bentham was one person who highlighted this in his writing.

He advocated for the rights of animals when there were no laws protecting animals from cruelty. He advocated for improving the conditions of prisoners and the poor.

Utilitarians advocated for broadening suffrage to extend it to women. They advocated for women’s rights more generally. Bentham advocated for homosexual rights. In these and many other areas, utilitarians supported policies that are today part of common sense (Lazari-Radek & Singer, 2017).

Other important contributors to utilitarianism include John Stuart Mill (1871), Henry Sidgwick (1874), Richard M. Hare (1993), and Peter Singer (Lazari-Radek & Singer, 2017).

Utilitarianism Examples

Redistributing money to the poor : Wealth and income have a diminishing marginal utility. The more wealth you have, the less well-being you get from additional money. It is, therefore, a utilitarian choice of a government to redistribute money to the poor who need it more than the rich do (MacAskill & Meissner, 2022).
Effective altruism : Effective altruism is a research field that aims to identify the world’s most vital problems and tries to find the most effective solutions to them. This is a philosophy and social movement endorsed by many utilitarians, most notably Peter Singer and William MacAskill. Not all effective altruists are utilitarians, but many utilitarians find this movement especially appealing.
Global health and development : This is a particularly important area for utilitarians because it has a great track record of improving overall well-being. Donating to organizations that give people access to better healthcare is one of the most important causes for utilitarians.
Farm animal welfare : For utilitarians, animals matter and humans are the cause of a large amount of their unnecessary suffering. There are ways to reduce the suffering of farmed animals. These include campaigns to make large retailers cut caged eggs out of their supply chains, donating money to animal charities, reducing meat consumption, improving the quality of animal shelters or farms, and so on.
Reducing existential risks : The value of our actions, according to utilitarians, depends largely on how those actions will affect the future in the long run. Existential threats such as a nuclear war, a global pandemic, extreme climate change, and so on are, therefore, of pressing concern for utilitarians.
Career choices : Many utilitarians emphasize the importance of choosing a career path that allows you to do the most overall good in the long run. This doesn’t involve much of a personal sacrifice, since the job you find satisfying is very often the one that allows you to help the largest number of people.
Outreach : Promoting utilitarian ideas is itself considered by many utilitarians to be a morally good action. This is because promoting utilitarian ideas is likely to increase the overall well-being of individuals. The people you inspire will do several times as much good as you could have done alone.
Women’s suffrage: Philosopher Jeremy Bentham argued for women’s suffrage from a universalist perspective. By increasing women’s rights, benefits are distributed to a greater number of people and therefore it suits a utilitarian ethic.
Bulldoze a house to build a highway: If a house stands in the way of a highway being built, a utilitarian perspective may argue that the house should be bulldozed. More benefit to more people will come from one person losing their house in return for millions of people getting faster access to work every day. This is called the ‘rights objection’ to utilitarianism.
Organ transplant hypothesis: There is a hospital with five people requiring transplants – a heart, a kidney, a foot, a liver, and bone marrow. The greatest good for the most people could theoretically justify killing one person so their organs can be donated to save five people.

Pros of Utilitarianism

Simplicity : The core of utilitarianism is easy to understand and apply. The fundamental question of ethics is: “What should I do?” Utilitarianism gives a very straightforward answer: The right thing to do is to bring about the greatest possible net increase in the surplus of happiness over suffering. This short answer gives everything one might need, at least in principle, to analyze what one ought to do in any possible situation (Lazari-Radek & Singer, 2017, p. xix).
Intuitiveness : It is impossible to prove all claims within a given theory. As Ludwig Wittgenstein pointed out, “at the foundation of well-founded belief lies belief that is not founded” (Wittgenstein, 1969, p. 33). Intuitiveness is, therefore, a vital aspect of any moral theory. The axiomatic parts of any ethical theory must be intuitive for the theory to be successful or convincing. Acting to promote the greatest good for the greatest number intuitively seems like an aim worth pursuing. This is because almost everyone agrees that happiness is good and suffering is bad.
Practicality : Utilitarian theory is immediately practical. The historical record shows that the causes utilitarians advocated for, such as universal suffrage, animal rights, gay rights, global health, and so on have become more and more important for the world. Utilitarianism seems to be effective because it can be easily applied.
Impartiality : The moral atrocities of the past were often sanctioned by the dominant societal norms of the time. A theory that is impartial and expands the moral circle as much as possible is, therefore, more appealing to us today. Utilitarianism, because of its commitment to giving equal weight to the interests of every individual, is impartial (Chappell & Meissner, 2022).

Cons of Utilitarianism

There are many objections to utilitarianism. Most of these are based on the idea that utilitarianism often leads to counterintuitive claims and conclusions about action (MacAskill et al., 2022).

The following list is incomplete, but it covers the most common objections raised against utilitarianism:

The alienation objection claims that utilitarianism is cold and impersonal, thereby alienating us from the particular people and projects that truly matter to us.
The demandingness objection claims that utilitarianism is too demanding because it requires excessive self-sacrifice.
The equality objection claims that utilitarianism ignores, or doesn’t give enough value to equality and distributive justice .
The mere means objection claims that utilitarianism treats people merely as means to the greater good. This objection is particularly popular with the followers of Kant (Kant, 1785/1993, p. 36).
The rights objection charges utilitarianism with being overly permissive, claiming that utilitarianism might allow infringing upon the rights of others to maximize overall well-being.
The separateness of persons objection claims that utilitarianism neglects the boundaries between individuals to maximize overall well-being.
The special obligations objection holds that utilitarianism is too impartial and does not account for the special obligations we have to our friends or family members.

Utilitarianism is one of the most widespread and intuitive approaches to ethics. It gives straightforward answers and actionable advice to those who subscribe to it.

Like any moral theory, it has many arguments for and against it. It was first fully articulated in the nineteenth century and is still an important and controversial ethical theory.

Bentham, J. (1879). An Introduction to the Principles of Morals and Legislation . Clarendon Press.

Brink, D. (2022). Mill’s Moral and Political Philosophy. In E. N. Zalta & U. Nodelman (Eds.), The Stanford Encyclopedia of Philosophy (Fall 2022). Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/fall2022/entries/mill-moral-political/

Chappell, R.Y. and Meissner, D. (2022). Arguments for Utilitarianism. In R.Y. Chappell, D. Meissner, and W. MacAskill (eds.), An Introduction to Utilitarianism . https://www.utilitarianism.net/arguments-for-utilitarianism , accessed 11/18/2022.

Driver, J. (2022). The History of Utilitarianism. In E. N. Zalta & U. Nodelman (Eds.), The Stanford Encyclopedia of Philosophy (Winter 2022). Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/win2022/entries/utilitarianism-history/

Hare, R. M. (1993). Essays in Ethical Theory . Clarendon Press.

Kant, I. (1993). Grounding for the metaphysics of morals ; with, On a supposed right to lie because of philanthropic concerns . Indianapolis : Hackett Pub. Co. (Original work published 1785) http://archive.org/details/groundingformet000kant

Lazari-Radek, K. de, & Singer, P. (2017). Utilitarianism: A Very Short Introduction . Oxford University Press.

MacAskill, W. and Meissner, D. (2022). Acting on Utilitarianism. In R.Y. Chappell, D. Meissner, and W. MacAskill (eds.), An Introduction to Utilitarianism . https://www.utilitarianism.net/acting-on-utilitarianism , accessed 11/18/2022.

MacAskill, W., Meissner, D., and Chappell, R.Y. (2022). Introduction to Utilitarianism. In R.Y. Chappell, D. Meissner, and W. MacAskill (eds.), An Introduction to Utilitarianism . https://www.utilitarianism.net/introduction-to-utilitarianism , accessed 11/18/2022.

MacAskill, W., Meissner, D., and Chappell, R.Y. (2022). Objections to Utilitarianism and Responses. In R.Y. Chappell, D. Meissner, and W. MacAskill (eds.), An Introduction to Utilitarianism . https://www.utilitarianism.net/objections-to-utilitarianism , accessed 11/18/2022.

Mill, J. S. (1871). Utilitarianism . Longmans, Green, Reader, and Dyer.

Sidgwick, H. (1874). The Methods of Ethics . Macmillan.

Wittgenstein, L. (1969). On Certainty . Basil Blackwell.

Tio Gabunia (B.Arch, M.Arch)

Tio Gabunia is an academic writer and architect based in Tbilisi. He has studied architecture, design, and urban planning at the Georgian Technical University and the University of Lisbon. He has worked in these fields in Georgia, Portugal, and France. Most of Tio’s writings concern philosophy. Other writings include architecture, sociology, urban planning, and economics.

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> Case Analysis in Clinical Ethics
> A utilitarian approach

Book contents

Frontmatter
Notes on contributors
Acknowledgements
1 Philosophical introduction: case analysis in clinical ethics
2 Families and genetic testing: the case of Jane and Phyllis
3 Family access to shared genetic information: an analysis of the narrative
4 A virtue-ethics approach
5 Interpretation and dialogue in hermeneutic ethics
6 ‘Power, corruption and lies’: ethics and power
7 Reading the genes
8 A utilitarian approach
9 A feminist care-ethics approach to genetics
10 A conversational approach to the ethics of genetic testing
11 Families and genetic testing: the case of Jane and Phyllis from a four-principles perspective
12 A phenomenological approach to bioethics
13 An empirical approach
14 Response to ethical dissections of the case
15 Philosophical reflections

8 - A utilitarian approach

Published online by Cambridge University Press: 01 September 2009

What is utilitarianism?

Utilitarianism is, on one level, a straightforward moral theory (Savulescu 2003). According to utilitarians, all that matters is well-being. The more well-being, the better. The right action is that action that results in the greatest sum total of well-being.

Utilitarianism has several strengths. It does not invoke mysterious or vague concepts like rights, duties (e.g. to some deity), enlightenment (e.g. of the Truth), liberation (e.g. of the worker), which are difficult to define plausibly or apply consistently and appropriately in practice. It invokes the most basic of concepts: that our lives can become better or worse. Our lives become worse, for example, when we die prematurely of some illness. And people's actions are wrong when they make our lives become worse.

Utilitarianism protects the welfare of the individual. People should not be harmed in the name of some ideal or human construct. One needs a very good reason to harm people, according to utilitarianism. Those reasons would have to do with great benefits to other people.

Application

Lucassen writes that in clinical genetics ‘there can be a direct conflict between preserving the confidentiality of one patient and the right of other family members to know information about their genetic status and risk of disease.’

It is notoriously difficult to define a right and balance different rights and interests. What is the ‘right of a family member to know information about their genetic status’? Where do such rights come from?

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A utilitarian approach
By Julian Savulescu , Founder and Director Oxford, Uehiro Centre
Edited by Richard Ashcroft , Imperial College of Science, Technology and Medicine, London , Anneke Lucassen , University of Southampton , Michael Parker , University of Oxford , Marian Verkerk , Rijksuniversiteit Groningen, The Netherlands , Guy Widdershoven , Universiteit Maastricht, Netherlands
Book: Case Analysis in Clinical Ethics
Online publication: 01 September 2009
Chapter DOI: https://doi.org/10.1017/CBO9780511545450.008

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Examples of Utilitarianism in Business: Utilitarianism Case Study

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Case 1: Blood for sale

Case 2: wal-mart, case 3: webporn, case 4: housing allowance, case 5: challenger, works cited.

The utilitarianism theory focuses on the moral aspect of various actions and decisions that people make and it attempts to explain whether the actions or decisions are right or wrong. The analysis of ‘rightness’ and ‘wrongness’ of a decision or action often depends on the values that each society holds dear (Callcut 24).

Therefore, the theory focuses on the justification of behavior and decisions as either moral or immoral. The concept of morality is entirely abstract. Perceptions of right and wrong depend both on individual and societal perspectives of morality often for the good of the individual analyzing the same.

In most cases, when people choose to undertake an analysis of the morality of actions and decisions, they focus on matters of public interest such as issues concerning politics, economic policies, and social constructs (Lukes 12).

Utilitarianism operates on several premises and one of them is the concept that an action or decision is right if it only affects the doer to the exclusion of any other person around the individual (Mill 41). For instance, if a person decides to set his/her house on fire at will, s/he should do so at will as long as the fire at the house does not spread to other people’s houses or cause damage to the neighboring properties.

However, some people argue that although a person has a right to set his or her own house on fire, the action affects others indirectly through ways such as spreading smoke and ash to the neighboring properties. This argument has led to the development of the second premise in the theory, which states that in order for actions and decisions to qualify as right and moral, they must appeal to the happiness of the greatest number.

This assertion means that the majority of people in any society or setting in which the actions or decisions take place must be in agreement with the same (Ferrell et al. 67). Using the example applied above, the burning of the house would only be right and moral if a majority of the people living in the area surrounding the house were okay with the action.

The reason for this rule is to set a standard for right and wrong behaviors and decisions and prevent clumsy decisions by individuals that are likely to affect a majority of other people simply due to individual preferences of morality, especially by representatives of the people in various governments (Alexander 48).

The third premise that the theory propagates is the perception that actions and decisions should increase happiness and reduce suffering for the greatest number of people. The theory thus places emphasis on the results rather than the procedure when analyzing the morality of actions and decisions (Parson 97).

For instance, if a man steals to feed his children, the morality of the action depends on whether it reduces suffering and increases happiness. However, in order to prevent outrageous actions and decisions, especially from government representatives, the second premise applies when vetting the moral validity of such actions and decisions (Sartorious 75).

Jeremy Bentham is one of the earliest proponents of this theory. According to him, absolute morality is impracticable as a vast majority of people hold conflicting views on what qualifies as right and what qualifies as wrong.

Therefore, utilitarianism provides a base regarding consideration and analysis of what qualifies as moral in terms of actions and decisions, especially with reference to government officials, civil servants, and other key figures in society (Bentham 12).

John Stuart mill, also a proponent of the theory, contributes to the discussion through his observation that the theory is result-oriented coupled with supporting Bentham’s opinion on the matter (Mill and Bentham 34).

In order to create a better understanding of the theory and its application, this paper explores five cases. It gives an overview of the main concerns in the cases and their moral implications according to the application of the utilitarian theory.

Case summary: Sol Levin was a successful stockbroker in Tampa. He observed that in the United States, the blood used for transfusions mostly comes from donation from well-wishers. However, since most people are not willing to donate, there was a blood deficit in the country.

He considered this scenario as an opportunity for a profitable business, and thus together with some colleagues, they formed Plasma International. The company mainly deals with the location, purchase, supply, and sale of blood to individuals and organizations that need it for transfusion.

During the initial stages of the company’s operation, the company bought contaminated blood from alcoholics and drug addicts as only a few people in the country were willing to exchange their blood for money. However, the organization later found a village in Africa where people were more willing to sell their blood to the company at prices as low as fifteen cents a pint.

The company made deals with local chiefs for purchase of blood from people in the villages. The company resold the blood in the US at prices that were ten times higher than the purchase price. In the US, about forty percent of people donate blood to build up credit so that they do not buy blood when they need it later.

In comparison, the National Health Service in the Great Britain relies solely on blood donations. The justification for the British system is that blood is something that can dictate whether a person lives or dies. Denying that person blood, especially if voluntary donors offer it, because the person cannot afford the blood is wrong and thus immoral.

Discussion and application: The main issue in this case is whether sale and purchase of blood for profit is moral. Richard Tittmus presents his opinion in support of the British system by stating that selling blood as a commodity reduces the need for people to donate blood, thus resulting in less blood in most blood banks (Steiner 149).

Additionally, when people place a price on their blood, they place high values on it, thus leaving companies like Plasma International with little demand.

Using the utilitarian theory, the morality in selling blood depends on the societal values coupled with what the majority of the population considers as right. In the US, since the system of blood sale is acceptable in society, the act is moral.

However, people in the Great Britain might consider the same as immoral for in their eyes, people donate blood as an act of altruism to save another person’s life. Selling blood like any other commodity degrades its intrinsic value.

Case summary: Wal-Mart is currently the world’s largest retail franchise. It has over 4,750 stores and it attracts about 138 million shoppers every week. Consequently, the franchise has gained enormous influence in the market place, thus controlling up to thirty percent of the household market staples. Most companies selling consumer products such as foods consider the company’s reach as an advantage to their businesses.

Consumers also benefit heavily from the low prices that the company sets for most products. However, some entities see the company as a hindrance to their progress and development. For instance, local businesses in most areas in the US consider the franchise a threat for its affordable prices attract customers previously loyal to such local businesses, thus running them out of business.

Closure of consumer-based businesses in such local communities often leads to loss of jobs, thus creating a monopoly while stifling the economy due to tax considerations that Wal-Mart stores get in most areas. Such occurrences destabilize entire communities.

Additionally, regardless of the profit that the company makes, it provides poor pay for employees without health insurance. The company thus has a high employee turnover of 44%. The company also uses its influence to dictate which products to stock on its shelves. This aspect has created a situation where some companies miss sales and profits while others get an unfair advantage.

Additionally, the company often uses its influence to control prices for goods from companies from which it stocks its products. The company has a tradition of advocating for low purchase prices from suppliers so that it can provide similarly lower prices when selling to its customers. This element is its trademark strategy and it has made the company and customers happy, even while leaving suppliers and local businesses in losses.

Discussion and application: The ethical issues that arise in this scenario is whether it is right for the company to expand without considering the local businesses in the areas of operation and whether the company has moral justification to alter market dynamics and force suppliers to lower prices in order to attract customers to its stores.

The application of the utilitarian theory to the case reveals that the determination of the morality of such actions depends on the group of people forming the majority at a given time. For instance, if customers form the majority, the actions are moral as they generate the greatest happiness and least suffering to consumers.

On the other hand, if the suppliers and local business owners form the majority, then Wal-Mart’s move would be wrong and immoral as it generates more pain than happiness to the greatest number of people.

In addition, application of the utilitarian theory reveals that the low wages to employees is wrong as the employees form a greater number as compared to the management of the company and the decision does not apply to the reduction of suffering concept for the majority, viz. the employees.

The franchise uses rules set by governments on businesses, and thus they apply equally to all business entities. Therefore, it is also possible that the company does not break any legal rules while conducting business, thus making its decisions rightful, hence moral.

Case Summary: Al Smetana, the CEO of Rayburn Unlimited Company, has built the company on foundations of honesty, integrity, and acknowledging the values that every individual at the company possesses. One day, he realized that an employee had found a way of accessing emails belonging to other people at the company. He immediately asked the employee to leave the company for violating the code of conduct.

As the employee was leaving, he made some remarks in anger regarding the vice president of the human resources division at the company, Mr. Craig Lindsey. The employee alleged that Lindsey used his computer to watch pornography.

At the time, Al Smetana was skeptical about the allegation, but later he decided to call Lindsey in his office and make inquiries. During the meeting, Lindsey accepted the allegations amid tears and stated that he was addicted to it and he was trying to stop. He asked the CEO for help, but Smetana said he needed time to think about the matter.

Discussion and application: The scenario creates a dilemma for Al Smetana where on one hand, he does not want to lose a friend, but on the other hand, he does not want to apply double standards and fail to abide by his own rules.

This scenario brings out Bentham’s point on morality as being an abstract concept that requires certain rules in order to apply to diverse situations without changing the core values. In this case, the rules are the presumptions that form the utilitarian theory. Application of the theory to the situation in this case will depend on the desired outcome as well as the company rules.

