Please discuss your experiences with ethics, including your ethical values, ethical theories, and an ethical decision you have had to make. It is important to remember that as you share your ethical experiences with your faculty that you do not discuss information and details regarding a company or individual by name that are not public information.
Ethical Decisions Worksheet
Page 2 of 2
Complete the matrix below. Respond to each section using 100 to 150 words.
Describe an event in which you made an individual ethical decision.
[Explain the impact of your decision.]
Describe your ethical values and how your personal ethical values impact your decisions.
[Explain how your values impacted your decision.]
Explain 2 ethical theories and how the theories could impact future ethical decisions in health care.
[Explain how these theories would impact your future ethical decisions in health care.]
Explain an ethical problem-solving methodology to positively impact ethical decisions in health care.
[Explain how you could use this formal ethical problem-solving method to positively impact future ethical decisions in health care.]
Copyright 2020 by University of Phoenix. All rights reserved.
Copyright© 2020 by University of Phoenix. All rights reserved.
ACP 3F EBK ETHICS THEORY & CONTEMPORARY ISSUES
After reading this chapter, you should be able to:• Explain differences between utilitarianism and egoism as kinds of consequentialism.• Explain the difference between act utilitarianism and rule utilitarianism.• Describe the trolley problem and how it exemplifies the challenge of utilitarianism.• Identify key components of the utilitarian assessment of pleasure: intensity, duration, fruitfulness, and likelihood.• Articulate ways that utilitarianism is connected with hedonism and Epicureanism.• Apply utilitarian reasoning to a variety of cases in the real world.• Provide an overview of John Stuart Mill's defense of utilitarianism.• Defend your own thesis with regard to the value of utilitarianism.
In 2015, the global population exceeded 7.3 billion people. The United Nations predicts that another billion people will be added to the world's population by 2030, with the population increasing to over 9 billion by 2050.1 The increase in human population during the past two centuries has been explosive. Causes for this growth include industrialization, a revolution in agriculture and other technologies, and better political organization. This growing population has created problems, however, as soils are depleted, oceans are overfished, and pollution has increased. Industrialization and technology have led to massive use of carbon-based fuels, which contribute to global climate change. If the world's population keeps growing at the current pace—and if the growing human population eats, drives, and consumes at current rates—we may be headed for a worldwide environmental and humanitarian crisis. A recent United Nations report concluded, “should the global population reach 9.6 billion by 2050, the equivalent of almost three planets could be required to provide the natural resources needed to sustain current lifestyles.”
Some argue that a prudent solution would be to take steps to limit consumption, population growth, or both. The means that are used to control population might include morally controversial technologies such as abortion. Moral concerns also haunt proposals to limit consumption: each of us wants the freedom to earn, spend, and consume as we wish. Even though individuals enjoy expanding their families and consuming products, the cumulative choices of individuals pursuing their own happiness can lead to less happiness for all—as the overall increase in population, pollution, and environmental degradation may well decrease opportunities and life prospects for everyone. When we think about issues from this perspective—one that takes into account the general happiness of everyone—we are adopting a utilitarian point of view.
Large social engineering projects are often grounded in utilitarian concerns. Consider the effort in China to control population growth by limiting reproduction to one child per family. Critics of the policy argued that this violates a fundamental right to reproduce. Can limitations on basic rights be justified by the larger utilitarian concerns of social policies? Utilitarian efforts to maximize good consequences require that we adjust our policies in light of changing circumstances. The one-child policy created outcomes that rippled across Chinese society, including, for example, a shift in family structure and gender ratios. As the Chinese government has adjusted its population policies, it has struggled to manage costs and benefits. Should morality be focused on complex and changing consequences or should it be concerned with abstract and invariable moral principles?
Utilitarian reasoning can be used to justify a variety of actions and policy decisions. How do we justify speed limits on the highways? It might seem that each of us should be free to go as fast as we want. However, unbridled speed would result in more accidents, which not only kill people but also slow the rest of us down. Speed limits satisfy the utilitarian goal of maximizing the greatest happiness for the greatest number. Some will be unhappy because they can't drive 100 mph. But when we each drive at 65 mph and arrive safely, we are each more likely to be better off. Some may be less happy because they are forced to drive more slowly, but overall, more of us are happier.
