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Utilitarianism and deontology—Gesundheit!!

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This is the second in a series of articles about medical ethics. In our last post, we reviewed the basics of medical ethics.

Deontology and utilitarianism are both big, five-dollar words that represent two competing systems of ethics. We cannot do justice to each of these theories here, but will briefly define them and provide links where you can learn more about their complex meanings and implications.

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According to the Stanford Encyclopedia of Philosophy, deontology was derived from deon and logos, the Greek words for duty and science, or the study of duty. It is a system of ethics that focuses on the intrinsic morality of any act. “Wrong” choices conform to some moral norm, regardless of the circumstances or the consequences. “Right” choices take priority over good outcomes. Sometimes this form of ethics is called “non-consequentialist” because one cannot justify an action by a good consequence, but by whether it held to a principle or law. This type of duty-based ethics tends to provide the basis for human rights because it forces a principle of right or wrong treatment of individuals even when the individuals’ interests are at odds with those of a larger group. It is limited because it is difficult to apply absolute rules to all circumstances, so a list of exceptions must be built. This limitation is promulgated in a quote by A. C. Ewing in The Definition of Good (1947):

“…it is hard to believe that it could ever be a duty deliberately to produce less good when we could produce more…”

This leads us to utilitarianism, which is the system of ethics that holds that the morally “right” action is the one that produces the “greatest amount of good for the greatest number of people”. Because morality is based on the net overall good achieved in the world based on an action, this ethical construct is also known as “consequentialism”. The Internet Encyclopedia of Philosophy states,

“…utilitarians acknowledge that it may be useful to have moral rules that are “rules of thumb”—i.e., rules that describe what is generally right or wrong, but they insist that whenever people can do more good by violating a rule rather than obeying it, they should violate the rule. They see no reason to obey a rule when more well-being can be achieved by violating it.”

We can see the tension between these two ethical systems in the famous example proposed by Immanuel Kant, an opponent of utilitarianism. According to Kant, it would be morally wrong to lie to a murderer who asked you where to find his next victim, even if it would save the victim’s life. In a utilitarian model, the outcome of saving the victim’s life by lying would be the right thing to do, even if telling a lie is generally wrong.

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Another example that demonstrates the limitations of the utilitarian construct is if a doctor could save five people from death by killing one healthy person and transplanting that person’s organs to the others. The utilitarian system would imply that it would be moral for the doctor to kill that one healthy person to save the other five. Generally, that decision would not be considered the best one, at least here in the US.

How do these complex ethical systems play into modern medical practice and clinical research? Mandal et al. suggests that both are important in medical ethics, and that balancing the two perspectives in medicine can bring the most harmony and justice to medical practice.

What do you think? We would love to hear your perspectives on deontological and utilitarian examples in clinical research.

In our next post in this series, we’ll continue to explore the foundations of medical ethics by reviewing The Belmont Report, which provides us with the modern distinction between medical research and practice, and affirms the three basic ethical principles generally accepted in our culture: respect for persons, beneficence, and justice.