Summary: This case revolves around Wilson Mutambara, an employee of NewComm, a cellular telephone service based in the US with branches in different locations including Rambia, which is Mutambara’s native home. Mutambara was brought up in shanties in his native country.

The area in which he grew was a slum. However, he overcame many challenges and worked hard to obtain a scholarship to study in the US after his high school education. He received MBA and got employment at the company. After three years in the company, his employer offered him the opportunity to return to his home of birth where he was working.

He excitedly accepted the opportunity and moved back to Rambia as his new workstation. The company set apart enough money for his utilities. In order to ensure that the employees utilized their allowance adequately, the company required its employees to produce receipts indicating an itemized list of expenditure preferences, with which Mutambara always complied.

Fifteen months into the job, a co-worker, Dale Garman, found out that Mutambara lived in a slum and alerted Mutambara’s supervisor, Barbara Weston, on the issue. Weston confronted Mutambara on the matter. Her concern on the issue was that the housing conditions that he chose to live with were unbecoming of an employee of his caliber at the company.

However, Mutambara defended his actions stating that even though the information in the monthly receipts was false; his reasons for doing so were justifiable. One of his justifications for his actions was that every employee in the company received the same allowance and exempting him from the same payment plan would amount to discriminatory actions by the company.

He also argued that wherever he chose to live was his choice and that he did it to support his kin back home. He stated that it would be unreasonable for him to live in a mansion while his kin did not have enough food to eat. Lastly, he accused the company of being insensitive to the feeling of the people living in the slums by terming it as unseemly.

Discussion and application: In this case, several moral issues stand out, with the main ones being whether Weston’s opinion of the slum as being unseemly was right and whether Mutambara was right to falsify receipts for a good reason. The issue of whether Mutambara’s argument that he was receiving payment like every other employee and had the right to use it as he wished was justified also stands out.

In applying the utilitarian theory to the first issue, the concept behind the opinion of the two parties depends mainly on the societies in which they grew up. Weston grew up in the US, which explains her sense of disgust towards slums in Rambia. On the other hand, Mutambara grew up in Rambia, hence his pride in the place.

According to the utilitarian theory, the majority for which the greatest happiness should be applied is the people of Rambia, as that is the location for the company at the time of the argument.

Mutambara’s falsification of receipts was wrong according to the theory as it affected the entire company and its reputation negatively. However, Mutambara’s claim for equality as an employee of the company was valid according the greatest happiness of the greatest number principle.

Case Summary: This case regards the 1986 detonation of the space shuttle, Challenger, whereby seven astronauts died. The event caused the shuttle’s grounding until safe flight was achievable. The explosion occurred due to low temperatures that caused the shuttle’s O-rings not to seal its joints properly, thus leading to an explosion.

Morton Thoikol Inc. was the responsible company for the manufacture of the booster rockets. During an investigation into the matter, it became apparent that one of Thoikol’s employees, Roger Boisjoly, had warned the company and NASA about the O-rings and predicted that the shuttle’s critical joints would be unable to seal on liftoff due to low temperatures.

On the evening of liftoff, Boisjoly and his fellow engineers advised their employers, but Thoikol and NASA declined to act. Boisjoly underwent dismissal from being a member of the commission investigating the issue, but the commission reinstated him after complaints that the action was paramount to punishment. However, he left the job a short while later on extended sick leave.

Discussion and application: The main moral issue in this case is whether Boisjoly had an obligation to the public to publicize the matter in order to prevent similar accidents in the future and the eventual launch of the shuttle later on. The utilitarian theory proposes, in this case, that the greatest number for which people should consider when making such decisions is the public.

Therefore, Boisjoly’s decision ought to be one that gives the greatest felicity for the greatest number. According to Bentham’s conceptualization of the theory, Boisjoly’s decision is a personal decision that mainly affects him in terms of retention of employment. Therefore, choosing what is best for himself would mean keeping the information secret in order to retain his job.

However, the impact of his decision would affect the public in terms of loss of more lives if the shuttle launched later without proper checks. Therefore, testifying on the matter is his obligation in his capacity as an engineer to protect public interests.

The decision would reduce pain by preventing future incidents and increase happiness by ensuring the procurement of justice for the dead astronauts. However, a dilemma occurs when considering the obligation that an employee has to his employer, in this case Thoikol and NASA. The best way for him to handle the issue would be to inform his employers of his concerns before deciding to publicize the matter.

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Bentham, Jeremy. An Introduction to the Principles of Morals and Legislation, New York: Dover Publications, 2007. Print.

Callcut, Daniel. “Mill, sentimentalism, and the problem of moral authority.” Utilitas 21.1 (2009): 22-35. Print.

Ferrell, Odies, John Fraedrich, and Linda Ferrell. Business Ethics: Ethical Decision Making and Cases , New York: Cengage, 2013. Print.

Parson, Patricia. Ethics in Public Relations: A Guide to Best Practice, London: Kogan Page, 2004. Print.

Lukes, Steven. Moral Relativism, London: Picador Publisher, 2008. Print.

Mill, John, and Jeremy Bentham. Utilitarianism and other essays , London: Penguin Books, 2004. Print.

Sartorious, Rolf. Individual Conduct and Social Norms: A Utilitarian Account of Social Union and the Rule of Law, Charleston: BookSurge Publishing, 2009. Print.

Steiner, Philippe. “Gifts of blood and organs: The market and “fictitious” commodities.” French Journal of Sociology 44.3 (2003): 147-162. Print.

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Handout: Utilitarianism and Business: Ford Pinto case

December 22, 2010.

Utilitarianism and Business Ethics

Introduction.

Welcome to philosophicalinvestigations – a site dedicated to ethical thinking (rather than one page summaries!!! Though I’m afraid I do add those at exam time – market pressures!). I hope you enjoy this case study which also has a powerpoint that goes with it. There’s plenty of other useful material on this site – case studies, handouts, powerpoints and summaries, and also I have written a number of books including best-selling revision guides and a useful book on ‘How to Write Philosophy Essays”.

If you’re worried about exams you might at least print out my strengths and weaknesses summaries under each moral theory. I deliberately quote only from my five favourite ethics books, visit our shop to find out which they are – because you might like to buy one of them to supplement your study. Of course, it’s important to quote the philosophers themselves in their own words – see my handouts, or for what academics say about them – see the key quotes section under the topic area of each moral theory. And if you’d like to blog on anything in the news send it to me – I’d be delighted to read it and – if it fulfils the criterion of good ethical thinking (!), post it!!!!!

Utilitarianism is a normative, consequentialist, empirical philosophy which links the idea of a good action to one which promotes maximum pleasure or happiness, found by adding up costs and benefits (or pains and pleasures). It has two classic formulations – Bentham’s hedonistic (pleasure-based) act utilitarianism and Mill’s eudaimonistic (happiness-based) rule utilitarianism. In this article we make some preliminary comments on Bentham and Mill before analysing a famous case in 1972 where utilitarian ethics seemed to cause a very immoral outcome – the Ford Pinto case.

Click here for a powerpoint presentation on the same subject containing a YouTube link for a ten minute documentary on this case.

Click here for a brilliant survey of the legal questions surrounding cost/benefit analysis – if you’re thinking of being a lawyer it’s a must read!

Bentham (1748-1832)

• There is one good, pleasure, and one evil, pain. • Human nature is naturally motivated by “two sovereign masters, pleasure and pain”. We are pleasure-seekers (hedonists). Other motives such as duty, respect, are irrelevant. • The empirical calculation could be done with a hedonic calculus which allocates hedons of pleasure to different choices. • Social goals should be fixed by aggregating personal goals in terms of maximising pleasure and minimising pain. • The aim of government is to harmonize conflicting interests by passing laws with appropriate penalties for those who cause pain to others – hence modifying their behaviour.

Bentham became convinced that the British Government was influenced solely by self-interest rather than some idea of the common good. He came to argue for the abolition of the monarchy, universal male suffrage (not just linked to land), and rule by parliament as judge of the common interest.

John Stuart Mill (1806-73)

Mill’s version of utilitarianism was so different from Bentham’s that it almost seems that he rejects it. Mill was concerned to move away from what he once called a “swinish” philosophy based on base pleasures, to something subtler.

• Goodness was based on more than just pleasure, but on the virtue of sympathy for our fellow human beings, a concern for their rights and our duty to promote the common good. • Pleasures were distinguishable between lower bodily pleasures and higher intellectual or spiritual pleasures – and if you wanted to know which was better ask someone who’d experienced both. • Mill was suspicious of universal male suffrage, and advocated education for all as a key to graduating to the happy life. • Mill was keen to see fairer distribution of wealth and income and rejected the extreme form of free market economics. • Mill argues for a weak rule utilitarianism. We maximise happiness by obeying laws and social conventions which experience has shown promote the common good – such as respect for life, personal freedom and private property, or good manners and politeness. However, when two principles or rules come into conflict, such as the choice to lie to save my friend’s reputation, I revert to being an act utilitarian – making my decision based on a balance of outcomes – choosing that action which maximises happiness.

Business applications

Utilitarianism can be used in any business decision that seeks to maximize positive effects (especially morally, but also financially) and minimize negative ones. As with Bentham’s formulation, utilitarianism in business ethics is primarily concerned with outcomes rather than processes. If the outcome leads to the greatest good (or the least harm) for the greatest number of people, then it is assumed the end justifies the means. As Lawrence Hinman observes, the aim is to find “the greatest overall positive consequences for everyone” (Ethics, 136). This can be linked to the idea of cost-benefit analysis, so that “correct moral conduct is determined solely by a cost-benefit analysis of an action’s consequences” (Fieser, p7).

Just as John Stuart Mill objected to the coldest, most basic version of the theory, modern business ethicists point to utilitarianism’s limits for practical choices. For example, Reitz, Wall, and Love argued that utilitarianism isn’t an appropriate tool when outcomes affect a large number of separate parties with different needs or in complex processes whose outcomes and side effects can’t be readily foreseen, e.g., implementing new technology.

Utilitarianism suffers from the difficulty that costs and benefits may not be equally distributed. As Hinman comments “utilitarians must answer the question of whom are these consequences for?” (Ethics, 137). For example, if the UK government fails to regulate carbon emissions, acid rain falls on Sweden. If a tax is then placed on UK business to pay for this, the cost is borne by the UK taxpayer, the benefit is enjoyed by Sweden. There can be broad social costs, for example, of promoting unhealthy eating that are paid for by UK taxpayers in higher bills for health care, whereas the benefit (McDonalds profits) are enjoyed by employees and shareholders.

Such rules as “always pay your taxes” suffer from this problem, that the rich are actually subsidising the poor. Why should they? Mill would argue that we are concerned for others because of a general feeling of sympathy, which as a matter of fact, we all have. But suppose (as a matter of fact) I don’t share this feeling, then the rational utility maximising thing to do is to avoid paying tax as far as possible – move abroad, set up tax shelters, register my company in the lowest tax economy.

In applying utilitarian principles to business ethics, the cost-benefit analysis is most often used – it is a good decision making tool. Companies will attempt to work out how much something is going to cost them before taking action that should, ideally, result in consequences favourable to everyone. That would mean the company could make a profit, while the consumer benefited from their product. Hopefully, products are fit for purpose, safe, and give value for money. No business would attempt a project without evaluation of all relevant factors first, as well as taking other issues or risks into account that might jeopardise success. Ethical business practice, using utilitarianism, would thus consider the good and bad consequence for everyone the action would affect, treat everybody as having equal rights (at least in Mill’s weak rule utilitarianism), with no bias towards self, and would use it as an objective, quantitative way to make a moral decision.

CASE STUDY: Ford Pinto Case, utilitarianism and Cost Benefit Analysis:

This is an extract from a longer article, by Annie Lundy. Read more: http://bizcovering.com/major-companies/applying-utilitarianism-to-business-ethics-the-ford-pinto-case/#ixzz18qFeyQRa

In applied business ethics, within the rule utilitarian theory of Mill, many principles exist which may be used to inform the morality of actions when analysing cost-benefit, or should be, if consequences are to favour more people overall. These include harm, honesty, justice and rights. So no harm should be done to others, people should not be deceived and their rights to life, free expression, and safety should be acknowledged. The argument here is that Ford abandoned these principles, abused the utilitarian theory to suit their needs, stayed within the laws of the time, but behaved unethically. The ‘utilities’ as a consequence, appeared to be money, and they used that to define the value of their needs against the value of human life.

Lacey (580-581) stated that:

“Ford pushed the federal regulators to put some price on auto safety…It was an agency of the U.S. government , the National Highway Traffic Safety Administration (NHTSA) which arrived at this blood-chilling calculation, not the Ford Motor Company. But the way in which Ford took this government figure ($250,725) and used it for its own purposes carried a chill…”

So the Ford Pinto went on sale with dangerous design faults in the position of the fuel tank and nearby bolts, and the tendency for the fuel valve to leak in rollover accidents. Design and production was rushed and cost of the vehicle kept down to sell it at $2000. It sold well, until 1972 when four people died ,the first of many incidents stemming from the Pinto’s flaws, and many more followed, costing Ford millions in compensation. The cost-benefit analysis demonstrated an abuse of utilitarian principles, and the engineers were fully aware of the flaws, yet the company continued to sell the car as it was, without safety modifications. They “weighed the risk of harm and the overall cost of avoiding it.” Leggett, (1999).

The government figure, mentioned earlier, was made up of 12 ‘social components’ that included $10,000 for ‘victim’s pain and suffering’ and was meant to determine the cost to society for each estimated death. Ford decided to estimate 180 deaths, 180 serious burn injuries, 2100 vehicles lost, and calculated $49.5 million overall, a figure that would be a benefit to the company, if they put things right with the car. The estimated cost of doing so came to $137 million, for 11 million vehicles at $11 dollars per tank and $11 per unit for other modifications. So costs outweighed benefits by $87m and the value of human life was quantified as an economic commodity.

It also emerged that some evidence suggested the actual costs to correct matters were over-estimated and would have been nearer to $63.5 million. Though these did not equate to the benefits, there would seem to be a moral duty somewhere for a huge corporation like Ford, to bear the cost of $15 million. That way, utilitarian ethics, normative principles and the most good and positive consequences for most people overall would have resulted. There seems to be some form of justice in the way the benefits dwindled and the costs grew over the years, as lawsuits and penalties took millions of dollars from Ford. The company did nothing illegal in terms of design at that time; they took advantage of the cost-benefit analysis, ignored ethical principles and abused the moral aspects in utilitarianism. As Lacey (577) put it:

“The question is whether Ford and Iacocca [Executive vice president] exhibited all due care for their customers’ safety when balanced in the complex car making equation that involves cost, time, marketability and profit.”

Conclusion:

Utilitarianism, business ethics and the Ford Pinto case present a dilemma, as the theory appears to be one of moral strength and a good guideline for ethical business choice. In relating its consequential content to the Ford Pinto case, it would seem that the application of ethics had been dismissed in favour of profits, reputation and unethical practices. The theory cannot possibly be used to put a value on human life, as Ford attempted to do. The dangers in utilitarianism lie with the potential for abuse, and in abandoning the inherent principles, Ford demonstrated those dangers in action.

The decision not to rectify faults represented a denial of doing no harm, not deceiving others, justice and the rights to life and safety. Nor can the theory measure human suffering or loss, as Ford found, to its cost; it cannot predict consequences accurately or quantify benefits and harms, simply by applying a cost-benefit measure. In considering that the ends justify the means, another aspect of utilitarianism, and determining the pain of actions, volume and not ‘who’ suffers, has significance. In principle, the evaluation of good and bad consequences provides one way of ensuring that companies consider the morality of their actions, which may suggest that utilitarianism can be a positive influence for ethical business practice as long as the true costs can be accurately determined and the right value placed on human life.

Fieser, J. Ethics: Consequentialist Theories Internet Encyclopaedia of Philosophy2006. University of Tennessee at Martin. 24 April 2007 http://www.iep.utm.edu/e/ethics.htm Hinman, L. M. Ethics: A Pluralistic Approach to Moral Theory: Chapter 5: The Ethics of Consequences: Utilitarianism. 3rd Edition. Belmont, CA:Wadsworth: 2003 Lacey, R. Ford: Book Club Associates by Arrangement with William Heinemann Ltd. 1988 Leggett, C. The Ford Pinto Case: The Valuation of Life as it Applies to theNegligence Efficiency Argument. Law and Valuation Papers, Spring 1999 at Wake Forest University. 24 April 2007 http://www.wfu.edu/~palmitar/Law&Valuation/Papers/1999/Leggett-pinto.html

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Utilitarian Principlism as a Framework for Crisis Healthcare Ethics

Laura vearrier.

1 Department of Emergency Medicine, Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216 USA

Carrie M. Henderson

2 Department of Pediatrics, Division of Critical Care Medicine, Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216 USA

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.

Introduction

The COVID-19 pandemic has strained healthcare delivery in the US and internationally, with hospitals, emergency departments, and intensive care units overwhelmed and routine medical and surgical care unavailable or limited to telemedicine. During times of crisis, healthcare resources, including personnel, physical space, medications, and equipment may become scarce. As a result, standards of care take on a dynamic nature, changing based on supply and demand—a phenomenon that typically does not influence non-crisis medical care in the US. As standards of care morph, the obligations and duties of healthcare providers (HCPs) expand as public health ethics and clinical ethics intersect in crisis healthcare ethics. The Institute of Medicine (IOM) has emphasized the importance of an ethical framework to guide crisis healthcare, stating that “an ethical framework serves as the bedrock for public policy and cannot be added as an afterthought” (Altevogt et al. 2009 , p. 5).

In this paper, we introduce the model of utilitarian principlism as a framework for crisis healthcare ethics. Principlism, the overarching ethical framework in biomedical ethics, is guided by the four principles of autonomy, nonmaleficence, beneficence, and justice. Ethical dilemmas arise when guidance from one principle is in tension with another. In non-crisis times, in our Western society, autonomy is typically given the greatest weight—the interest of the individual patient is paramount. The physician–patient relationship is a deontological construct where the physician’s primary duty is to the patient, therefore we term non-crisis principlism as deontological principlism.

During times of crisis, the lens through which principlism is viewed must shift from deontological to utilitarian. The interests of the individual are overshadowed by the interests of the population at large, with a utilitarian approach that maximizes net benefit on a societal level. In the same way, justice, typically the least considered principle in healthcare ethics, takes a central role but must also adopt a utilitarian emphasis given the public health crisis at hand. Healthcare is guided by both deontological and utilitarian aspects; principlism as a guiding framework can be viewed along a spectrum where the emphasis shifts between the underlying focus. The fundamental values and core principles are unchanged—it is the emphasis on the various principles that shifts as one moves across the spectrum from deontological toward utilitarian. Where we fall on the spectrum depends on the nature and extent of the crisis society and healthcare face.

In this paper, we discuss each of the four principles from a Utilitarian Principlism perspective and use clinical vignettes, based on real cases that have occurred in US hospitals during the COVID-19 pandemic, for illustrative purposes. In Utilitarian Principlism, autonomy transitions from individualistic to relational, nonmaleficence tolerates a “learn as we go mentality”, beneficence seeks population health, and justice takes on a more important role as healthcare adjusts to the needs of many over the needs of an individual.