Some uses of utilitarian reasoning are controversial because they seem to run counter to our intuitions about basic principles of right and wrong. Consider, for example, the use of torture in interrogations of terror suspects. If a terrorist had planted a bomb in a public place that would threaten to kill thousands of innocent people, would it be justifiable to torture the terrorist to force him to reveal the location of the bomb? On the one hand, some assert that torture is never permissible because it violates basic moral principles. The Geneva Conventions regulating warfare prohibit torture and define it as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession.”3 On the other hand, suppose, for example, that torture could save many lives. Would it then be justified? Former Vice President Dick Cheney maintained that “enhanced interrogation techniques” including waterboarding (a process that simulates drowning) produced useful information. According to the New York Times, the CIA waterboarded terror suspect Khaled Sheikh Mohammed 183 times.
In a speech on the tenth anniversary of September 11, Cheney claimed that by waterboarding terrorists such as Mohammed, information was extracted that led to the assassination of Osama bin Laden.5 Cheney and other members of the Bush administration justified torture on utilitarian grounds. Their view is shared by many. A Pentagon study of “the ethics of troops on the front line” in Iraq found that 41 percent said that “torture should be allowed to save the life of a soldier or Marine,” and about the same number said that it “should be allowed to gather important information from insurgents.”6 From a utilitarian standpoint, it may make good sense to inflict pain on someone to prevent pain that would be inflicted on a greater number of others. From the same standpoint, however, one may argue that practices such as torture cause greater harm than good—by extracting false confessions and lowering a country's standing with potential allies. In any event, the question remains: Does a good end justify otherwise objectionable means? Crowded village ferry crossing the River Hooghly, West Bengal, India. Weighing Consequences.
One way of thinking about this is to compare the benefits and costs of each alternative. Whichever has the greater net benefit is the best alternative. Such an approach begins with the belief that we can measure and compare the risks and benefits of various actions. The idea is that actions are morally better or worse depending on whether they produce pleasure or pain or, more abstractly, on how they affect human well-being and happiness. Unlike egoism, utilitarianism focuses on the sum of individual pleasures and pains. It is not my pleasures or pains that matter—but the cumulative happiness of a number of people.
Another aspect of utilitarianism is the belief that each of us counts equally. Peter Singer, an influential contemporary defender of utilitarianism, derives utilitarianism from the basic idea that each person's interests ought to be given equal consideration. Related to this is the idea that “my own interests cannot count for more, simply because they are my own, than the interests of others.”7 The basic procedure for utilitarianism is to add up the interests of everyone who is affected by an action without privileging the interests of anyone in particular. Utilitarianism is thus opposed to racist or sexist ideas, for example, which often hold that the interests of some people matter more than the interests of others.
Utilitarianism suggests that we ought to consider the totality of consequences of a policy or action. Forms of utilitarianism will differ depending on how we understand what sorts of consequences or interests matter. Complexities arise in defining key concepts such as happiness, interest, and well-being. Singer, for example, wants to focus on interests instead of pleasures or happiness. This indicates that it is possible that some pleasures are not really in our interest. For example, drug use can produce pleasure, but it is not in anyone's long-term interest to be addicted to cocaine or heroin. We might also focus on people's preferences—that is, what people themselves state that they prefer. But again there is an important question of whether our preferences actually coordinate with our interests—or can we prefer things that are not in our interest? In different terms, we might wonder whether pleasure is a good thing or whether genuine happiness can be reduced to pleasure. In any case, utilitarians have to provide an account of what matters when we try to add up benefits and harms—whether it is subjective feeling, taste, and preference, or whether it is something deeper and more objective such as well-being or other interests (in health, longevity, fulfillment, accomplishment, etc.).
Utilitarianism has to provide an account of whose interests or happiness matters. Jeremy Bentham, one of the founding fathers of utilitarianism, extended his utilitarian concern in a way that included all suffering beings, including nonhuman animals. Peter Singer would agree. He is well-known as an advocate of animal welfare. Like Bentham, he claims that the interests of nonhuman animals ought to be taken into account. (We discuss the issue of animal ethics further in Chapter 17.)One important point to bear in mind when discussing utilitarianism is that utilitarians generally do not think that actions or policies are good or bad in themselves. Rather, for the utilitarian, the goodness or badness of an action is solely a function of its consequences. Thus, even killing innocent people may be acceptable if it produces an outcome that saves a greater number of others from harm.
Jeremy Bentham and John Stuart Mill The classical formulation of utilitarian moral theory is found in the writings of Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873). Jeremy Bentham was an English-born student of law and the leader of a radical movement for social and legal reform based on utilitarian principles. His primary published work was Introduction to the Principles of Morals and Legislation (1789). The title indicates his aim: to take the same principles that provide the basis for morals as a guide for the formation and revision of law. Bentham believed that the same principles guided both social and personal morality.
