Utilitarianism, Deontology and
Confidentiality
Andrew Latus
Ethics/Humanities/
Health Law
Sept. 26/02
Announcements
Oct. 3 session is cancelled
Next session: Oct. 7, 10-10:50 a.m.
Then: Oct. 17 session is now from 10-11:50 a.m.
– Group discussion 10-10:50
– Plenary session 11-11:50
– Read Chapters 5 and 6
Objectives
Finish our brief survey of ethical theories
– Remember: the goal is not to settle the question
of what the best theory is but to give us some
tools to draw upon
Apply the theories to Clinical Skills Case 1
Course Web Page
[Link]
Recall: Utilitarianism
a variety of consequentialism
"actions are right in proportion as they tend
to promote happiness, wrong as they tend to
produce the reverse of happiness." (John
Stuart Mill's Greatest Happiness Principle)
In other words, judge an action by the total
amount of happiness and unhappiness it
creates
An Alternative Theory: Deontology
'Duty Based' Ethics
Deontologists deny that what ultimately
matters is an action's consequences.
They claim that what matters is the kind of
action it is. What matters is doing our duty.
There are many kinds of deontological theory
– e.g., The 'Golden Rule' - "Do unto others as
you'd have them do unto you."
Kantian Deontology
Immanuel Kant (1724-1804) is the most influential
deontologist.
Rejecting Consequentialism: "A good will is good
not because of what it effects or accomplishes."
Even if by bad luck a good person never
accomplishes anything much, the good will would
"like a jewel, still shine by its own light as something
which has its full value in itself."
The Categorical Imperative
Kant claims that all our actions should be judged
according to a rule he calls the Categorical
Imperative.
First Version: "Act only according to that maxim
[i.e., rule] whereby you can at the same time will that
it become a universal law."
Second Version: "Act in such a way that you treat
humanity, whether in your own person or in the
person of another, always at the same time as an
end and never simply as a means."
Important to treat people as autonomous agents
Autonomy
A central element in many deontological
theories is the idea of autonomy
Autonomy = self + rule
Roughly, the idea is that people must be
respected as autonomous agents.
– This means there are certain ways we must not
treat people (no matter how much utility might be
produced by treating them in those ways)
3 Elements of ‘Ideal’ Autonomy
Rationality
– only informed decisions are truly autonomous
Freedom of Action
– lack of coercion
Freedom of Choice
– availability of alternative options
Problems with Deontology and
Utiliarianism/Consequentialism
Deontology: What if doing your duty has
repugnant consequences?
– Kant on telling lies
Consequentialism: What if you have to do
something that seems wrong in order to
produce the best consequences?
– Convicting the innocent
Principilism
Principilism attempts to have it both ways
Popularized by Beauchamp and Childress
– Principles of Biomedical Ethics
– The ‘Georgetown Mantra’
Now the dominant theory in medical ethics
Useful, but frustrating
Four Principles
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
– 1 & 4 are deontological
– 2 & 3 are consequentialist
It is really possible to have it both ways?
Test-driving the Theories
What do utilitarianism and deontology tell us
to do in the case of Aaron/Erin White?
The theories ask us to focus on different
aspects of the case.
– Principilism tells us all these aspects are
important
– This is why Principilism annoys some people
Utilitarianism 1
Focus on the consequences of maintaining
confidentiality
– A tension: Should we focus on
the consequences of this case alone (act utilitarianism)
or
on general rules for maintaining confidentiality (rule
utilitarianism)?
Utilitarianism 2
Assessing consequences requires attention
to the concrete details of the case
– e.g., the age of Aaron’s/Erin’s partners
– your assessment of how Aaron/Erin is likely to
behave from here on
– what any test results might show
Deontology
Asks us to focus on our duties
– Respecting the autonomy of the patient
– Helping the patient
– Helping others
Common Ground?
In neither case is the duty to maintain
confidentiality absolute
– The possible consequences of absolute
confidentiality are too dire
– Our duty to respect patient autonomy may be
outweighed by our duty to help others (and the
patient)