Background: Crisis Standards of Care

In response to the 2009 H1N1 influenza pandemic and the need to prepare for a public health emergency that threatened to overwhelm the nation’s healthcare system, the Office of the Assistant Secretary for Preparedness and Response within the Department of Health and Human Services charged the Institute of Medicine (IOM) with the task of developing guidelines for standards of care that would apply during disaster situations (Altevogt et al. 2009 ). Disasters, whether natural or manmade, have the potential to make resources scarce, demanding a shift in the practice of medicine. The IOM Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations generated a letter report presenting concepts and preliminary guidance to assist states, public health officials, healthcare systems and institutions, and healthcare professionals in the development of comprehensive policies and protocols for disaster situations.

The committee defined crisis standards of care as “a substantial change in usual healthcare operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster” (Altevogt et al. 2009 , p. 3). In the IOM model, changes in the level of care are to be initiated by a formal declaration by state governments that crisis standards of care are in operation. This formal declaration is to be accompanied by legal and regulatory protections for providers who are forced to practice in suboptimal conditions that require the allocation of scarce resources and altering standard practices to respond to a surge in demand for healthcare providers and hospital resources.

Principlism, Deontology and Utilitarianism

The four-principles approach, now commonly referred to as principlism, is the overarching ethical framework in biomedical ethics, guiding both clinical ethics and public health ethics. Beauchamp and Childress define the four principles that guide modern biomedical ethics as autonomy, nonmaleficence, beneficence, and justice (Childress and Beauchamp 2001 ). Autonomy involves respect for persons and individual, informed choices. Nonmaleficence is the obligation to avoid inflicting harm on others. Beneficence is the commitment to promote the well-being of others. Justice focuses on promoting equality in healthcare.

Even in the absence of a crisis situation, healthcare providers apply principlism in nearly all patient interactions, albeit often unconsciously. Discussions of risks, benefits, and alternatives are routine in order to promote patient autonomy and maximize beneficence. Nonmaleficence is supported by widespread systems to reduce medical errors, including identification bracelets, allergy bracelets, procedure time-outs, checklists, medication dosing and interaction alerts on electronic medical records, among many others. Triage conducted at arrival to any emergency department in the US is an accepted form of justice, as it prioritizes patients based on urgency of the medical treatment needed, equality and fairness, and the utility of the treatment.

In standard, non-crisis clinical care, the physician’s prima facie obligation is to the individual patient. In the American Medical Association code of ethics, principle VIII states “A physician shall, while caring for a patient, regard responsibility to the patient as paramount” (American Medical Association, revised 2001 , p. 1). In this respect, the physician–patient relationship is a deontological construct. Morality is determined by the nature of the action and the duty is to the patient. In deontology, harmful actions are unacceptable, even if the end result is a net benefit. We refer to principlism during non-crisis times as deontological principlism to reflect the primacy of the provider’s duty to the individual patient in our current healthcare system. In deontological principlism, justice in the distribution of resources is less important than the fiduciary duty the physician has to the patient.

In times of crisis, there is a shift from a deontological to a utilitarian focus. Utilitarianism is a consequentialist theory that determines morality based on the outcomes of interventions. The principle of utility asserts that the moral course is one that maximizes value over disvalue and seeks the greatest benefit for the greatest number. In this framework, harm to some individuals may be acceptable for an overall net benefit to the group at large. We propose Utilitarian Principlism as an ideal framework for Crisis Healthcare Ethics.

By accepting Utilitarian Principlism as the Crisis Healthcare Ethics framework, clinicians already accustomed to principlism need only shift their view rather than convert to a new way of thinking and operating during a crisis. Utilitarian Principlism allows providers and institutions to apply the ethical knowledge and skills they utilize on a daily basis, simply with a shift in focus and realignment of the principles to deemphasize autonomy and elevate justice in order to benefit the health of communities and populations at large. Justice as the paramount principle is in accord with what the IOM considerers the overarching goal in developing crisis protocols, which is for “them to be recognized as fair by all affected parties” (Altevogt et al. 2009 , p. 28).

Utilitarian Principlism

Utilitarian autonomy, clinical vignette.

A 50-year-old woman presents to the emergency department. She states that she is anxious about COVID-19 and that she is having repeated panic attacks because she thinks she may have it even though she does not have any symptoms. She is requesting a COVID screening test and a prescription for the medication that she heard about on the news as being effective against the disease. The physician explains to the patient that due to a lower inventory of nasal swabs needed to perform the test, the institutional protocol is not currently allowing for asymptomatic screening. The physician refers the patient to a community testing center. She also explains to the patient that due to insufficient scientific evidence regarding the safety and efficacy of the requested medication, institutional protocol recommends against the routine use of the drug. She informs the patient about a clinical trial of the drug that the patient can enroll in if she would like. The patient begins yelling and demanding the test and the prescription. She states she is getting claustrophobic in her house which is worsening her anxiety and that she needs the COVID test to ease her anxiety. She also states that she doesn't want to be in a trial because she doesn't care about scientific evidence. Despite lengthy discussions and counseling, the patient remains angry and threatens to sue the physician.

In Deotological Principlism, autonomy tends to be individualistic; however, in Utilitarian Principlism, autonomy becomes more relational and embedded within the social context. As opposed to non-crisis times, during times of crisis, previously unrestricted autonomy may become limited in several ways. The interests of the individual become overshadowed by the interests of the community and population at large. Availability of physical space, healthcare personnel, lab testing equipment, and/or medications limit what care can be offered to patients, thereby narrowing the scope of individual autonomy. In the vignette above, perhaps the physician during non-crisis times would have acquiesced to the patient to diffuse the tension, gain trust, or just to avoid further legal or administrative headaches. But during a pandemic, the needs of others may be more clearly in the forefront of each clinician’s mind, becoming a small part of every patient interaction.

Autonomy is not only passively limited by resource shortages, but actively imposed upon in order to protect the health of the public. Public health and clinical care limits on autonomy and individual freedoms may be necessary in the interest of justice. Public health ethics offers examples of this notion with imposed quarantine. Isolation and quarantine are effective measures for controlling the spread of communicable diseases. Isolation separates people who are sick with a contagious disease from those who are not sick; quarantine separates and restricts the movement of persons who have been exposed to a contagious disease to see if they become sick. Table Table1 1 shows a list of quarantinable diseases in the US that can be revised by executive order by the president.

Communicable diseases for which isolation and quarantine are authorized (Centers for Disease Control and Prevention 2020a )

Cholera

Diphtheria

Infectious tuberculosis

Plague

Smallpox

Yellow fever

Viral hemorrhagic fever

Severe acute respiratory syndromes

Flu that can cause a pandemic

Imposing on the freedoms of sick and exposed asymptomatic persons is often accepted as ethical and legal. The Centers for Disease Control and Prevention (CDC), as a federal governmental entity, possesses the authority to propose and promulgate isolation and quarantine regulations. The Public Health Service Act (42 U.S. Code § 264) authorizes the apprehension, examination, detention, and/or conditional release of persons with communicable diseases or suspected to have communicable diseases to prevent the spread of disease from foreign countries or between states. The enforcement of CDC regulations may involve various law enforcement entities on the federal, state, or local level.

The US has seen unprecedented quarantines and travel restrictions with the COVID-19 pandemic. Social distancing and the use of face masks have become morally, socially, and politically charged. The opposing sides have been referred to as the “distancers” and “non-distancers” (Prosser et al. 2020 ). Distancers describe a moral obligation to protect others from disease even if their personal benefits are secondary. Non-distancers deem these actions to be unnecessary limitations on personal liberties. They report wariness of governmental overreach and motivations. Morally charged disagreements lend to particularly hostile disagreements between parties who do not see each other as merely different, but as wrong and a threat to others and/or society.

Another public health intervention that limits personal autonomy is the closure of non-essential sectors of the economy. Such interventions are effective in limiting or slowing the spread of communicable disease in a population (Lau et al. 2020 ). The COVID-19 pandemic has resulted in widespread employee layoffs and furloughs, leading to a record number of jobless claims. Americans who obtained health insurance through their employers are either without insurance, must purchase insurance, or apply for governmental assistance. Unemployment and loss of insurance negatively impact social determinants of health, which have a greater impact on health outcomes than healthcare itself (Artiga and Hinton 2019 ). Therefore, there has been considerable debate about the timing and extent of economic closures.

The US’s failure to prevent or adequately slow the COVID-19 pandemic suggest a more coherent strategy may be needed. During the Ebola outbreak, electronic monitoring was implemented with webcams to observe persons taking their temperatures. Webcams are also used for the routine public health control of tuberculosis. Webcams facilitate “directly observed therapy” to ensure that persons take their prescribed anti-tuberculosis medications. While electronic monitoring has raised concerns regarding privacy, the protection of the health of the public is considered to outweigh these concerns (with appropriate security measures in place).

In clinical care, Utilitarian Principlism reins in the autonomy of individual patients. In non-crisis time, the United States consistently spends more money than other countries on healthcare, without having better outcomes than countries that spend significantly less (U.S. Health Care from a Global Perspective 2020 ). While the reasons for this are complex and multifactorial, unbridled autonomy, patient requests, and physician acquiescence to requests for tests or treatments that may be non-beneficial or minimally beneficial are certainly contributing factors (Brett and McCullough 2012 ; LiPuma and Robichaud 2020 ). Considering it a duty, physicians may continue to provide aggressive care for patients at the end-of-life even when they perceive it as futile, resulting in a substantial critical healthcare burden (Huynh et al. 2013 ). Confusing autonomy as an unqualified right to choose, and the culture of consumerism in healthcare, help to drive the misinterpretation of deontological patient-centered medicine (Zeckhauser and Sommers 2013 ). In Utilitarian Principlism, providers must consider fair allocation of scarce resources when devising and re-evaluating treatment plans.

This is not to say that autonomy becomes unimportant during times of crisis; patients are still entitled to the right to self-determination facilitated by informed consent. The how, what, where, and when of treatment may be limited in crisis, but among the available options, patient preferences and values guide treatment decisions.

Case Discussion

The patient in the above case was denied the request for a COVID-19 screen due to the limited supply and the need to save tests for patients who exhibited symptoms. She was also denied a prescription for a medication that lacked a scientific proof of efficacy and held no formulary indication to be given for possible COVID-19. If the patient had presented requesting a Lyme titer be drawn for no reason other than anxiety after hearing about Lyme disease on the news, the physician very well may have acquiesced because Lyme tests are not in short supply and the social context does not need to be considered. A central goal of medicine is to alleviate suffering. The risks of a blood draw are minimal. If a negative Lyme test would alleviate the patient’s anxiety and the test is within appropriate stewardship of resources, performing the test would be a reasonable course of action. And, if the patient had asked for a prescription for penicillin, while there is increased attention to antibiotic stewardship, the physician may have acquiesced to strong demands for a medication prescription with a good safety profile that is also not in short supply. It is not uncommon for physicians to influenced by patient pressure for antibiotics (Scott et al. 2001 ). Additionally, the physician provided the patient with alternatives—including community testing sites and involvement in a clinical trial.

Utilitarian Non-Maleficence

A premature infant suffered a grade 2 interventricular hemorrhage shortly after birth as a consequence of his prematurity. After a prolonged stay in the Neonatal Intensive Care Unit (NICU), he was discharged home with close follow up by a pediatric neurosurgeon due to concern that he could develop symptomatic hydrocephalus; head circumference measurements and clinical exam are critical to tracking this development. If not treated urgently, hydrocephalus can cause permanent brain damage or death. As a result of the COVID-19 pandemic and institutional restrictions on outpatient visits to prevent the spread of disease, the infant’s next appointment with neurosurgery was changed to a telehealth visit. His mother was mailed a tape measure in order to report the head circumference to the neurosurgeon in lieu of a robust physical examination and comprehensive neurologic evaluation.

The principle of nonmaleficence provides that clinicians avoid or minimize harms to their patients. In utilitarian nonmaleficence, threats to population health may outweigh potential or actual harms to individuals. Across the country, non-emergent surgeries, procedures, and office visits were postponed in an effort to thwart virus transmission. Patients with cholelithiasis without cholecystitis endured pain; patients with cancer delayed treatments or further screening; patients with functional limitations due to non-urgent ailments had surgeries postponed. These harms have been justified as a protection to society afforded by minimizing human encounters.

Another concern attributed to the COVID-19 pandemic is the inadvertent harm to patients with therapies initially thought to be efficacious. In conventional medicine, therapeutic interventions, including medications and devices, must be thoroughly studied prior to utilization in routine patient care as a safeguard against maleficence. Candidate drugs typically undergo three phases of clinical trials, over several years, prior to receiving approval for an indication by the FDA (Table (Table2). 2 ). Medical devices undergo a two-phase testing process prior to approval. Use of a medication for condition(s) other than those for which it was approved, also known as off-label use, typically occurs only after clinical trials have demonstrated that the medication is as effective or more effective than currently utilized treatments or with tightly regulated compassionate use exceptions. This process is effective—in the 1960s, the US almost completely avoided the maleficence due to the thalidomide scandal, which worldwide resulted in tens of thousands of infants being born with thalidomide embryopathy, due to the FDA withholding approval of the medication for sale pending additional studies.

Clinical trial testing

Medications	Devices
1. Safety & toxicity	1. Pilot/feasibility
2. Safety & efficacy	2. Pivotal/confirmatory
3. Clinical effectiveness relative to standard therapy

In crisis situations, the use of novel or unproven therapies may be undertaken when standard therapies have not yet been developed, increasing the risk of potential harm to patients. This potential risk is justified by Utilitarian Principlism—the risk is acceptable in order to save as many lives as possible using what we have available, even with limited scientific study. In crisis situations, we are forced to take on a “learn as we go” mentality (Rubin et al. 2020 ). Early in the COVID-19 pandemic, two therapies that were widely deployed in the management of infected persons ultimately proved to result in patient harms: early mechanical ventilation and hydroxychloroquine.

In the early phases of the pandemic, profound hypoxia seen in patients with COVID-19 led to calls for early mechanical ventilation. Comparisons were drawn between Acute Respiratory Distress Syndrome (ARDS) and COVID-19 leading to the utilization of ARDS protocols in the care of COVID-19 patients (Huang et al. 2020 ; Pan et al. 2020 ; Yang et al. 2020 ; Marini and Gattinoni 2020 ). Early endotracheal intubation was also thought to reduce virus aerosolization through the use of cuffed endotracheal tubes equipped with viral filters, offering protection to other patients and medical staff as compared to non-invasive ventilation where the airway is not secured in a closed loop circuit (Wax and Christian 2020 ). Over time, however, it became apparent that the pulmonary pathophysiological mechanisms underlying COVID-19 were distinct from ARDS and that early mechanical ventilation was causing more harm than benefit, due to ventilator-induced lung injury (Gattinoni et al. 2020 ; Tobin et al. 2020 ). The treatment of COVID-19-associated hypoxia shifted to both permissive hypoxia and oxygen therapy via high flow nasal cannula with improvement in patient outcomes.

The lack of a clear medication to abate the symptoms and/or severity of COVID-19 has hindered patient care since the onset of the pandemic. Early small-scale studies performed in China and France (Gautret et al. 2020 ; Chen et al. 2020 ) suggested a benefit from hydroxychloroquine, a quinolone traditionally used for malaria, although their methods were later questioned (Ferner and Aronson 2020 ). Due to the lack of other effective medical treatments, and public and political pressure, the FDA issued an Emergency Use Authorization for hydroxychloroquine for COVID-19 on March 28, 2020. The medical community quickly embraced hydroxychloroquine in the treatment of COVID-19 despite a lack of convincing evidence of benefit. On May 22, 2020, a manuscript published by The Lancet reported that use of hydroxychloroquine or chloroquine in hospitalized patients with COVID -19 was associated with a decreased risk of in-hospital survival and an increased frequency of ventricular arrhythmias, immediately calling into question the widespread adoption of these medications (Mehra et al. 2020 ). However, less than 2 weeks later on June 4, 2020, The Lancet retracted the study after questions were raised about the integrity of the data and the refusal of the company that owned the dataset to transfer it for third-party review. Since that time, additional studies have reported no benefit to hydroxychloroquine use, but harms include QTc interval prolongation and elevation of liver enzyme levels (Geleris et al. 2020 ; Molina et al. 2020 ; Bessière et al. 2020 ; Mégarbane and Scherrmann 2020 ).

The COVID-19 pandemic has also prompted providers to rethink and reframe how interventions may result in harm for their patients in an era of dynamic risk/benefit profiles. In the treatment of neuro-oncology patients, Weller and Preusser state that now, “more than ever, it seems mandatory to adhere to evidence-based practices and not to prescribe potentially toxic, notably immunosuppressive systemic therapy where evidence for efficacy is low” (Weller and Preusser 2020 , p. 1). They advocate for increased advance care planning and discussing goals of care with patients. For patients involved in clinical trials, the risks and benefits should be re-evaluated with patients.

In the clinical vignette, the infant is not brought to the office due to cancelled outpatient visits and a reliance on telemedicine to minimize face-to-face contact and potential disease transmission. The mother was mailed a measuring tape, suggesting limited or no training on how to properly perform a head circumference measurement. Even if the mother had been trained, there is limited evidence to support the reliability of parental measurements of head circumference. The potential harms of an inaccurate measurement included a delay in diagnosis that could lead to brain damage or death, worse than, or at least tantamount to the potential harms of COVID-19 infection. However, the potential harm to the individual infant was tolerated to minimize the chance of the perceived greater threat—disease spread within the community. During the pandemic, many patients avoided urgent care, primary care, or even emergency care due to worry about becoming sick with COVID-19 or because these resources were unavailable or limited, with consequences that are difficult to quantify and follow over time.

Utilitarian Beneficence

A 31-year-old woman with a history of alcoholism presented to the emergency department with acute liver failure. During her hospital admission, she developed acute renal failure and severe hepatic encephalopathy with anoxic brain injury. Her clinical course was marked by severe clinical decline and intensive medical needs and she was considered unlikely to survive the hospital admission. Three days into her hospitalization, and due to bed shortages as a result of the influx of COVID-19 patients to the adult ICU’s, she is transferred to the Pediatric Intensive Care Unit (PICU) and her care was assumed by pediatricians trained to care for critically ill infants and children. She died 8 days into her hospitalization when her family elected to withdraw medical support as her condition deteriorated. The pediatric intensivists experienced moral distress over caring for an adult patient at the end of her life as this was beyond their typical practice; however, the institution deemed this the most appropriate use of the available resources in order to benefit the most patients. The family reported a high level of satisfaction with the care their loved one received.

In traditional medical care not affected by a crisis state, beneficence is focused on what is best for the individual patient. In utilitarian beneficence, the focus shifts to what is best for the patient with respect given to the population at large, possibly resulting in a decrease in beneficence on the individual level. The utilitarian benefit in a crisis is typically interpreted as either saving the most lives or saving the most life-years by prioritizing patients who are most likely to benefit from treatment and/or are the youngest and therefore have the most years left to live (Emanuel et al. 2020 ).