James Mill, the father of John Stuart Mill, was an associate of Bentham's and a supporter of his views. John Stuart was the eldest of James's nine children. He was educated in the classics and history at home. By the time he was twenty, he had read Bentham and had become a devoted follower of his philosophy. The basic ideas of utilitarian moral theory are summarized in Mill's short work Utilitarianism, in which he sought to dispel the misconception that morality has nothing to do with usefulness or utility or that morality is opposed to pleasure. Mill was also a strong supporter of personal liberty, and in his pamphlet On Liberty he argued that the only reason for society to interfere in a person's life was to prevent him or her from doing harm to others. People might choose wrongly, but he believed that allowing bad choices was better than government coercion. Liberty to speak one's own opinion, he believed, would benefit all. However, it is not clear that utility is always served by promoting liberty. Nor is it clear what Mill would say about cases in which liberty must be restricted to promote the general good, as in the case of speed limits or airport security rules. In his work, On the Subjection of Women, Mill also emphasized the general good and criticized those social treatments of women that did not allow them to develop their talents and contribute to the good of society. Consistent with these views, he also supported the right of women to vote. Later in life he married his longtime companion and fellow liberal, Harriet Taylor. Mill also served in the British Parliament from 1865 to 1868.A portrait of the utilitarian philosopher John Stuart Mill (1806–1873).
The original utilitarians were democratic, progressive, empiricist, and optimistic. They were democratic in the sense that they believed that social policy ought to work for the good of all persons, not just the upper class. They believed that when interests of various persons conflicted, the best choice was that which promoted the interests of the greater number. The utilitarians were progressive in that they questioned the status quo. For example, they believed that if the contemporary punishment system was not working well, then it ought to be changed. Social programs should be judged by their usefulness in promoting the greatest happiness for the greatest number. Observation would determine whether a project or practice succeeded in this goal. Thus, utilitarianism is part of the empiricist tradition in philosophy, which holds that we know what is good only by observation or by appeal to experience. Bentham and Mill were also optimists. They believed that human wisdom and science would improve the lot of humanity. Mill wrote in Utilitarianism, “All the grand sources of human suffering are in a great degree, many of them almost entirely, conquerable by human care and effort.”
The Principle of Utility
The basic moral principle of utilitarianism is called the principle of utility or the greatest happiness principle. As John Stuart Mill explained it (and as you will see in the reading that follows) “actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.”
Utilitarianism is a form of consequentialism. It focuses on the consequences of actions. Egoism is also a form of consequentialism. But unlike egoism, utilitarianism focuses on the consequences for all persons impacted by an action. Consider the diagram used to classify moral theories provided in Chapter 1.
According to classical utilitarian moral theory, when we evaluate human acts or practices, we consider neither the nature of the acts or practices nor the motive for which people do what they do. As Mill puts it, “He who saves a fellow creature from drowning does what is morally right, whether his motive be duty or the hope of being paid for his trouble.”9 It is the result of one's action—that a life is saved—that matters morally. According to utilitarianism, we ought to decide which action or practice is best by considering the likely or actual consequences of each alternative. For example, over the years, people have called for a suicide barrier on the Golden Gate Bridge to prevent people from using it to commit suicide. More than 1,600 people have jumped from the bridge to their deaths.10 Building a suicide barrier on a bridge is neither good nor bad in itself, according to utilitarianism. Nor is it sufficient that people supporting the building of such a barrier be well intentioned. The only thing that matters for the utilitarian is whether, by erecting such a barrier, we would actually increase happiness by preventing suicides. After much dispute, officials have agreed to build a suicide barrier—a net to catch would-be jumpers—on the bridge.
Pleasure and Happiness
Of course, there is an open question about whether suicide is good or bad. Some will argue that there is something inherently or intrinsically wrong with suicide. The deontologist Immanuel Kant provides this sort of argument, as you will see in Chapter 6, maintaining that suicide is wrong in principle. But utilitarians cannot argue that suicide is intrinsically wrong—since they do not focus on the intrinsic rightness or wrongness of acts. Instead, utilitarians have to consider the impact of suicide on the happiness of all those it affects.