In the beginning of the COVID-19 pandemic, it appeared as if mechanical ventilators would be the scarce resource that would require rationing. In response, ethics literature and allocation protocols for mechanical ventilators took over the forefront of the discussion—who gets the last ventilator (White and Lo 2020 ; Ranney et al. 2020 ; Truog et al. 2020 ; Cohen et al. 2020 )? Given the early outbreak in the Northeast, many institutions looked to the New York State Department of Health Ventilator Allocation Guidelines for guidance. This document, initially written in 2007 after the avian flu outbreak, and then revised after the 2009 H1N1 influenza pandemic, specifies their goal as saving the most lives, while balancing this goal with other societal values, such as protecting vulnerable populations, and promoting fairness (New York State Task Force on Life and the Law 2015 ).

In prioritizing patients, in addition to considering saving the most lives and life years, some authors and existing crisis protocols gave priority to frontline healthcare workers and workers who are essential to the healthcare infrastructure (Emanuel et al. 2020 ; White and Lo 2020 ). This priority is not based on evaluations of worth, but rather utility as these persons are instrumental in the care of patients and the net goal of beneficence to all.

For physicians, beneficence is a driving force—physicians do not want to only avoid harm, they want to improve the well-being of their patients. During the COVID-19 pandemic, healthcare providers have stepped up in a variety of ways including working longer hours, traveling to “hot spots” to pitch in, and shifting their work to more essential purposes. In early March, a physician in Italy described how other subspecialists (cardiologists, rheumatologists, dermatologists, etc.) were quickly trained to manage ventilated patients with COVID-19 as their critical care staff were overburdened (Di Marco 2020 ). In the US, in order to expand the ability to provide care and maximize benefits in the current circumstances, states passed a variety of reforms including allowing providers to practice outside their usual scope of practice, waiving licensing requirements and fees, and expanding access to telemedicine (Bayne et al. 2020 ).

In the above case, the patient has an end-stage disease process with a low probability of survival or neurological recovery. She was transferred to a pediatric ICU and cared for by staff who were practicing beyond their usual scope of care, but the patient still received ICU level care. Moving her to the pediatric ICU did several things: it opened a critical care bed for a patient more likely to survive to hospital discharge, it facilitated cohorting of adult patients with COVID-19 within the adult ICU, and it moved her away from other patients critically ill with COVID-19.

Thankfully, the low case rates of COVID-19 in pediatric patients resulted in very few hospitalized children and has allowed the utilization and expansion of ICU resources in a novel way. While imperfect, many US hospitals sought to extend their intensive care coverage both by moving non-COVID critically ill adults to pediatric ICU’s where beds, nurses, and clinicians were available, but also by increasing the acceptable age for pediatric emergency department triage to 20–25 years-old—all with a utilitarian beneficence mindset.

Utilitarian Justice

To this point, we have examined how in Utilitarian Principlism, the shift in focus on the net benefit for society requires the other three principles—autonomy, nonmaleficence, and beneficence—to have a public health emphasis that is not typically present in non-crisis clinical care. This public health perspective promotes justice in Crisis Healthcare Ethics. The previous clinical vignettes demonstrated how the other principles shift so that the interests of society were incorporated into individual medical decision-making.

As previously discussed, the 2009 IOM letter report for guidance on establishing standards of care during a crisis identifies justice as paramount. Justice in Crisis Healthcare Ethics includes protections for vulnerable populations in the equitable allocation of resources. Pandemics disproportionately affect socially disadvantaged populations (DeBruin et al. 2012 ), creating an ethical responsibility to direct resources to at-risk populations. Understanding how pandemics disproportionately affect socially disadvantaged populations can be facilitated by a discussion of structural violence. Structural violence, a term introduced in the 1960s, is the mechanism by which large-scale social forces, such as racism, poverty, political forces, and gender inequalities, among others, indirectly harm persons and populations (DeBruin et al. 2012 ). Structural violence leads to poor health outcomes, disability, and premature death.

DeBruin explains how procedural notions of justice, that are often applied in crisis protocols, are insufficient (DeBruin et al. 2012 ). Procedural justice, focused on equality, strives for neutral decision making. Bias is ideally removed with blindness to race, ethnicity, gender, socioeconomic status, and other social categories. However, when applied to already systematically unequal populations with inherent health disparities, the neutral approach maintains, if not exacerbates, existing inequities (DeBruin et al. 2012 ). Debruin advocates for early identification of at-risk populations so that more resources can be directed to them and barriers to access to care can be addressed. A focus on equitable healthcare outcomes as opposed to equal distribution of resources maximizes justice.

As part of the Minnesota Pandemic Ethics Project, the project team led a series of community engagement meetings designed to foster inclusion of typically under-represented groups, including ethnic minorities, lower income persons, and persons with disabilities (DeBruin et al. 2012 ). Frequently identified barriers to care included: (1) lack of accessible information about the pandemic disease and the available public health and healthcare resources in the community; (2) Distrust of government entities as well as the healthcare infrastructure and providers; (3) lack of or inadequate insurance; (4) geographical distance to care; and (5) limited transportation options or other mobility issues. Another issue identified was the need for assurance that immigration authorities would not be present in the delivery of healthcare or involved in resource distribution.

The obvious and marked racial disparities emerging as factors in COVID-19 incidence and severity raise concern regarding healthcare equity and justice with respect to resource availability. Minority, underserved, impoverished inner city communities have been particularly affected by the pandemic. In Chicago, COVID-19 deaths in Blacks are nearly six times those in Whites, and cases were concentrated in impoverished South Side neighborhoods (Reyes 2020 ). West Detroit, an impoverished mostly Black neighborhood, was hard hit by COVID-19, complicated by lack of access to health care (Burns 2020 ). Proposed factors driving the increased incidence of COVID-19 in inner city minority communities are summarized in Table Table3 3 .

Factors thought to be driving increased COVID-19 incidence in inner city minority communities

Inability to socially distance

Reliance on public transportation

Crowded housing conditions

Availability and affordability of face masks

Inability to self-isolate

Homelessness

Availability and affordability of delivered essential items

Work-related issues

Service-industry or front-facing jobs

Inability to work remotely or from home

Essential industry jobs

Co-morbidities associated with more severe infection (greater infectivity)

Diabetes mellitus

Hypertension

Obesity

In a discussion on ethical guidelines for pandemic influenza, the CDC emphasized the importance of community engagement and transparency in decision-making. Ethical decision-making requires a diversity of public voices to represent populations. Acknowledgment of the historical context of distrust of the healthcare system and the government is essential. In the past, vulnerable populations have been abused in the name of the public good (e.g., the US Public Health Service syphilis study at Tuskegee, involuntary sterilization of mentally retarded persons, the internment of Japanese Americans during World War II (Kinlaw et al. 2009 ). Addressing the distrust that exists should be a core mission of healthcare in general, but becomes even more central during times of crisis when fears exist regarding the potential for pure utilitarian arguments, not guided by the principle of justice, in order to condone the harm of persons or populations.

The COVID-19 pandemic has occurred during a time of complex social and political tensions. Amidst the pandemic, protesters swarmed the streets across the country to express outrage and sorrow over a longstanding history of unchecked police brutality against African American men. The protests exposed how deeply ingrained systemic racism in our country leaves vulnerable populations fearful of the very institutions from which they should be receiving protection, whether it be law enforcement or healthcare.

Maximizing justice in healthcare requires considering it within the overall social context. The healthcare institution is only one aspect contributing to health outcomes. The social determinants of health (SDH)—the conditions in which persons live, work, and play—have a larger impact on health outcomes than healthcare itself (Artiga and Hinton 2019 ). While addressing the social determinants of health is important during non-crisis times, it becomes even more imperative during crises that exacerbate inequalities. The most effective social interventions to promote health during pandemics is an area in need of further research. More effective public health policies directed at inequities in SDH during non-crisis times may be the most effective way to address unequal health outcomes during crisis as well as non-crisis times.

Western medicine’s deontological principlist approach focuses on individuals as opposed to populations, resulting in rising healthcare costs without improved health outcomes and an inadequate framework to guide resource allocation when a healthcare crisis occurs. The COVID-19 pandemic has challenged society and healthcare in unprecedented ways. These challenges have reminded us how interdependent we are as a society, as healthcare is embedded within a greater social context. As we endure and hopefully emerge from the pandemic, it is perhaps time to reconsider where crisis healthcare should fall on the principlism spectrum. Improving the health of populations during the COVID-19 pandemic may require a shift toward a more utilitarian principlism perspective, maintaining an emphasis on justice and the promotion of health within its social context.

Not applicable.

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The authors declares that they have no conflict of interest.

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Journal of Business Ethics Education

Volume 15, 2018.

Utilitarianism, Deontology and Virtue Ethics Teaching Ethical Philosophy by Means of a Case Study

The concepts behind three of the principal normative ethical theories (utilitarianism, deontology, virtue ethics) are evident in a real-life scenario. This case study involves videotapes recorded from inside Grootvlei Prison, Bloemfontein, South Africa in 2002. Prisoners captured sensational footage of warders selling alcohol, drugs, loaded firearms and juveniles for sex to inmates. It was footage every journalist would want to broadcast and it was for sale to the highest bidder. The country’s three flagship current affairs programs, broadcast on three different channels, were each approached to buy the footage. Each of the television channels operates under different business models: one is the public broadcaster; another a free-to-air private channel; the third is a pay channel and part of a multinational listed company. Upon analysis it is clear that each executive producer/company espoused different ethical philosophies, yet each decision was ultimately ethical. The reasoning and philosophies of three ethical theories are highlighted in business decision-making, commercial judgments as well as journalistic choices.

2.4 Utilitarianism: The Greatest Good for the Greatest Number

Learning objectives.

By the end of this section, you will be able to:

Identify the principle elements of Jeremy Bentham’s utilitarianism
Distinguish John Stuart Mill’s modification of utilitarianism from Bentham’s original formulation of it
Evaluate the role of utilitarianism in contemporary business

Although the ultimate aim of Aristotelian virtue ethics was eudaimonia , later philosophers began to question this notion of happiness. If happiness consists of leading the good life, what is good? More importantly, who decides what is good? Jeremy Bentham (1748–1842), a progressive British philosopher and jurist of the Enlightenment period, advocated for the rights of women, freedom of expression, the abolition of slavery and of the death penalty, and the decriminalization of homosexuality. He believed that the concept of good could be reduced to one simple instinct: the search for pleasure and the avoidance of pain. All human behavior could be explained by reference to this basic instinct, which Bentham saw as the key to unlocking the workings of the human mind. He created an ethical system based on it, called utilitarianism . Bentham’s protégé, John Stuart Mill (1806–1873), refined Bentham’s system by expanding it to include human rights. In so doing, Mill reworked Bentham’s utilitarianism in some significant ways. In this section we look at both systems.

Maximizing Utility

During Bentham’s lifetime, revolutions occurred in the American colonies and in France, producing the Bill of Rights and the Déclaration des Droits de l’Homme (Declaration of the Rights of Man), both of which were based on liberty, equality, and self-determination. Karl Marx and Friedrich Engels published The Communist Manifesto in 1848. Revolutionary movements broke out that year in France, Italy, Austria, Poland, and elsewhere. 37 In addition, the Industrial Revolution transformed Great Britain and eventually the rest of Europe from an agrarian (farm-based) society into an industrial one, in which steam and coal increased manufacturing production dramatically, changing the nature of work, property ownership, and family. This period also included advances in chemistry, astronomy, navigation, human anatomy, and immunology, among other sciences.

Given this historical context, it is understandable that Bentham used reason and science to explain human behavior. His ethical system was an attempt to quantify happiness and the good so they would meet the conditions of the scientific method. Ethics had to be empirical, quantifiable, verifiable, and reproducible across time and space. Just as science was beginning to understand the workings of cause and effect in the body, so ethics would explain the causal relationships of the mind. Bentham rejected religious authority and wrote a rebuttal to the Declaration of Independence in which he railed against natural rights as “rhetorical nonsense, nonsense upon stilts.” 38 Instead, the fundamental unit of human action for him was utility —solid, certain, and factual.

What is utility? Bentham’s fundamental axiom, which underlies utilitarianism , was that all social morals and government legislation should aim for producing the greatest happiness for the greatest number of people. Utilitarianism, therefore, emphasizes the consequences or ultimate purpose of an act rather than the character of the actor, the actor’s motivation, or the particular circumstances surrounding the act. It has these characteristics: (1) universality, because it applies to all acts of human behavior, even those that appear to be done from altruistic motives; (2) objectivity, meaning it operates beyond individual thought, desire, and perspective; (3) rationality, because it is not based in metaphysics or theology; and (4) quantifiability in its reliance on utility. 39

Ethics Across Time and Cultures

The “auto-icon”.

In the spirit of utilitarianism, Jeremy Bentham made a seemingly bizarre request concerning the disposition of his body after his death. He generously donated half his estate to London University, a public university open to all and offering a secular curriculum, unusual for the times. (It later became University College London.) Bentham also stipulated that his body be preserved for medical instruction ( Figure 2.7 ) and later placed on display in what he called an “auto-icon,” or self-image. The university agreed, and Bentham’s body has been on display ever since. Bentham wanted to show the importance of donating one’s remains to medical science in what was also perhaps his last act of defiance against convention. Critics insist he was merely eccentric.

Critical Thinking

What do you think of Bentham’s final request? Is it the act of an eccentric or of someone deeply committed to the truth and courageous enough to act on his beliefs?
Do you believe it makes sense to continue to honor Bentham’s request today? Why is it honored? Do requests have to make sense? Why or why not?

Bentham was interested in reducing utility to a single index so that units of it could be assigned a numerical and even monetary value, which could then be regulated by law. This utility function measures in “utils” the value of a good, service, or proposed action relative to the utilitarian principle of the greater good, that is, increasing happiness or decreasing pain. Bentham thus created a “hedonic calculus” to measure the utility of proposed actions according to the conditions of intensity, duration, certainty, and the probability that a certain consequence would result. 40 He intended utilitarianism to provide a reasoned basis for making judgments of value rather than relying on subjectivity, intuition, or opinion. The implications of such a system on law and public policy were profound and had a direct effect on his work with the British House of Commons, where he was commissioned by the Speaker to decide which bills would come up for debate and vote. Utilitarianism provided a way of determining the total amount of utility or value a proposal would produce relative to the harm or pain that might result for society.

Utilitarianism is a consequentialist theory. In consequentialism , actions are judged solely by their consequences, without regard to character, motivation, or any understanding of good and evil and separate from their capacity to create happiness and pleasure. Thus, in utilitarianism, it is the consequences of our actions that determine whether those actions are right or wrong. In this way, consequentialism differs from Aristotelian and Confucian virtue ethics, which can accommodate a range of outcomes as long as the character of the actor is ennobled by virtue. For Bentham, character had nothing to do with the utility of an action. Everyone sought pleasure and avoided pain regardless of personality or morality. In fact, too much reliance on character might obscure decision-making. Rather than making moral judgments, utilitarianism weighed acts based on their potential to produce the most good (pleasure) for the most people. It judged neither the good nor the people who benefitted. In Bentham’s mind, no longer would humanity depend on inaccurate and outdated moral codes. For him, utilitarianism reflected the reality of human relationships and was enacted in the world through legislative action.

To illustrate the concept of consequentialism, consider the hypothetical story told by Harvard psychologist Fiery Cushman. When a man offends two volatile brothers with an insult, Jon wants to kill him; he shoots but misses. Matt, who intends only to scare the man but kills him by accident, will suffer a more severe penalty than his brother in most countries (including the United States). Applying utilitarian reasoning, can you say which brother bears greater guilt for his behavior? Are you satisfied with this assessment of responsibility? Why or why not? 41

Link to Learning

A classic utilitarian dilemma considers an out-of-control streetcar and a switch operator’s array of bad choices. Watch the video on the streetcar thought experiment and consider these questions. How would you go about making the decision about what to do? Is there a right or wrong answer? What values and criteria would you use to make your decision about whom to save?

Synthesizing Rights and Utility

As you might expect, utilitarianism was not without its critics. Thomas Hodgskin (1787–1869) pointed out what he said was the “absurdity” of insisting that “the rights of man are derived from the legislator” and not nature. 42 In a similar vein, the poet Samuel Taylor Coleridge (1772–1834) accused Bentham of mixing up morality with law. 43 Others objected that utilitarianism placed human beings on the same level as animals and turned people into utility functions. There were also complaints that it was mechanistic, antireligious, and too impractical for most people to follow. John Stuart Mill sought to answer these objections on behalf of his mentor but then offered a synthesis of his own that brought natural rights together with utility, creating a new kind of utilitarianism, one that would eventually serve to underpin neoclassical economic principles. 44

Mill’s father, James, was a contemporary and associate of Bentham’s who made sure his son was tutored in a rigorous curriculum. According to Mill, at an early age he learned enough Greek and Latin to read the historians Herodotus and Tacitus in their original languages. 45 His studies also included algebra, Euclidean geometry, economics, logic, and calculus. 46 His father wanted him to assume a leadership position in Bentham’s political movement, known as the Philosophical Radicals. 47 Unfortunately, the intensity and duration of Mill’s schooling—utilitarian conditions of education—were so extreme that he suffered a nervous breakdown at the age of twenty years. The experience left him dissatisfied with Bentham’s philosophy of utility and social reform. As an alternative, Mill turned to Romanticism and poets like Coleridge and Johann Wolfgang Goethe (1749–1832). 48 What he ended up with, however, was not a rejection of utilitarianism but a synthesis of utility and human rights.

Why rights? No doubt, Mill’s early life and formation had a great deal to do with his championing of individual freedom. He believed the effort to achieve utility was unjustified if it coerced people into doing things they did not want to do. Likewise, the appeal to science as the arbiter of truth would prove just as futile, he believed, if it did not temper facts with compassion. “Human nature is not a machine to be built after a model, and set to do exactly the work prescribed for it, but a tree, which requires to grow and develop itself on all sides, according to the tendency of the inward forces which make it a living thing,” he wrote. 49 Mill was interested in humanizing Bentham’s system by ensuring that everyone’s rights were protected, particularly the minority’s, not because rights were God given but because that was the most direct path to truth. Therefore, he introduced the harm principle , which states that the “only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” 50

To be sure, there are limitations to Mill’s version of utilitarianism, just as there were with the original. For one, there has never been a satisfactory definition of “harm,” and what one person finds harmful another may find beneficial. For Mill, harm was defined as the set back of one’s interests. Thus, harm was defined relative to an individual’s interests. But what role, if any, should society play in defining what is harmful or in determining who is harmed by someone’s actions? For instance, is society culpable for not intervening in cases of suicide, euthanasia, and other self-destructive activities such as drug addiction? These issues have become part of the public debate in recent years and most likely will continue to be as such actions are considered in a larger social context. We may also define intervention and coercion differently depending on where we fall on the political spectrum.

Considering the social implications of an individual action highlights another limitation of utilitarianism, and one that perhaps makes more sense to us than it would to Bentham and Mill, namely, that it makes no provision for emotional or cognitive harm. If the harm is not measurable in physical terms, then it lacks significance. For example, if a reckless driver today irresponsibly exceeds the speed limit, crashes into a concrete abutment, and kills himself while totaling his vehicle (which he owns), utilitarianism would hold that in the absence of physical harm to others, no one suffers except the driver. We may not arrive at the same conclusion. Instead, we might hold that the driver’s survivors and friends, along with society as a whole, have suffered a loss. Arguably, all of us are diminished by the recklessness of his act.

Watch this video for a summary of utilitarian principles along with a literary example of a central problem of utility and an explanation of John Stuart Mill’s utilitarianism.

The Role of Utilitarianism in Contemporary Business

Utilitarianism is used frequently when business leaders make critical decisions about things like expansion, store closings, hiring, and layoffs. They do not necessarily refer to a “utilitarian calculus,” but whenever they take stock of what is to be gained and what might be lost in any significant decision (e.g., in a cost-benefit analysis), they make a utilitarian determination. At the same time, one might argue that a simple cost-benefits analysis is not a utilitarian calculus unless it includes consideration of all stakeholders and a full accounting of externalities, worker preferences, potentially coercive actions related to customers, or community and environmental effects.

As a practical way of measuring value, Bentham’s system also plays a role in risk management. The utility function, or the potential for benefit or loss, can be translated into decision-making, risk assessment, and strategic planning. Together with data analytics, market evaluations, and financial projections, the utility function can provide managers with a tool for measuring the viability of prospective projects. It may even give them an opportunity to explore objections about the mechanistic and impractical nature of utilitarianism , especially from a customer perspective.

Utilitarianism could motivate individuals within the organization to take initiative, become more responsible, and act in ways that enhance the organization’s reputation rather than tarnish it. Mill’s On Liberty ( Figure 2.8 ), a short treatment of political freedoms in tension with the power of the state, underscored the importance of expression and free speech, which Mill saw not as one right among many but as the foundational right, reflective of human nature, from which all others rights derive their meaning. And therein lay the greatest utility for society and business. For Mill, the path to utility led through truth, and the main way of arriving at truth was through a deliberative process that encouraged individual expression and the clash of ideas.

As for Mill’s harm principle, the first question in trying to arrive at a business decision might be, does this action harm others? If the answer is yes, we must make a utilitarian calculation to decide whether there is still a greater good for the greatest number. Then we must ask, who are the others we must consider? All stakeholders? Only shareholders? What does harm entail, and who decides whether a proposed action might be harmful? This was the reason science and debate were so important to Mill, because the determination could not be left to public opinion or intuition. That was how tyranny started. By introducing deliberation, Mill was able to balance utility with freedom, which was a necessary condition for utility.

Where Bentham looked to numerical formulas for determining value, relying on the objectivity of numbers, Mill sought value in reason and in the power of language to clarify where truth lies. The lesson for contemporary business, especially with the rise of big data, is that we need both numbers and reasoned principles. If we apply the Aristotelian and Confucian rule of the mean, we see that balance of responsibility and profitability makes the difference between sound business practices and poor ones.

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Calculating Consequences: The Utilitarian Approach
Markkula Center for Applied Ethics
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Ethical Decision Making

Calculating Consequences:The Utilitarian Approach to Ethics

Imagine that the U.S. Central Intelligence Agency gets wind of a plot to set off a dirty bomb in a major American city. Agents capture a suspect who, they believe, has information about where the bomb is planted. Is it permissible for them to torture the suspect into revealing the bomb's whereabouts? Can the dignity of one individual be violated in order to save many others?

Greatest Balance of Goods Over Harms If you answered yes, you were probably using a form of moral reasoning called "utilitarianism." Stripped down to its essentials, utilitarianism is a moral principle that holds that the morally right course of action in any situation is the one that produces the greatest balance of benefits over harms for everyone affected. So long as a course of action produces maximum benefits for everyone, utilitarianism does not care whether the benefits are produced by lies, manipulation, or coercion.

Many of us use this type of moral reasoning frequently in our daily decisions. When asked to explain why we feel we have a moral duty to perform some action, we often point to the good that will come from the action or the harm it will prevent. Business analysts, legislators, and scientists weigh daily the resulting benefits and harms of policies when deciding, for example, whether to invest resources in a certain public project, whether to approve a new drug, or whether to ban a certain pesticide.

Utilitarianism offers a relatively straightforward method for deciding the morally right course of action for any particular situation we may find ourselves in. To discover what we ought to do in any situation, we first identify the various courses of action that we could perform. Second, we determine all of the foreseeable benefits and harms that would result from each course of action for everyone affected by the action. And third, we choose the course of action that provides the greatest benefits after the costs have been taken into account.

The principle of utilitarianism can be traced to the writings of Jeremy Bentham, who lived in England during the eighteenth and nineteenth centuries. Bentham, a legal reformer, sought an objective basis that would provide a publicly acceptable norm for determining what kinds of laws England should enact. He believed that the most promising way of reaching such an agreement was to choose that policy that would bring about the greatest net benefits to society once the harms had been taken into account. His motto, a familiar one now, was "the greatest good for the greatest number."

Over the years, the principle of utilitarianism has been expanded and refined so that today there are many variations of the principle. For example, Bentham defined benefits and harms in terms of pleasure and pain. John Stuart Mill, a great 19th century utilitarian figure, spoke of benefits and harms not in terms of pleasure and pain alone but in terms of the quality or intensity of such pleasure and pain. Today utilitarians often describe benefits and harms in terms of the satisfaction of personal preferences or in purely economic terms of monetary benefits over monetary costs.

Utilitarians also differ in their views about the kind of question we ought to ask ourselves when making an ethical decision. Some utilitarians maintain that in making an ethical decision, we must ask ourselves: "What effect will my doing this act in this situation have on the general balance of good over evil?" If lying would produce the best consequences in a particular situation, we ought to lie. Others, known as rule utilitarians, claim that we must choose that act that conforms to the general rule that would have the best consequences. In other words, we must ask ourselves: "What effect would everyone's doing this kind of action have on the general balance of good over evil?" So, for example, the rule "to always tell the truth" in general promotes the good of everyone and therefore should always be followed, even if in a certain situation lying would produce the best consequences. Despite such differences among utilitarians, however, most hold to the general principle that morality must depend on balancing the beneficial and harmful consequences of our conduct.

Problems With Utilitarianism While utilitarianism is currently a very popular ethical theory, there are some difficulties in relying on it as a sole method for moral decision-making. First, the utilitarian calculation requires that we assign values to the benefits and harms resulting from our actions and compare them with the benefits and harms that might result from other actions. But it's often difficult, if not impossible, to measure and compare the values of certain benefits and costs. How do we go about assigning a value to life or to art? And how do we go about comparing the value of money with, for example, the value of life, the value of time, or the value of human dignity? Moreover, can we ever be really certain about all of the consequences of our actions? Our ability to measure and to predict the benefits and harms resulting from a course of action or a moral rule is dubious, to say the least.

Perhaps the greatest difficulty with utilitarianism is that it fails to take into account considerations of justice. We can imagine instances where a certain course of action would produce great benefits for society, but they would be clearly unjust. During the apartheid regime in South Africa in the last century, South African whites, for example, sometimes claimed that all South Africans—including blacks—were better off under white rule. These whites claimed that in those African nations that have traded a whites-only government for a black or mixed one, social conditions have rapidly deteriorated. Civil wars, economic decline, famine, and unrest, they predicted, will be the result of allowing the black majority of South Africa to run the government. If such a prediction were true—and the end of apartheid has shown that the prediction was false—then the white government of South Africa would have been morally justified by utilitarianism, in spite of its injustice.

If our moral decisions are to take into account considerations of justice, then apparently utilitarianism cannot be the sole principle guiding our decisions. It can, however, play a role in these decisions. The principle of utilitarianism invites us to consider the immediate and the less immediate consequences of our actions. Given its insistence on summing the benefits and harms of all people, utilitarianism asks us to look beyond self-interest to consider impartially the interests of all persons affected by our actions. As John Stuart Mill once wrote:

The happiness which forms the utilitarian standard of what is right in conduct, is not...(one'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.

In an era today that some have characterized as "the age of self-interest," utilitarianism is a powerful reminder that morality calls us to look beyond the self to the good of all.

The views expressed do not necessarily represent the position of the Markkula Center for Applied Ethics at Santa Clara University. We welcome your comments, suggestions, or alternative points of view.

This article appeared originally in Issues in Ethics V2 N1 (Winter 1989)

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covid 19 and limits utilitarianism

COVID-19 and the Limits of Utilitarianism

Why our usual method for deliberating about policy decisions is failing us right now

By Nicholas Buck | June 11, 2020

Crafting policy decisions in response to the COVID-19 global pandemic calls for careful practical moral and political reasoning. Amid debates about next steps, Peter Singer, a prominent utilitarian ethicist, has weighed in on the matter. Wrestling with Singer’s arguments allows us to reflect on how we tend to think through these matters given that our policy deliberations often assume something of a utilitarian form.

Utilitarianism is an ethical model that determines right action primarily in reference to outcomes. Generally speaking, it posits that actions are right to the extent they result (or tend to result) in the greatest benefit for the greatest number of people. To be sure, this way of thinking has strong intuitive force. Shouldn’t we always aspire to do the greatest amount of good possible?

Singer recently put utilitarianism on display by publicly reasoning through how to approach reopening the U.S. economy. He joined a panel that The New York Times assembled to discuss the issue after co-authoring an article about it with Michael Plant in Project Syndicate .

Outlining the nature of the situation as he sees it, and stressing the need for thinking about outcomes and trade-offs, he explained in the Times :

I think the assumption… that we have to do everything to reduce the number of deaths, is not really the right assumption. Because at some point we are willing to trade off loss of life against loss of quality of life. No government puts every dollar it spends into saving lives. And we can’t really keep everything locked down until there won’t be any more deaths. So I think that’s something that needs to come into this discussion. How do we assess the overall cost to everybody in terms of loss of quality of life, loss of well-being, as well as the fact that lives are being lost?

In Project Syndicate , Singer and Plant focused especially on the costs of a slowed economy and argued that these must be weighed in some way against the benefits of social distancing. They advise the use of empirical data such as the average number of “life years lost” by people who have died from COVID-19 for comparison against the steep economic toll of lockdowns.

They conclude:

[M]aking trade-offs requires converting different outcomes into a single unit of value. A problem with the current conversations about whether we should strangle the economy to save lives is that we cannot directly compare “lives saved” against “lost GDP.” We need to put them into some common unit… To do that, we think it’s best to measure wellbeing by using individuals’ reports of how happy and how satisfied with their lives they are.... Doing this means we can, in a principled way, weigh up otherwise hard-to-compare considerations when deciding how to respond to COVID-19—or to any other systemic risk.

Some version of Singer’s approach is prominent in our public debate, and understandably so. Among utilitarianism’s strengths are its scalability, practicality, and realism. However, it can also seem crass. Surely Singer is right that there is tension between the loss of life and the diminishing quality of life, as well as between the economic and human costs of our policies. And yet, the ease with which he seems to consider all of these as finally calculable is unsettling

It is important to note that Singer is not arguing in bad faith. In the Times , he readily admits of his age and of belonging to a segment of the population most vulnerable to the potentially unfortunate consequences of his reasoning. Nonetheless, Singer’s approach clearly depersonalizes the situation.

On one hand, large-scale analyses and the requirements of political office surely demand an emotional distance of some kind in order to make the best decision in non-ideal circumstances. On the other, we might think that something is wrong when decisions that sacrifice many of the intuitions and values we depend on appear to come too quickly and without clear overriding arguments. The English philosopher Bernard Williams has criticized utilitarians on just this point.

To my mind, Charles Taylor has exposed devastating problems with utilitarianism. In Sources of the Self: The Making of Modern Identity (1989) and elsewhere, Taylor contends that moral reasoning is an essentially qualitative task anchored in some orienting conception(s) of the good. He argues that utilitarians, who reject such a picture of morality, cannot escape relying on substantive intuitions for which they cannot account (i.e., that happiness is worth pursuing and an ideal of universal and impartial benevolence). Further, he argues that their move to quantitative analysis distorts the evaluative nature of moral reasoning by reducing what are different kinds of goods to a single one. Doing so, he claims, misses the intrinsic value belonging to many of our moral concepts and empties them of motivating power.

Following Taylor, we might say that a cohering, motivating, situation-transcending source of value is necessary to maintain a properly moral perspective. In light of the features of their approach, utilitarians are unable to do so. Thinking with Singer about our present situation reveals another, related problem.

In his critique, Williams draws attention to the way utilitarians frame the moral situation. Notice this in Singer’s arguments. At no point does he consider the political decisions that have shaped and continue to shape the trade-offs as he presents them. Rather, he proceeds as if these were givens , more or less stable and fixed. To be sure, there are legitimate concerns regarding the effects of economic slowdown, and Singer is right to consider the psychological and emotional effects of prolonged social distancing. But it is not at all obvious that we are left to trade-off the economic and human costs in the way implied.

We might instead approach the matter by critically considering who is likely to bear the greatest burden of our decisions, particularly which racial groups and classes of people, and whether that is just. Without avoiding the need for trade-offs, we could opt to redistribute our enormous national wealth on a large scale, ensure the provision of necessary resources, and offer alternatives to unemployment. After all, perhaps the COVID-19 crisis is best understood as further revealing and exacerbating many of our current economic arrangement’s existing problems rather than generating entirely new ones of its own. Utilitarianism, in either Singer’s philosophically rigorous version or the inchoate form it often takes in our public debates, seems mostly unable to arrive at and properly consider these possibilities. Because of its narrow view of the moral situation and its reductive move to quantitative reasoning, utilitarianism appears to be hamstrung by an implicit and unwarranted status quo bias.

As it turns out, utilitarianism operates at both an ideal and an empirical deficit—it lacks perspective in both dimensions. Not only is it unmoored from a motivating and cohering source of value, it tends to mistake the terms of our trade-offs for something like brute facts when at least many of them are the contingent and impermanent results of political decision.

An example of this can be seen in Lieutenant Governor of Texas Dan Patrick’s recent suggestion that re-opening the economy involves a potential trade-off between the lives of people in their seventies (those most at risk of fatality due to COVID-19) and the possibility of losing “our whole country.” Setting aside the ideological reasons Patrick might have for not questioning the economic arrangements and other details implicit in his view of the “great American dream,” his framing is premised on taking these arrangements and details as givens. Not incidentally, he also does not offer clear moral values that allow for the critical consideration of these implicit elements.

Even granting the validity of some of my concerns, a utilitarian could respond that the urgency of our situation prevents any major economic or political overhaul. This, however, seems like a false choice and a curiously narrow view of the problem, and it stubbornly elides the inherent limitations of such an approach. We cannot adequately respond to our situation without drawing on substantive commitments that both allow us to see our situation in its larger moral and political context and help to make proper sense of the many goods and values at stake. Only then might we be able to prudently navigate the difficult matter of trade-offs and begin to grasp what is becoming increasingly evident—that our most urgent need lies where genuine reform and proper attention to the pandemic meet.

Sightings is edited by Joel Brown, a PhD Candidate in Religions in the Americas at the Divinity School. Sign up here to receive Sightings via email. You can also follow us on Facebook and Twitter . The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the Marty Center or its editor.

Nicholas Buck

Author, Nicholas Buck , is a PhD student in Religious Ethics at the Divinity School. He studies religion and the development of modern moral and political thought, liberal democracy, and human rights.

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Home — Essay Samples — Philosophy — Deontology — Utilitarianism Vs Deontology: A Case Study

Utilitarianism Vs Deontology: a Case Study

Categories: Deontology Immanuel Kant Utilitarianism

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Published: Dec 16, 2021

Words: 2997 | Pages: 7 | 15 min read

“Act only on that maxim through which you can at the same time will that it should become a universal law of nature.” This means that, if you wish to act morally, you should act as if what your moral decision is what will become the law for everyone, including yourself.
“So act as to treat humanity, both in your own person, and in the person of every other, always at the same time as an end, never simply as a means.” What Kant means by this is that treating people as if they are tools used to be further ambitions and ends is highly unethical and morally wrong.
”Every rational being must so act as if he were through his maxim always a law making member in the universal kingdom of ends”. Kant holds the view that everyone must be respected as everyone possesses their own emotions, hopes, fears, just as you and I do. He feels that everyone should be respected equally. Kant believes that everyone should act as a member of a community of “ends”, all who possess the same ability to make moral abilities. Each member of this community should respect the wishes and needs of others and allow them the freedom of decision.

Bibliography

Dimmock, M. Fisher, A. (2017) Ethics for A-Level. Cambridge: Open Book Publishers.
Johnson, R. Cureton, A. (2019) Kant’s Moral Philosophy, Stanford, available: https://plato.stanford.edu/entries/kant-moral/ [accessed 28 Nov 19]
Rich, K, L. (forthcoming) Nursing Ethics: Across the Curriculum and Into Practice. Burlington: Jones and Bartlett Learning
Seedhouse, D. (1998) Ethics: The Heart of Healthcare. Chichester: John Wiley and Sons

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Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health

Elliot Marseille ORCID: orcid.org/0000-0001-8518-1143 1 &
James G. Kahn 2

Philosophy, Ethics, and Humanities in Medicine volume 14 , Article number: 5 ( 2019 ) Cite this article

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Efficiency as quantified and promoted by cost-effectiveness analysis sometimes conflicts with equity and other ethical values, such as the “rule of rescue” or rights-based ethical values. We describe the utilitarian foundations of cost-effectiveness analysis and compare it with alternative ethical principles. We find that while fallible, utilitarianism is usually superior to the alternatives. This is primarily because efficiency – the maximization of health benefits under a budget constraint – is itself an important ethical value. Other ethical frames may be irrelevant, incompatible with each other, or have unacceptable implications. When alternatives to efficiency are considered for precedence, we propose that it is critical to quantify the trade-offs, in particular, the lost health benefits associated with divergence from strict efficiency criteria. Using an example from HIV prevention in a high-prevalence African country, we show that favoring a rights-based decision could result in 92–118 added HIV infections per $100,000 of spending, compared to one based on cost-effectiveness.

Economic efficiency is a leading criterion for resource allocation decisions for global (or public) health [ 1 , 2 ]. Yet assessments of efficiency in the form of cost-effectiveness (CEA) or cost-benefit analysis (CBA) are regarded with a mixture of enthusiasm and suspicion: enthusiasm, because, all else equal, program managers and policy makers seek to maximize the benefit from limited dollars; and suspicion, because all else is rarely equal, when other considerations are included such as fairness and reduction in disparities. Indeed, CEAs are perceived by some as ethically suspect because they rest on a conceptual foundation that violates everyday moral intuitions [ 3 ]. By representing human life in dollar terms and choosing among life-saving interventions based on mathematically-derived return-on-investment metrics, they undermine the expression of communitarian values, and often appear to conflict with a range of ethical principles including equity, urgent need, and human rights as enshrined in international law [ 4 , 5 ].

In this article, we describe the ethical framework implied by CEA, utilitarianism, as applied to global health. Second, after describing some of the moral objections to utilitarianism, we show that the criticisms leveled against CEA on ethical grounds are often misleading: Efficiency in promoting human life and health is itself a valid ethical standard, and that alternative formal ethical approaches, as well as everyday ethical intuitions, present their own problems when applied to real world situations. In particular, we discuss the moral equivalence between identified and statistical lives implied by utilitarianism. Using the example of the female condom to prevent HIV transmission in developing countries, we also show that using non-efficiency based principles to guide resource allocation, even central principles such as human rights, when applied too narrowly, can inadvertently lead to undermining those very principles. Third, we argue that while no infallible theory of the ethics of resource allocation is yet available, the utilitarian framework underlying CEA and CBA generally provides trustworthy guidance; is usually superior to the alternatives, and should therefore constitute the default perspective. Finally, we propose that when utilitarianism generates results that stakeholders deem ethically unacceptable, the grounds for that dissatisfaction should be made numerically explicit. A good faith effort should be made to describe and quantify the trade-offs associated with decisions that diverge from efficiency criteria.