Since utilitarians reject the idea that certain acts are intrinsically good or evil, they are open to experimentation and evidence. And they are open to various ways of conceiving the goodness of consequences. Any sort of consequences might be considered good—for example, power, fame, or fortune. However, classical utilitarianism is a pleasure or happiness theory, meaning that it tends to reduce all other goods to some form of pleasure or happiness. Utilitarianism was not the first such theory to appear in the history of philosophy. Aristotle's ethics, as we shall see in Chapter 8, also focuses on happiness, although it is different from utilitarianism in its focus on virtue. Closer to utilitarianism is the classical theory that has come to be known as hedonism (from hedon, the Greek word for pleasure) or Epicureanism (named after Epicurus, 341–270 BCE). Epicurus held that the good life was the pleasant life. For him, this meant avoiding distress and desires for things beyond one's basic needs. Bodily pleasure and mental delight and peace were the goods to be sought in life.
Utilitarians believe that pleasure or happiness is the good to be produced. As Bentham puts it, “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do.”11 Things such as fame, fortune, education, and freedom may be good, but only to the extent that they produce pleasure or happiness. In philosophical terms, they are instrumental goods because they are useful for attaining the goals of happiness and pleasure. Happiness and pleasure are the only intrinsic goods—that is, the only things good in themselves.
In this explanation of utilitarianism, you may have noticed the seeming identification of pleasure and happiness. In classical utilitarianism, there is no difference between pleasure and happiness. Both terms refer to a kind of psychic state of satisfaction. However, there are different types of pleasure of which humans are capable. According to Mill, we experience a range of pleasures or satisfactions from the physical satisfaction of hunger to the personal satisfaction of a job well done. Aesthetic pleasures, such as the enjoyment of watching a beautiful sunset, are yet another type of pleasure. We also can experience intellectual pleasures such as the peculiar satisfaction of making sense out of something. Mill's theory includes the idea that there are higher, uniquely human pleasures—as we will explain below.
In Mill's view, we should consider the range of types of pleasure in our attempts to decide what the best action is. We also ought to consider other aspects of the pleasurable or happy experience. According to the greatest happiness or utility principle, we must measure, count, and compare the pleasurable experiences likely to be produced by various alternative actions in order to know which is best.
CalCulating the Greatest Amount of Happiness
Utilitarianism is not an egoistic theory. As we noted in Chapter 4's presentation on egoism, those versions of egoism that said we ought to take care of ourselves because this works out better for all in the long run are actually versions of utilitarianism, not egoism. Some philosophers have called utilitarianism universalistic because it is the happiness or pleasure of all who are affected by an action or practice that is to be considered. We are not just to consider our own good, as in egoism, nor just the good of others, as in altruism. Sacrifice may be good, but not in itself. As Mill puts it, “A sacrifice which does not increase or tend to increase the sum total of happiness, (utilitarianism) considers as wasted.”
Everyone affected by some action is to be counted equally. We ourselves hold no privileged place, so our own happiness counts no more than that of others. I may be required to do what displeases me but pleases others. Thus, in the following scenario, Act B is a better choice than Act A:
Act A makes me happy and two other people happy.
Act B makes me unhappy but five others happy.
In addition to counting each person equally, Bentham and his followers identified five elements that are used to calculate the greatest amount of happiness: the net amount of pleasure or happiness, its intensity, its duration, its fruitfulness, and the likelihood of any act to produce it.
Pleasure Minus Pain
Almost every alternative that we choose produces unhappiness or pain as well as happiness or pleasure for ourselves, if not for others. Pain is intrinsically bad, and pleasure is intrinsically good. Something that produces pain may be accepted, but only if it causes more pleasure overall. For instance, if the painfulness of a punishment deters an unwanted behavior, then we ought to punish, but no more than is necessary or useful. When an act produces both pleasure or happiness and pain or unhappiness, we can think of each moment of unhappiness as canceling out a moment of happiness so that what is left to evaluate is the remaining or net happiness or unhappiness. We are also to think of pleasure and pain as coming in bits or moments. We can then calculate this net amount by adding and subtracting units of pleasure and displeasure. This is a device for calculating the greatest amount of happiness even if we cannot make mathematically exact calculations. The following simplified equation indicates how the net utility for two acts, A and B, might be determined. We can think of the units as either happy persons or days of happiness:
Act A produces twelve units of happiness and six of unhappiness (12 − 6 = 6 units of happiness).
Act B produces ten units of happiness and one of unhappiness (10 − 1 = 9 units of happiness).
On this measure, Act B is preferable because it produces a greater net amount of happiness, namely, nine units compared with six for Act A.