Ethical framework implied by cost-effectiveness analysis

The ethical foundation of CEA and CBA, utilitarianism, was originally developed by the nineteenth century British philosophers Jeremy Bentham and John Stuart Mills [ 6 , 7 ] and was recently revisited and advanced by Peter Singer in “Practical Ethics” and other writings, and by Joshua Greene in “Moral Tribes” [ 8 , 9 ].

Utilitarianism is a species of Consequentialism, which is the ethical doctrine that one should judge actions by the outcomes that can reasonably be expected to follow, and not by the actors’ intention or by fidelity to an abstract moral principle. Thus, the overarching maxim of Utilitarianism is, “Act in such a way as to generate the maximum quantum of well-being, happiness, or utility”, or in Bentham’s famous dictum, “the greatest good for the greatest number” [ 6 ]. In the context of global health, this implies:

Resources should be allocated consistent with maximizing overall benefit, such as deaths averted or quality-adjusted life-years gained. Such allocation decisions are consistent with the findings of cost-effectiveness analyses.

All lives have the same value. While anodyne at first sight, this concept helps fuel utilitarianism’s reputation for replacing common humanity with hyper-rational calculation. It means, for example, that there is no basis for distinguishing between identified lives (e.g., a sick person treated at a hospital) versus statistical lives (e.g., unknown individuals who avoid disease). We argue that in general, this principle is in fact consistent with our humanity and is at the heart of the unique contribution of the global health perspective.

No special claim accrues to alleviating inequality. The exception is when privileging vulnerable populations, or those with less access to care, is an efficient means to achieving #1, above. This seeming indifference to the plight of the poor may be part of the reason for the “.. . widespread suspicion that CEA does favor the healthy and well-to-do” [ 10 ]. We will argue that there is less to object to here than meets the eye: in most populations, efficiency and inequality alleviation are concordant. This is because poor people are usually sicker and start with fewer health resources than wealthier neighbors.

Few would dispute the notion that #1 is an important part of rational resource allocation. Our difference with some critics of CEA is that we believe other ethical values should onely rarely substantially modify guidance based on efficiency alone. As expounded below, those other ethical values are not necessarily of a higher order than efficiency, and have their own problems.

Regarding #2, powerful, often irresistible emotions, especially empathy, impel decision makers to privilege identified lives. Nevertheless, we are aware of no rational basis for elevating this sense of empathy to a principle that should guide policy. Public health as distinct from clinical medicine is, at its core, concerned with populations, not identified individuals. Statistical lives are in fact identified lives for the friends and family members of those persons. The impulse to favor identified individuals is thus a failure of imagination. For public health professionals to treat identified lives as having a primary claim because they are less visible to those professionals, lacks ethical foundation.

Regarding #3, as a practical matter, the area of potential conflict between equity and utilitarianism is smaller than one might expect. This is because the incremental benefit of investing additional global health dollars for the poor and others with limited access to health care is generally greater than the incremental benefits generated by the same dollars spent on the more affluent and those with better access to health care [ 2 ]. Thus, in most cases, efficiency and equity goals are aligned. For example, malaria and neglected tropical diseases account for 15% of the total burden of disease in sub-Saharan Africa [ 11 ] and malaria deaths are closely associated with poverty [ 12 ]. A 2013 systematic review and meta-analysis found a roughly two-fold higher risk of parasitemia in children of lower compared with children of higher socio-economic status [ 13 ]. Malaria treatment and prevention is one of the areas where investment in global health have seen the greatest returns in the past 20 years. These interventions are included in the “enhanced investment scenario” for low-income countries needed to achieve global health convergence by 2035 [ 12 ].

Limitations to criticisms of cost-effectiveness analysis and problems with other ethical principles

Various ethical principles are cited to justify policy positions or resource allocation decisions in global health [ 5 ]. Each represents a broadly shared moral intuition. However, the policy choices implied by these different principles often conflict. Current public health discourse makes no reference to a meta-ethic which might lead us to choose one ethical principle over another, and thus invites an ad hoc application of decision rules. Policy actors and advocates often choose whatever ethical principle aligns with their existing action preferences. Rather than ethical argument fulfilling its proper function of constraining and informing political and ideological predispositions, the invocation of ethical principles can devolve into justification of those predispositions. At their worst, they may be used to deprecate opponents into silence. For example, because rights are associated with non-negotiable moral and legal imperatives, framing a choice in human rights terms can appear to preclude inquiry and analysis.

A 2012 article by Ruth Macklin and Ethan Cowan outlined several ethical principles that could be brought to bear on the question of how, in developing countries, limited supplies of antiretroviral drugs should be divided between HIV/AIDS treatment and prevention via pre-exposure prophylaxis [ 14 ]. The piece concisely describes six ethical principles: utilitarianism, equity, urgent need, prioritarianism, rule of rescue, and equal worth to which we have added a seventh, “Rights”.

Utilitarianism: Maximize total health benefit given the relevant budget.

Equity: Divide resources to reduce disparities in health status among different groups or strata, poor, women, rural areas, ethnic/racial minorities.

Urgent need: More urgent needs give rise to stronger moral claims

Prioritarianism: Provide resources to the least advantaged.

Rule of rescue: Identified lives in imminent danger take precedence.

Equal worth: All lives have equal worth; therefore, all are entitled to the same resources.

Rights: Certain freedoms and protections under the law, or material goods and services are due all human beings.

The authors then discuss the difficulties in interpreting each of these in the context of this HIV/AIDS-related policy decision. For example, if one were to adopt the principle of “urgent need” it is unclear whose needs (those benefiting from treatment versus from prevention) should be considered most urgent. Similarly, it is hard to know what is “equitable” since we have no guidance for choosing equal inputs over equal health effects, or vice versa. Furthermore, does “equity” mean equality, or does it refer to justice based on another unstated criterion? Likewise, too much weight applied to the rule of rescue would quickly exhaust available funds, and thus seriously undermine the ability to build sustainable health systems, and thus progress towards the utilitarian goal of maximizing health, or right-based access to health care. Similar questions and objections apply to each of the principles outlined. It is worth noting that no mention is made by Macklin and Cowan of human rights. But the practical meaning of “rights” in this context would also be difficult to interpret. Does the right to treatment supersede the right to prevention? If so, why? If there is an ethical imperative to provide both adequate treatment and prevention, we’ve assumed away the trade-off, which is at the heart of this and of all resource allocation decisions See Fig. 1 .

Likelihood of convergence between ethical principles

The figure above shows in rough, qualitative fashion how well these principles coincide in the case of the allocation of antiretroviral medications for HIV prevention via Pre-Exposure Prophylaxis (PrEP) versus HIV treatment. These principles have different possible practical interpretations, particularly Equity, Urgent Need, and Prioritarianism. While the article offers a clear statement of the problem (i.e., the difficulty in choosing among ethical theories and in understanding how each should be interpreted in the context of a specific program choice), the arguments advanced for the selected option are unconvincing. The authors, citing Macklin’s own earlier work write,

“When principles conflict, it becomes necessary to balance competing concerns. There is no correct way of achieving this balance. Moreover, there is no consensus on how the different principles ought to be weighted, or on what weight should be given to the goal of maximizing health compared to other social goods such as education or environmental protection.”

This problem has also been identified by other analysts such as Johri and Norheim in their systematic review of efforts to integrate concerns for equity with cost-effectiveness analysis [ 15 ]. They point out that, “A central problem relates to the fact that equity is understood in multiple ways, each demarcating a distinct set of intuitions concerning fairness. Each method takes a distinct approach to how values should articulate with cost-effectiveness evidence.”

Macklin and Cowan advocate for balancing the influence of multiple principles. Akin to advancing an unfalsifiable hypothesis, the appeal to weighing moral desiderata based on unspecified criteria makes it hard to know under what circumstances a choice can be said to be ethically incorrect. Later we find, “The ultimate goal, of course, is to achieve a utilitarian outcome tempered by considerations of equity and urgent need.” Why “of course”? If this conclusion flows naturally from ordinary moral intuitions, why attempt to identify and apply general principles? The proposed conclusion is only a re-statement of the original problem, begging the question, “In what proportions should these principles be mixed, and what principle would guide us to the optimal proportions?” The conclusion advocated in the article, namely that treatment has a prior claim over prevention in the allocation of antiretroviral drugs for HIV/AIDS, is simply asserted based on an opaque weighting of competing ethical principles. The unstated meta-ethical principle is that a result that highly over-weights any one principle is likely to be unethical. But why should that be? Why is it not just as plausible that one principle should dominate? Since this question is not addressed, we are left with the ad hoc mix of ethical appeals that policy makers now use. In the absence of guidance on how to weight the multiple ethical principles described, decisions based on historical and cultural norms, politics and ideology can be dressed in whatever ethical clothing seems to fit. This is a description of the world we now inhabit. It is unclear how “balancing” multiple competing ethical principles puts health resource allocation on a more reliable ethical foundation.

A set of thought experiments dubbed the “Trolley Problem” was advanced by the British philosopher Philippa Foot at Oxford University in 1967 and later elaborated by Judith Thomson at MIT and others [ 16 , 17 , 18 , 19 ]. The trolley problems demonstrate vividly that different respondents consider different circumstances to be morally relevant. More tellingly, the same respondent may find acceptable a principle such as “one must take no action that results in the death of an innocent” in one set of circumstances, only to be repulsed by the consequences of applying such a principle under slightly altered circumstances. Footnote 1 If contemplation of “Trolleyology” reduces one’s confidence in everyday ethical judgments, Joshua Greene, in Moral Tribes , [ 9 ] and Randall Moore in his 1996 article, Caring for Identified Versus Statistical Lives: An Evolutionary View of Medical Distributive Justice [ 20 ] advance the idea that far from being a direct line to sound ethical understanding, ordinary ethical intuitions are a function of evolutionary pressures of the ancient savannah, especially the need to interact successfully with small numbers of fellow tribe members.

Humans, including scientists trained in statistics, also handle small numbers much better than large numbers (Tversky and Kahneman 1971). This is consistent with our evolutionary need to deal with small numbers of people and objects and not with large numbers. Throughout the great majority of human history, an ability to easily understand and manipulate large numbers would have been wasted and wasteful. We would expect that evolution did not emphasize cognitive abilities that would be little used, because such an emphasis would waste neurological energy that could be spent on more practical tasks [ 20 ].

The theory that different types of cognitive processes are used to make judgments about specific as opposed to general objects is supported by a number of psychological theories, [ 21 , 22 ] and dual-process models [ 23 , 24 ]. A discussion of the state of the neuroscience relevant to these claims is beyond the scope of this article. However, on this account, the general tendency to accord preferential treatment to identified lives [ 25 , 26 ] may be a function of the evolution of “moral brains” molded by the survival advantage conferred by forming strong affiliations and reciprocal loyalties, not on recognizable principles of justice.

The single most common objection to utilitarianism is that it seems to permit using human beings as a means to an end, thus violating the rights of those people [ 9 ]. John Rawls, in particular, criticized utilitarianism on these grounds [ 27 ]. For example, if it could be shown that the unhappiness of slaves was outweighed by the happiness of slave owners, would slavery therefore be morally justified? This is the kind of counter-intuitive, and indeed, repugnant outcome that utilitarian rationality sometimes appears to imply. On the other hand, utilitarianism can also seem to place demands on moral actors that appear too stringent. The logical terminus of Peter Singer’s famous thought experiment regarding what we should be willing to give up to save a drowning child, is that we should be willing to impoverish ourselves in order to save the lives of the poor and sick in less developed countries [ 28 ]. These and other arguments against utilitarianism and replies to these objections are summarized in Moral Tribes. For example, according to Greene, slavery is actually not permitted on the utilitarian account because, as a practical matter, it is implausible that slavery could increase net utility, though it might increase wealth.

Arguments for utilitarianism as the default ethical perspective

The possibility of repugnant outcomes is by no means unique to utilitarianism. As shown in the Trolley Problem, and in evaluating the ethical implications of favoring expenditures on antiretroviral drugs for treatment over pre-exposure prophylaxis, non-efficiency based principles are often hard to interpret, irrelevant, or contradictory. They may also lead to outcomes that diverge dramatically from that of health-maximization. Cost-effectiveness analysis has the virtue of being relevant to any resource allocation decision. Its operational definition is unambiguous (maximization of health benefits for a given budget) even if performing cost-effectiveness calculations is sometimes challenging.

Other principles, such as rule of rescue or the urgent need based adjudications of claims on health care resources, have expression in clinical medicine and elsewhere. However, the principles appropriate when considering the welfare of large populations differs from those appropriate for clinical medicine or for small communities and families. Utilitarianism, because it does not distinguish between identified and statistical lives is, in general, the framework best suited to the former.

We do not propose that utilitarianism is the only legitimate guide to global health resource allocation decisions. However, we do suggest that it should be the point of departure for further analysis. Because of its intrinsic ethical dimensions, efficiency is not merely one criterion among many. The promotion of human flourishing is a central goal of most ethical system. Attaining the greatest population health available with given resources is consonant with that flourishing. Thus, decisions to diverge from pursuit of that goal to promote other ethical values should be acknowledged and justified.

Wherever possible, decision-makers should quantify the tradeoff, i.e. the loss of health resulting from pursuit of other ethical values. This will often be possible in a rough but serviceable manner. For example, spending incremental dollars on the male condom will almost always generate greater health benefit than spending the same money on female condoms [ 29 ]. The details of why this is true in almost every HIV epidemic type and risk sub-population are complex, but this finding was driven primarily by two factors: a) the female condom is much more expensive than the male condom while conferring the same protective benefit per unprotected sex episode; and b) use of a female condom often displaces use of a male condom, thus providing no additional protection. However, one of the virtues of the female condom according to proponents, is that it enhances women’s autonomy in negotiating the terms of sexual relations, and thus contributes to the empowerment and rights of women [ 30 , 31 ]. Though potentially significant, the degree to which access to the female condom helps secure this right to autonomy is hard to quantify. Rather than either ignoring right-based imperatives on the one hand, or insisting that these values trump “mere” efficiency concerns on the other hand, we performed an analysis which solved for the value that would need to be placed on the incremental empowerment of women, such that investments in the female condom over the male condom would be justified. Table 1 illustrates the health consequences of promoting the female condom over the male condom in high-prevalence HIV countries. The figures are the results of a cost-effectiveness model that assumes the full costs of $0.13 for the male condom and $1.00 for the female condom. This is a low estimate of the cost of the female condom and the results displayed are therefore likely tilted in favor of the female condom. The model incorporates information on HIV transmission risk per episode; protective benefits of both types of condoms; sexual behavioral data on three sub-populations, sex workers, women with regular partners and women with casual partners; rates of substitution between male and female condoms; and other parameters affecting the cost of generating an incremental protected sexual episode.

The key finding is that for every $100,000 spent on condoms in an African country with high HIV prevalence, between 92 and 118 additional cases of HIV could be averted by investing in the male condom rather than the female condom. If one believes in the power of the female condom to enhance women’s rights, one might want to argue that this is a price worth paying. It would be an example of what Johri terms “the opportunity cost of equity” [ 15 ]. However, in the context of the female condom it seems a difficult case to make, particularly if one is concerned about the rights and health, of those 92–118 additionally infected people, many of whom will be women. Article 25 of the United Nations Universal Declaration of Human Rights guarantees access to adequate medical care for all persons [ 32 ]. Similar language exists in Articles 12 and14 of the Convention on the Elimination of All Forms of Discrimination Against Women, and Article 12 of the International Covenant on Economic, Social and Cultural Rights [ 33 , 34 ]. These legal and moral principles are not superseded by utilitarian values. But the full realization of these rights-based values will, for the foreseeable future be imperfect given health care budgets and other constraints. Therefore, efficiency concerns as expressed in utilitarianism and cost-effectiveness analysis will often be the best guide to rapidly securing those rights for as many people as possible. However, this can only be accomplished when decision makers acknowledge that the trade-offs of the type illustrated in the female condom example are real and consequential.

When competing ethical principles favor different actions, following non-efficiency based principles may increase mortality or morbidity. It is true that a small fraction of what the world spends on armaments and on ultra-luxurious or frivolous pursuits could, if re-deployed, have huge global health benefits. But this information is of no use to the Minister of Health in a low-income country as she decides what portion of her budget should be allocated to TB drugs, versus bed nets to control malaria.

Conclusions

The long-term social and political project of re-directing resources away from activities that undermine human flourishing and toward those that are conducive, is one of the most urgent of our era. However, for any meaningful time horizon there will be insufficient money to pursue all beneficial activities. Trade-offs, and the problems of resource allocation will therefore persist. Utilitarianism will usually be the most reliable guide in resolving those trade-offs.

Once the domain of philosophers and ethicists, “Trolleyology” is now widely discussed in the popular press. This may be in part because the types of fanciful situations concocted in the original trolley problems are now similar to actual dilemmas that must be addressed by those writing the software governing autonomous vehicles.

Abbreviations

Cost-benefit analysis

Cost-effectiveness analysis

Human Immunodeficiency Virus

Pre-Exposure Prophylaxis

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EAM is principal of the firm, Health Strategies International, that specializes in the economic evaluation of both global and domestic public health programs. Trained in health policy analysis, Dr. Marseille has over 30 years of senior public health management and research experience with a focus on the empirical and modeled assessment of the cost and cost-effectiveness of programs, and policies related to HIV/AIDS and other diseases relevant to global health. JGK is Emeritus Professor at the Philip R. Lee Institute for Health Policy Studies, the Institute for Global Health Sciences, and the Department of Epidemiology and Biostatistics, all at UCSF. Dr. Kahn is an expert in cost-effectiveness analysis, evidence-based medicine, and policy modeling in health care. His work focuses on the use of cost-effectiveness analysis to inform decision-making in public health and medicine. He is a widely published expert in the economic assessment of HIV prevention and treatment programs and on a wide range of other global health issues.

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Marseille, E., Kahn, J.G. Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health. Philos Ethics Humanit Med 14 , 5 (2019). https://doi.org/10.1186/s13010-019-0074-7

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Introduction

Basic concepts

Methodologies.

Antecedents of utilitarianism among the ancients
Growth of classical English utilitarianism
Utilitarianism since the late 19th century
Effects of utilitarianism in other fields
Summary and evaluation

utilitarianism

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utilitarianism , in normative ethics , a tradition stemming from the late 18th- and 19th-century English philosophers and economists Jeremy Bentham and John Stuart Mill according to which an action (or type of action) is right if it tends to promote happiness or pleasure and wrong if it tends to produce unhappiness or pain—not just for the performer of the action but also for everyone else affected by it. Utilitarianism is a species of consequentialism , the general doctrine in ethics that actions (or types of action) should be evaluated on the basis of their consequences. Utilitarianism and other consequentialist theories are in opposition to egoism , the view that each person should pursue his or her own self-interest, even at the expense of others, and to any ethical theory that regards some actions (or types of action) as right or wrong independently of their consequences ( see deontological ethics ). Utilitarianism also differs from ethical theories that make the rightness or wrongness of an action dependent upon the motive of the agent—for, according to the utilitarian, it is possible for the right thing to be done from a bad motive. Utilitarians may, however, distinguish the aptness of praising or blaming an agent from whether the action was right.

(Read Peter Singer’s Britannica entry on ethics.)

The nature of utilitarianism

Utilitarianism is an effort to provide an answer to the practical question “What ought a person to do?” The answer is that a person ought to act so as to maximize happiness or pleasure and to minimize unhappiness or pain.

In the notion of consequences the utilitarian includes all of the good and bad produced by the action, whether arising after the action has been performed or during its performance. If the difference in the consequences of alternative actions is not great, some utilitarians would not regard the choice between them as a moral issue. According to Mill, acts should be classified as morally right or wrong only if the consequences are of such significance that a person would wish to see the agent compelled, not merely persuaded and exhorted, to act in the preferred manner.

In assessing the consequences of actions, utilitarianism relies upon some theory of intrinsic value : something is held to be good in itself, apart from further consequences, and all other values are believed to derive their worth from their relation to this intrinsic good as a means to an end. Bentham and Mill were hedonists ; i.e, they analyzed happiness as a balance of pleasure over pain and believed that these feelings alone are of intrinsic value and disvalue. Utilitarians also assume that it is possible to compare the intrinsic values produced by two alternative actions and to estimate which would have better consequences. Bentham believed that a hedonic calculus is theoretically possible. A moralist, he maintained, could sum up the units of pleasure and the units of pain for everyone likely to be affected, immediately and in the future, and could take the balance as a measure of the overall good or evil tendency of an action. Such precise measurement as Bentham envisioned is perhaps not essential, but it is nonetheless necessary for the utilitarian to make some interpersonal comparisons of the values of the effects of alternative courses of action.

As a normative system providing a standard by which an individual ought to act and by which the existing practices of society, including its moral code, ought to be evaluated and improved, utilitarianism cannot be verified or confirmed in the way in which a descriptive theory can, but it is not regarded by its exponents as simply arbitrary. Bentham believed that only in terms of a utilitarian interpretation do words such as “ought,” “right,” and “wrong” have meaning and that, whenever people attempt to combat the principle of utility , they do so with reasons drawn from the principle itself. Bentham and Mill both believed that human actions are motivated entirely by pleasure and pain, and Mill saw that motivation as a basis for the argument that, since happiness is the sole end of human action, the promotion of happiness is the test by which to judge all human conduct.

One of the leading utilitarians of the late 19th century, the Cambridge philosopher Henry Sidgwick , rejected such theories of motivation as well as Bentham’s theory of the meaning of moral terms and sought to support utilitarianism by showing that it follows from systematic reflection on the morality of “ common sense .” Most of the requirements of commonsense morality , he argued, could be based upon utilitarian considerations. In addition, he reasoned that utilitarianism could solve the difficulties and perplexities that arise from the vagueness and inconsistencies of commonsense doctrines.

Most opponents of utilitarianism have held that it has implications contrary to their moral intuitions—that considerations of utility, for example, might sometimes sanction the breaking of a promise. Much of the defense of utilitarian ethics has consisted in answering these objections, either by showing that utilitarianism does not have the implications that its opponents claim it has or by arguing against the opponents’ moral intuitions . Some utilitarians, however, have sought to modify the utilitarian theory to accommodate the objections.

One such criticism is that, although the widespread practice of lying and stealing would have bad consequences, resulting in a loss of trustworthiness and security, it is not certain that an occasional lie to avoid embarrassment or an occasional theft from a rich person would not have good consequences and thus be permissible or even required by utilitarianism. But the utilitarian readily answers that the widespread practice of such acts would result in a loss of trustworthiness and security. To meet the objection to not permitting an occasional lie or theft, some philosophers have defended a modification labelled “ rule ” utilitarianism. It permits a particular act on a particular occasion to be adjudged right or wrong according to whether it is in keeping with or in violation of a useful rule, and a rule is judged useful or not by the consequences of its general practice . Mill has sometimes been interpreted as a “rule” utilitarian, whereas Bentham and Sidgwick were “ act” utilitarians.

Another objection, often posed against the hedonistic value theory held by Bentham, holds that the value of life is more than a balance of pleasure over pain. Mill, in contrast to Bentham, discerned differences in the quality of pleasures that make some intrinsically preferable to others independently of intensity and duration (the quantitative dimensions recognized by Bentham). Some philosophers in the utilitarian tradition have recognized certain wholly nonhedonistic values without losing their utilitarian credentials. Thus, the English philosopher G.E. Moore , one of the founders of contemporary analytic philosophy , regarded many kinds of consciousness —including friendship, knowledge, and the experience of beauty—as intrinsically valuable independently of pleasure, a position labelled “ ideal ” utilitarianism. Even in limiting the recognition of intrinsic value and disvalue to happiness and unhappiness, some philosophers have argued that those feelings cannot adequately be further broken down into terms of pleasure and pain and have thus preferred to defend the theory in terms of maximizing happiness and minimizing unhappiness. It is important to note, however, that, even for the hedonistic utilitarians, pleasure and pain are not thought of in purely sensual terms; pleasure and pain for them can be components of experiences of all sorts. Their claim is that, if an experience is neither pleasurable nor painful, then it is a matter of indifference and has no intrinsic value.

Another objection to utilitarianism is that the prevention or elimination of suffering should take precedence over any alternative act that would only increase the happiness of someone already happy. Some modern utilitarians have modified their theory to require this focus or even to limit moral obligation to the prevention or elimination of suffering—a view labelled “negative” utilitarianism.

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3.2: Utilitarianism- The Greater Good

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Learning Objectives

Define utilitarian ethics.
Show how utilitarianism works in business.
Distinguish forms of utilitarianism.
Consider advantages and drawbacks of utilitarianism.

The College Board and Karen Dillard

“Have you seen,” the blog post reads, “their parking lot on a Saturday?” “CB-Karen Dillard Case Settled-No Cancelled Scores,” College Confidential, accessed May 15, 2011, http://talk.collegeconfidential.com/parents-forum/501843-cb-karen-dillard-case-settled-no-cancelled-scores.html . It’s packed. The lot belongs to Karen Dillard College Prep (KDCP), a test-preparation company in Dallas. Like the Princeton Review, they offer high schoolers courses designed to boost performance on the SAT. Very little real learning goes on in these classrooms; they’re more about techniques and tricks for maximizing scores. Test takers should know, for example, whether a test penalizes incorrect answers. If it doesn’t, you should take a few minutes at each section’s end to go through and just fill in a random bubble for all the questions you couldn’t reach so you’ll get some cheap points. If there is a penalty, though, then you should use your time to patiently work forward as far as you can go. Knowing the right strategy here can significantly boost your score. It’s a waste of brain space, though, for anything else in your life.

Some participants in KDCP—who paid as much as $2,300 for the lessons—definitely got some score boosting for their money. It was unfair boosting, however; at least that’s the charge of the College Board, the company that produces and administers the SAT.

Here’s what happened. A KDCP employee’s brother was a high school principal, and he was there when the SATs were administered. At the end of those tests, everyone knows what test takers are instructed to do: stack the bubble sheets in one pile and the test booklets in the other and leave. The administrators then wrap everything up and send both the answer sheets and the booklets back to the College Board for scoring. The principal, though, was pulling a few test booklets out of the stack and sending them over to his brother’s company, KDCP. As it turns out, some of these pilfered tests were “live”—that is, sections of them were going to be used again in future tests. Now, you can see how getting a look at those booklets would be helpful for someone taking those future tests.

Other stolen booklets had been “retired,” meaning the specific questions inside were on their final application the day the principal grabbed them. So at least in these cases, students taking the test-prep course couldn’t count on seeing the very same questions come exam day. Even so, the College Board didn’t like this theft much better because they sell those retired tests to prep companies for good money.

When the College Board discovered the light-fingered principal and the KDCP advantage, they launched a lawsuit for infringement of copyright. Probably figuring they had nothing to lose, KDCP sued back. Paulina Mis, “College Board Sues Test-Prep Company, Countersuit Filed,” Scholarships.com, February 26, 2008, accessed May 15, 2011, http://www.scholarships.com/blog/high-school/college-board-sues-test-prep-company-countersuit-filed/161 .

College Board also threatened—and this is what produced headlines in the local newspaper—to cancel the scores of the students who they determined had received an unfair advantage from the KDCP course. As Denton Record-Chronicle reported (and as you can imagine), the students and their families freaked out.Staci Hupp, “SAT Scores for Students Who Used Test Prep Firm May Be Thrown Out,” Denton Record Chronicle , February 22, 2008, accessed May 15, 2011. The scores and full application packages had already been delivered to colleges across the country, and score cancellation would have amounted to application cancellation. And since many of the students applied only to schools requiring the SAT, the threat amounted to at least temporary college cancellation. “I hope the College Board thinks this through,” said David Miller, a Plano attorney whose son was apparently on the blacklist. “If they have a problem with Karen Dillard, that’s one thing. But I hope they don’t punish kids who wanted to work hard.”

Predictably, the episode crescendoed with everyone lawyered up and suits threatened in all directions. In the end, the scores weren’t canceled. KDCP accepted a settlement calling for them to pay $600,000 directly to the College Board and provide $400,000 in free classes for high schoolers who’d otherwise be unable to afford the service. As for the principal who’d been lifting the test booklets, he got to keep his job, which pays about $87,000 a year. The CEO of College Board, by the way, gets around $830,000. “AETR Report Card,” Americans for Educational Testing Reform, accessed May 15, 2011, www.aetr.org/college-board.php. KDCP is a private company, so we don’t know how much Karen Dillard or her employees make. We do know they could absorb a million-dollar lawsuit without going into bankruptcy. Finally, the Plano school district in Texas—a well-to-do suburb north of Dallas—continues to produce some of the nation’s highest SAT score averages.

One Thief, Three Verdicts

Utilitarianism is a consequentialist ethics—the outcome matters, not the act. Among those who focus on outcomes, the utilitarians’ distinguishing belief is that we should pursue the greatest good for the greatest number . So we can act in whatever way we choose—we can be generous or miserly, honest or dishonest—but whatever we do, to get the utilitarian’s approval, the result should be more people happier. If that is the result, then the utilitarian needs to know nothing more to label the act ethically recommendable. (Note: Utility is a general term for usefulness and benefit, thus the theory’s name. In everyday language, however, we don’t talk about creating a greater utility but instead a greater good or happiness.)

In rudimentary terms, utilitarianism is a happiness calculation. When you’re considering doing something, you take each person who’ll be affected and ask whether they’ll end up happier, sadder, or it won’t make any difference. Now, those who won’t change don’t need to be counted. Next, for each person who’s happier, ask, how much happier? Put that amount on one side. For each who’s sadder, ask, how much sadder? That amount goes on the other side. Finally, add up each column and the greater sum indicates the ethically recommendable decision.

Utilitarian ethics function especially well in cases like this: You’re on the way to take the SAT, which will determine how the college application process goes (and, it feels like, more or less your entire life). Your car breaks down and you get there very late and the monitor is closing the door and you remember that…you forgot your required number 2 pencils. On a desk in the hall you notice a pencil. It’s gnawed and abandoned but not yours. Do you steal it? Someone who believes it’s an ethical duty to not steal will hesitate. But if you’re a utilitarian you’ll ask: Does taking it serve the greater good? It definitely helps you a lot, so there’s positive happiness accumulated on that side. What about the victim? Probably whoever owns it doesn’t care too much. Might not even notice it’s gone. Regardless, if you put your increased happiness on one side and weigh it against the victim’s hurt on the other, the end result is almost certainly a net happiness gain. So with a clean conscience you grab it and dash into the testing room. According to utilitarian reasoning, you’ve done the right thing ethically (assuming the pencil’s true owner isn’t coming up behind you in the same predicament).

Pushing this theory into the KDCP case, one tense ethical location is the principal lifting test booklets and sending them over to his brother at the test-prep center. Everything begins with a theft. The booklets do in fact belong to the College Board; they’re sent around for schools to use during testing and are meant to be returned afterward. So here there’s already the possibility of stopping and concluding that the principal’s act is wrong simply because stealing is wrong. Utilitarians, however, don’t want to move so quickly. They want to see the outcome before making an ethical judgment. On that front, there are two distinct outcomes: one covering the live tests, and the other the retired ones.

Live tests were those with sections that may appear again. When students at KDCP received them for practice, they were essentially receiving cheat sheets. Now for a utilitarian, the question is, does the situation serve the general good? When the testing’s done, the scores are reported, and the college admissions decisions made, will there be more overall happiness then there would’ve been had the tests not been stolen? It seems like the answer has to be no. Obviously those with great scores will be smiling, but many, many others will see their scores drop (since SATs are graded on a curve, or as a percentile). So there’s some major happiness for a few on one side balanced by unhappiness for many on the other. Then things get worse. When the cheating gets revealed, the vast majority of test takers who didn’t get the edge are going to be irritated, mad, or furious. Their parents too. Remember, it’s not only admission that’s at stake here but also financial aid, so the students who didn’t get the KDCP edge worry not only that maybe they should’ve gotten into a better school but also that they end up paying more too. Finally, the colleges will register a net loss: all their work in trying to admit students on the basis of fair, equal evaluations gets thrown into question.

Conclusion. The theft of live tests fails the utilitarian test. While a few students may come out better off and happier, the vast majority more than balances the effect with disappointment and anger. The greater good isn’t served.

In the case of the theft of “retired” tests where the principal forwarded to KDCP test questions that won’t reappear on future exams, it remains true that the tests were lifted from the College Board and it remains true that students who took the KDCP prep course will receive an advantage because they’re practicing the SAT. But the advantage doesn’t seem any greater than the one enjoyed by students all around the nation who purchased prep materials directly from the College Board and practiced for the exam by taking old tests. More—and this was a point KDCP made in their countersuit against the College Board—stealing the exams was the ethically right thing to do because it assured that students taking the KDCP prep course got the same level of practice and expertise as those using official College Board materials. If the tests hadn’t been stolen, then wouldn’t KDCP kids be at an unfair disadvantage when compared with others because their test practices hadn’t been as close to the real thing as others got? In the end, the argument goes, stealing the tests assured that as many people as possible who took prep courses got to practice on real exams.

Conclusion. The theft of the exams by the high school principal may conceivably be congratulated by a utilitarian because it increases general happiness. The students who practiced on old exams purchased from the College Board can’t complain. And as for those students at KDCP, their happiness increases since they can be confident that they’ve prepared as well as possible for the SAT.

The fact that a utilitarian argument can be used to justify the theft of test booklets, at least retired ones, doesn’t end the debate, however. Since the focus is on outcomes, all of them have to be considered. And one outcome that might occur if the theft is allowed is, obviously, that maybe other people will start thinking stealing exam books isn’t such a bad idea. If they do—if everyone decides to start stealing—it’s hard to see how anything could follow but chaos, anger, and definitely not happiness.

This discussion could continue as more people and consequences are factored in, but what won’t change is the basic utilitarian rule. What ought to be done is determined by looking at the big picture and deciding which acts increase total happiness at the end of the day when everyone is taken into account.

Should the Scores Be Canceled?

After it was discovered that KDCP students got to practice for the SATs with live exams, the hardest question facing the College Board was, should their scores be canceled? The utilitarian argument for not canceling is straightforward. Those with no scores may not go to college at all next year. This is real suffering, and if your aim is to increase happiness, then counting the exams is one step in that direction. It’s not the last step, though, because utilitarians at the College Board need to ask about everyone else’s happiness too: what’s the situation for all the others who took the exam but have never heard of KDCP? Unfortunately, letting the scores be counted is going to subtract from their happiness because the SAT is graded comparatively: one person doing well means everyone getting fewer correct answers sees their score drop, along with college choices and financial aid possibilities. Certainly it’s true that each of these decreases will be small since there were only a handful of suspect tests. Still, a descent, no matter how tiny, is a descent, and all the little bits add up.

What’s most notable, finally, about this decision is the imbalance. Including the scores of KDCP students will weigh a tremendous increase in happiness for a very few against a slight decrease for very many. Conversely, a few will be left very sad, and many slightly happier. So for a utilitarian, which is it? It’s hard to say. It is clear, however, that this uncertainty represents a serious practical problem with the ethical theory. In some situations you can imagine yourself in the shoes of the different people involved and, using your own experience and knowledge, estimate which decision will yield the most total happiness. In this situation, though, it seems almost impossible because there are so many people mixed up in the question.

Then things get still more difficult. For the utilitarian, it’s not enough to just decide what brings the most happiness to the most individuals right now; the future needs to be accounted for too. Utilitarianism is a true global ethics ; you’re required to weigh everyone’s happiness and weigh it as best as you can as far into the future as possible. So if the deciders at the College Board follow a utilitarian route in opting to include (or cancel) the scores, they need to ask themselves—if we do, how will things be in ten years? In fifty? Again, these are hard questions but they don’t change anything fundamental. For the utilitarian, making the right decision continues to be about attempting to predict which choice will maximize happiness.

Utilitarianism and the Ethics of Salaries

When he wasn’t stealing test booklets and passing them on to KDCP, the principal in the elite Plano school district was dedicated to his main job: making sure students in his building receive an education qualifying them to do college-level work. Over at the College Board, the company’s CEO leads a complementary effort: producing tests to measure the quality of that preparation and consequently determine students’ scholastic aptitude. The principal, in other words, is paid to make sure high schoolers get an excellent education, and the CEO is paid to measure how excellent (or not) the education is.

Just from the job descriptions, who should get the higher salary? It’s tempting to say the principal. Doesn’t educating children have to be more important than measuring how well they’re educated? Wouldn’t we all rather be well educated and not know it than poorly educated and painfully aware of the fact?

Regardless, what’s striking about the salary that each of these two actually receives isn’t who gets more; it’s how much. The difference is almost ten times: $87,000 for the principal versus the CEO’s $830,000. Within the doctrine of utilitarianism, can such a divergence be justified?

Yes, but only if we can show that this particular salary structure brings about the greatest good, the highest level of happiness for everyone considered as a collective. It may be, for example, that objectively measuring student ability, even though it’s less important than instilling ability, is also much harder. In that case, a dramatically higher salary may be necessary in order to lure high-quality measuring talent. From there, it’s not difficult to fill out a utilitarian justification for the pay divergence. It could be that inaccurate testing would cause large amounts of unhappiness: students who worked hard for years would be frustrated when they were bettered by slackers who really didn’t know much but managed to score well on a test.

To broaden the point, if tremendous disparities in salary end up making people happier, then the disparities are ethical. Period. If they don’t, however, then they can no longer be defended. This differs from what a libertarian rights theorist might say here. For a libertarian—someone who believes individuals have an undeniable right to make and keep whatever they can in the world, regardless of how rich or poor anyone else may be—the response to the CEO’s mammoth salary is that he found a way to earn it fair and square, and everyone should quit complaining about it. Generalized happiness doesn’t matter, only the individual’s right to try to earn and keep as much as he or she can.

Can Money Buy Utilitarian Happiness? The Ford Pinto Case

Basic questions in business tend to be quantitative, and money is frequently the bottom line: How many dollars is it worth? What’s my salary? What’s the company’s profit? The basic question of utilitarianism is qualitative: how much happiness and sadness is there? Inevitably, it’s going to be difficult when businesses accustomed to bottom-line number decisions are forced to cross over and decide about general happiness. One of the most famous attempts to make the transition easier occurred back in the 1970s.

With gas prices on the rise, American car buyers were looking for smaller, more efficient models than Detroit was manufacturing. Japanese automakers were experts in just those kinds of vehicles and they were seizing market share at an alarming rate. Lee Iaccoca, Ford’s president, wanted to rush a car into production to compete. His model was the Pinto.Case facts taken from Manuel Velasquez, Business Ethics, Concepts and Cases , 6th ed. (Upper Saddle River, NJ: Pearson Prentice Hall, 2006), 60–61.

A gas sipper slated to cost $2,000 (about $12,000 today), Ford rushed the machine through early production and testing. Along the way, unfortunately, they noticed a design problem: the gas tank’s positioning in the car’s rump left it vulnerable to rear-end collisions. In fact, when the rear-end hit came faster than twenty miles per hour, not only might the tank break, but gasoline could be splattered all the way up to the driver’s compartment. Fire, that meant, ignited by sparks or anything else could engulf those inside.

No car is perfectly safe, but this very scary vulnerability raised eyebrows. At Ford, a debate erupted about going ahead with the vehicle. On the legal end, the company stood on solid ground: government regulation at the time only required gas tanks to remain intact at collisions under twenty miles per hour. What about the ethics, though? The question about whether it was right to charge forward was unavoidable because rear-end accidents at speeds greater than twenty miles per hour happen—every day.

The decision was finally made in utilitarian terms. On one side, the company totaled up the dollar cost of redesigning the car’s gas tank. They calculated

12.5 million automobiles would eventually be sold,
eleven dollars would be the final cost per car to implement the redesign.

Added up, that’s $137 million total, with the money coming out of Pinto buyers’ pockets since the added production costs would get tacked onto the price tag. It’s a big number but it’s not that much per person: $11 is about $70 today. In this way, the Pinto situation faced by Ford executives is similar to the test cancellation question for the College Board: one option means only a little bit of suffering for specific individuals, but there are a lot of them.

On the other side of the Pinto question—and, again, this resembles the College Board predicament—if the decision is made to go ahead without the fix, there’s going to be a lot of suffering but only for a very few people. Ford predicted the damage done to those few people in the following ways:

Death by burning for 180 buyers
Serious burn injuries for another 180 buyers
Twenty-one hundred vehicles burned beyond all repair

That’s a lot of damage, but how do you measure it? How do you compare it with the hike in the price tag? More generally, from a utilitarian perspective, is it better for a lot of people to suffer a little or for a few people to suffer a lot?

Ford answered both questions by directly attaching monetary values to each of the injuries and damages suffered:

At the time, 1970, US Government regulatory agencies officially valued a human life at $200,000. (That would be about $1.2 million today if the government still kept this problematic measure.)
Insurance companies valued a serious burn at $67,000.
The average resale value on subcompacts like the Pinto was $700, which set that as the amount lost after a complete burnout.

The math coming out from this is (180 deaths × $200,000) + (180 injuries × $67,000) + (2,100 burned-out cars × $700) = $49 million. The result here is $137 million worth of suffering for Pinto drivers if the car is redesigned and only $49 million if it goes to the streets as is.

Ford sent the Pinto out. Over the next decade, according to Ford estimates, at least 60 people died in fiery accidents and at least 120 got seriously burned (skin-graft-level burns). No attempt was made to calculate the total number of burned vehicles. Shortly thereafter, the Pinto was phased out. No one has final numbers, but if the first decade is any indication, then the total cost came in under the original $49 million estimate. According to a utilitarian argument, and assuming the premises concerning dollar values are accepted, Ford made the right decision back in 1970.

If every Pinto purchaser had been approached the day after buying the car, told the whole Ford story, and been offered to change their car along with eleven dollars for another one without the gas tank problem, how many would’ve handed the money over to avoid the long-shot risk? The number might’ve been very high, but that doesn’t sway a utilitarian conclusion. The theory demands that decision makers stubbornly keep their eye on overall happiness no matter how much pain a decision might cause certain individuals.

Versions of Utilitarian Happiness

Monetized utilitarianism attempts to measure happiness, to the extent possible, in terms of money. As the Ford Pinto case demonstrated, the advantage here is that it allows decisions about the greater good to be made in clear, objective terms. You add up the money on one side and the money on the other and the decision follows automatically. This is a very attractive benefit, especially when you’re dealing with large numbers of individuals or complex situations. Monetized utilitarianism allows you to keep your happiness calculations straight.

Two further varieties of utilitarianism are hedonistic and idealistic . Both seek to maximize human happiness, but their definitions of happiness differ. Hedonistic utilitarians trace back to Jeremy Bentham (England, around 1800). Bentham was a wealthy and odd man who left his fortune to the University College of London along with the stipulation that his mummified body be dressed and present at the institution. It remains there today. He sits in a wooden cabinet in the main building, though his head has been replaced by a wax model after pranking students repeatedly stole the real one. Bentham believed that pleasure and happiness are ultimately synonymous. Ethics, this means, seeks to maximize the pleasures—just about any sensation of pleasure—felt by individuals. But before dropping everything and heading out to the bars, it should be remembered that even the most hedonistic of the utilitarians believe that getting pleasure right now is good but not as good as maximizing the feeling over the long term . (Going out for drinks, in others words, instead of going to the library isn’t recommendable on the evening before midterms.)

A contemporary of Bentham, John Stuart Mill, basically agreed that ethics is about maximizing pleasure, but his more idealistic utilitarianism distinguished low and highbrow sensations. The kinds of raw, good feelings that both we and animals can find, according to Mill, are second-rate pleasures. Pleasures with higher and more real value include learning and learnedness. These aren’t physical joys so much as the delights of the mind and the imagination. For Mill, consequently, libraries and museums are scenes of abundant pleasure, much more than any bar.

This idealistic notion of utilitarianism fits quite well with the College Board’s response to the KDCP episode. First, deciding against canceling student scores seems like a way of keeping people on track to college and headed toward the kind of learning that rewards our cerebral inclinations. Further, awarding free prep classes to those unable to pay seems like another step in that direction, at least if it helps get them into college.

Versions of Utilitarian Regulation

A narrow distinction with far-reaching effects divides soft from hard utilitarianism. Soft utilitarianism is the standard version; when people talk about a utilitarian ethics, that’s generally what they mean. As a theory, soft utilitarianism is pretty laid back: an act is good if the outcome is more happiness in the world than we had before. Hard utilitarianism , on the other hand, demands more: an act is ethically recommendable only if the total benefits for everyone are greater than those produced by any other act .

According to the hard version, it’s not enough to do good; you must do the most good possible. As an example, think about the test-prep company KDCP under the microscope of utilitarian examination.

When a soft utilitarian looks at KDCP, the company comes out just fine. High schoolers are learning test-taking skills and tricks that they’ll only use once but will help in achieving a better score and leave behind a sense that they’ve done all they can to reach their college goals. That means the general happiness level probably goes up—or at worst holds steady—because places like KDCP are out there.
When a hard utilitarian looks at KDCP, however, the company doesn’t come off so well. Can we really say that this enterprise’s educational subject—test taking—is the very best use of teaching resources in terms of general welfare and happiness? And what about the money? Is SAT prep really the best way for society to spend its dollars? Wouldn’t a hard utilitarian have to recommend that the tuition money collected by the test-prep company get siphoned off to pay for, say, college tuition for students who otherwise wouldn’t be able to continue their studies at all?

If decisions about businesses are totally governed by the need to create the most happiness possible, then companies like KDCP that don’t contribute much to social well-being will quickly become endangered.

The demands of hard utilitarianism can be layered onto the ethical decision faced by the College Board in their courtroom battle with KDCP. Ultimately, the College Board opted to penalize the test-prep company by forcing it to offer some free classes for underprivileged students. Probably, the result was a bit more happiness in the world. The result wasn’t , however, the most happiness possible. If hard utilitarianism had driven the decision, then the College Board would’ve been forced to go for the jugular against KDCP, strip away all the money they could, and then use it to do the most good possible, which might have meant setting up a scholarship fund or something similar. That’s just a start, though. Next, to be true to hard utilitarianism , the College Board would need to focus on itself with hard questions. The costs of creating and applying tests including the SAT are tremendous, which makes it difficult to avoid this question: wouldn’t society as a whole be better off if the College Board were to be canceled and all their resources dedicated to, for example, creating a new university for students with learning disabilities?

Going beyond KDCP and the College Board, wouldn’t almost any private company fall under the threat of appropriation if hard utilitarians ran the world? While it’s true, for example, that the money spent on steak and wine at expensive Las Vegas restaurants probably increases happiness a bit, couldn’t that same cash do a lot more for the general welfare of people whose income makes Las Vegas an impossibly expensive dream? If it could, then the hard utilitarian will propose zipping up Las Vegas and rededicating the money.

Finally, since utilitarianism is about everyone’s total happiness, don’t hard questions start coming up about world conditions? Is it possible to defend the existence of McDonald’s in the United States while people are starving in other countries?

Conclusion. In theory, there’s not much divergence between soft and hard utilitarianism. But in terms of what actually happens out in the world when the theory gets applied, that’s a big difference. For private companies, it’s also a dangerous one.

Two further versions of utilitarian regulation are act and rule . Act utilitarianism affirms that a specific action is recommended if it increases happiness. This is the default form of utilitarianism, and what people usually mean when they talk about the theory. The separate rule-based version asserts that an action is morally right if it follows a rule that, when applied to everyone, increases general happiness.

The rule utilitarian asks whether we’d all be benefitted if everyone obeyed a rule such as “don’t steal.” If we would—if the general happiness level increases because the rule is there—then the rule utilitarian proposes that we all adhere to it. It’s important to note that rule utilitarians aren’t against stealing because it’s intrinsically wrong, as duty theorists may propose. The rule utilitarian is only against stealing if it makes the world less happy. If tomorrow it turns out that mass stealing serves the general good, then theft becomes the ethically right thing to do.

The sticky point for rule utilitarians involves special cases. If we make the rule that theft is wrong, consider what happens in the case from the chapter’s beginning: You forgot your pencil on SAT test day, and you spot one lying on an abandoned desk. If you don’t take it, no one’s going to be any happier, but you’ll be a lot sadder. So it seems like rule utilitarianism verges on defeating its own purpose, which is maximizing happiness no matter what.

On the other hand, there are also sticky points for act utilitarians. For example, if I go to Walmart tonight and steal a six-pack of beer, I’ll be pretty happy. And assuming I don’t get caught, no one will be any sadder. The loss to the company—a few dollars—will disappear in a balance sheet so huge that it’s hard to count the zeros. Of course if everyone starts stealing beers, that will cause a problem, but in practical terms, if one person does it once and gets away with it, it seems like an act utilitarian would have to approve. The world would be a happier place.

Advantages and Disadvantages of Utilitarian Ethics in Business

Basic utilitarianism is the soft, act version. These are the theory’s central advantages:

Clarity and simplicity. In general terms, it’s easy to understand the idea that we should all act to increase the general welfare.
Acceptability. The idea of bringing the greatest good to the greatest number coheres with common and popular ideas about what ethical guidance is supposed to provide.
Flexibility. The weighing of individual actions in terms of their consequences allows for meaningful and firm ethical rules without requiring that everyone be treated identically no matter how different the particular situation. So the students whose scores were suspended by the College Board could see them reinstated, but that doesn’t mean the College Board will take the same action in the future (if, say, large numbers of people start stealing test booklets).
Breadth. The focus on outcomes as registered by society overall makes the theory attractive for those interested in public policy. Utilitarianism provides a foundation and guidance for business regulation by government.

The central difficulties and disadvantages of utilitarianism include the following:

Subjectivity. It can be hard to make the theory work because it’s difficult to know what makes happiness and unhappiness for specific individuals. When the College Board demanded that KDCP give free classes to underprivileged high schoolers, some paying students were probably happy to hear the news, but others probably fretted about paying for what others received free. And among those who received the classes, probably the amount of resulting happiness varied between them.
Quantification. Happiness can’t be measured with a ruler or weighed on a scale; it’s hard to know exactly how much happiness and unhappiness any particular act produces. This translates into confusion at decision time. (Monetized utilitarianism, like that exhibited in the case of the Ford Pinto, responds to this confusion.)
Apparent injustices. Utilitarian principles can produce specific decisions that seem wrong. A quick example is the dying grandmother who informs her son that she’s got $200,000 stuffed into her mattress. She asks the son to divide the money with his brother. This brother, however, is a gambling alcoholic who’ll quickly fritter away his share. In that case, the utilitarian would recommend that the other brother—the responsible one with children to put through college—just keep all the money. That would produce the most happiness, but do we really want to deny grandma her last wish?
The utilitarian monster is a hypothetical individual who really knows how to feel good. Imagine that someone or a certain group of people were found to have a much greater capacity to experience happiness than others. In that case, the strict utilitarian would have no choice but to put everyone else to work producing luxuries and other pleasures for these select individuals. In this hypothetical situation, there could even be an argument for forced labor as long as it could be shown that the servants’ suffering was minor compared to the great joy celebrated by those few who were served. Shifting this into economic and business terms, there’s a potential utilitarian argument here for vast wage disparities in the workplace.
The utilitarian sacrifice is the selection of one person to suffer terribly so that others may be pleasured. Think of gladiatorial games in which a few contestants suffer miserably, but a tremendous number of spectators enjoy the thrill of the contest. Moving the same point from entertainment into the business of medical research, there’s a utilitarian argument here for drafting individuals—even against their will—to endure horrifying medical experiments if it could be shown that the experiments would, say, cure cancer, and so create tremendous happiness in the future.

Key Takeaways

Utilitarianism judges specific decisions by examining the decision’s consequences.
Utilitarianism defines right and wrong in terms of the happiness of a society’s members.
Utilitarian ethics defines an act as good when its consequences bring the greatest good or happiness to the greatest number of people.
There are a variety of specific forms of utilitarianism.
Theoretically, utilitarianism is straightforward, but in practical terms it can be difficult to measure the happiness of individuals.

Exercise $\PageIndex{1}$

What is a utilitarian argument in favor of a college education? How does it differ from other reasons you might want to go to college or graduate school?
How could a utilitarian justify cheating on an exam?
What is a “global ethics”?
What practical problem with utilitarianism is (to some degree) resolved by monetized utilitarianism?
What are two advantages of a utilitarian ethics when compared with an ethics of duties?
What are two disadvantages of a utilitarian ethics when compared with an ethics of duties?
What’s an example from today’s world of a utilitarian monster?
What’s an example from today’s world of a utilitarian sacrifice?

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5 Utilitarianism: Theory and Applications

Published: October 2002
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Utilitarianism is a comprehensive doctrine claiming that the greatest amount of happiness is an end that should exclusively guide all actions of both government and individuals. The fact that people value the happiness of those close to them more than that of strangers makes utilitarianism personally unacceptable to many, but it may still be a proper principle for government, given some overriding respect for individual rights. There are, however, basic problems concerning the value of life, and the treatment of future people and foreigners. The conventional discounting of future incomes does not imply that the utility of future people is discounted. The state's primary responsibility is to its own citizens, but it should not treat aliens as mere instruments for the welfare of citizens.

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Utilitarianism

Utilitarianism is an ethical theory that asserts that right and wrong are best determined by focusing on outcomes of actions and choices.

Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of consequentialism.

Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number. It is the only moral framework that can be used to justify military force or war. It is also the most common approach to moral reasoning used in business because of the way in which it accounts for costs and benefits.

However, because we cannot predict the future, it’s difficult to know with certainty whether the consequences of our actions will be good or bad. This is one of the limitations of utilitarianism.

Utilitarianism also has trouble accounting for values such as justice and individual rights. For example, assume a hospital has four people whose lives depend upon receiving organ transplants: a heart, lungs, a kidney, and a liver. If a healthy person wanders into the hospital, his organs could be harvested to save four lives at the expense of one life. This would arguably produce the greatest good for the greatest number. But few would consider it an acceptable course of action, let alone the most ethical one.

So, although utilitarianism is arguably the most reason-based approach to determining right and wrong, it has obvious limitations.

Related Terms

Consequentialism

Consequentialism is an ethical theory that judges an action’s moral correctness by its consequences.

Moral Philosophy

Moral Philosophy studies what is right and wrong, and related philosophical issues.

Moral Reasoning

Moral Reasoning is the branch of philosophy that attempts to answer questions with moral dimensions.

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ETHICAL THEORY & BUSINESS A study based on Utilitarianism and Kantianism

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Ethics Case Study: Application Of Utilitarianism, Kantian And Virtue Ethics To Make Ethical Choice

Ethics Case Study Assignment

Utilitarianism
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3. Management Team

4. other employees, kantian ethics, universal acceptability.

Virtue Ethics

Conclusion/Recommendation

Utilitarianism - Ethics Unwrapped. (2019). Retrieved 20 August 2019, from https://ethicsunwrapped.utexas.edu/glossary/utilitarianism
Kant's Moral Philosophy. (2004). Retrieved 20 August 2019, from https://plato.stanford.edu/entries/kant-moral/
Athanassoulis, n. Virtue Ethics. Retrieved 20 August 2019, from https://www.iep.utm.edu/virtue/

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10 Utilitarianism Examples (Plus Pros and Cons)

Utilitarianism Definition

Utilitarian Case study: Jeremy Bentham

Utilitarianism Examples

Pros of Utilitarianism

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Examples of Utilitarianism in Business: Utilitarianism Case Study

Case 1: Blood for sale

Handout: Utilitarianism and Business: Ford Pinto case

Utilitarianism and Business Ethics

Bentham (1748-1832)

John Stuart Mill (1806-73)

Business applications

CASE STUDY: Ford Pinto Case, utilitarianism and Cost Benefit Analysis:

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Utilitarian Principlism as a Framework for Crisis Healthcare Ethics

Carrie M. Henderson

Introduction

Background: Crisis Standards of Care

Principlism, Deontology and Utilitarianism

Utilitarian Principlism

Case Discussion

Utilitarian Non-Maleficence

Utilitarian Beneficence

Utilitarian Justice

Compliance with Ethical Standards

Journal of Business Ethics Education

2.4 Utilitarianism: The Greatest Good for the Greatest Number

Maximizing Utility

Ethics Across Time and Cultures

Link to Learning

Synthesizing Rights and Utility

The Role of Utilitarianism in Contemporary Business

Calculating Consequences:The Utilitarian Approach to Ethics

COVID-19 and the Limits of Utilitarianism

By Nicholas Buck | June 11, 2020

Nicholas Buck

Utilitarianism Vs Deontology: a Case Study

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Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health

Ethical framework implied by cost-effectiveness analysis

Limitations to criticisms of cost-effectiveness analysis and problems with other ethical principles

Arguments for utilitarianism as the default ethical perspective

Conclusions

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Philosophy, Ethics, and Humanities in Medicine

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