Moments of happiness or pleasure are not all alike. Some are more intense than others. The thrill of some exciting adventure—say, running river rapids—may produce a more intense pleasure than the serenity we feel standing before a beautiful vista. All else being equal, the more intense the pleasure, the better. All other factors being equal, if I have an apple to give away and am deciding which of two friends to give it to, I ought to give it to the friend who will enjoy it most. In calculations involving intensity of pleasure, a scale is sometimes useful. For example, we could use a positive scale of 1 to 10 degrees, from the least pleasurable to the most pleasurable. In the following scenario, then, Act B is better (all other things being equal) than Act A, even though Act A gives pleasure to thirty more people; this result is because of the greater intensity of pleasure produced by Act B:
Act A gives forty people each mild pleasure (40 × 2 = 80 degrees of pleasure).
Act B gives ten people each intense pleasure (10 × 10 = 100 degrees of pleasure).
Intensity is not all that matters regarding pleasure. The more serene pleasure may last longer. This also must be factored in our calculation. The longer lasting the pleasure, the better, all else being equal. Thus, in the following scenario, Act A is better than Act B because it gives more total days of pleasure or happiness. This is so even though it affects fewer people (a fact that raises questions about how the number of people counts in comparison to the total amount of happiness):
Act A gives three people each eight days of happiness (3 × 8 = 24 days of happiness).
Act B gives six people each two days of happiness (6 × 2 = 12 days of happiness).
A more serene pleasure from contemplating nature may or may not be more fruitful than an exciting pleasure such as that derived from running rapids. The fruitfulness of experiencing pleasure depends on whether it makes us more capable of experiencing similar or other pleasures. For example, the relaxing event may make one person more capable of experiencing other pleasures of friendship or understanding, whereas the thrilling event may do the same for another. The fruitfulness depends not only on the immediate pleasure, but also on the long-term results. Indulging in immediate pleasure may bring pain later on, as we know only too well. So also the pain today may be the only way to prevent more pain tomorrow. The dentist's work on our teeth may be painful today, but it makes us feel better in the long run by providing us with pain-free meals and undistracted, enjoyable mealtime conversations.
If before acting we are attempting to decide between two available alternative actions, we must estimate the likely results of each before we compare their net utility. If we are considering whether to go out for some sports competition, for example, we should consider our chances of doing well. We might have greater hope of success trying something else. It may turn out that we ought to choose an act with lesser rather than greater beneficial results if the chances of it happening are better. It is not only the chances that would count, but also the size of the prize. In the following equation, A is preferable to B. In this case, “A bird in the hand is worth two in the bush,” as the old saying goes
Act A has a 90 percent chance of giving eight people each five days of pleasure (40 days × 0.90 = 36 days of pleasure).
Act B has a 40 percent chance of giving ten people each seven days of pleasure (70 days × 0.40 = 28 days of pleasure).
Quality of Pleasure
Bentham and Mill are in agreement that the more pleasure or happiness, the better. However, there is one significant difference between them. According to Bentham, we ought to consider only the quantity of pleasure or happiness brought about by various acts: how much pleasure, to how many people, how intense it is, how long-lasting, how fruitful, and how likely the desired outcome will occur. Consider Bentham's own comment on this point: The “quantity of pleasure being equal, pushpin (a children's game) is as good as poetry.”14 The aesthetic or intellectual pleasure that one might derive from reading and understanding a poem is no better in itself than the simple pleasure of playing a mindless game
.Mill agreed with Bentham that the greater amount of pleasure and happiness, the better. But Mill believed that the quality of the pleasure should also count. In his autobiography, Mill describes a personal crisis in which he realized that he had not found sufficient place in his life for aesthetic experiences; he realized that this side of the human personality also needed developing and that these pleasures were significantly different from others. This experience and his thoughts about it may have led him to focus on the quality of pleasures. Some are intrinsically better than others, he believed. For example, intellectual pleasures are more valuable in themselves than purely sensual pleasures. Although he does not tell us how much more valuable they are (twice as valuable?), he clearly believed this greater value ought to be factored into our calculation of the “greatest amount of happiness.” Although I may not always be required to choose a book over food (for example, I may now need the food more than the book), the intellectual pleasures that might be derived from reading the book are of a higher quality than the pleasures gained from eating.
Mill attempts to prove or show that intellectual pleasures are better than sensual ones. We are to ask people who have experienced a range of pleasures whether they would prefer to live a life of a human, despite all its disappointments and pains, or the life of an animal, which is full of pleasures but only sensual pleasures. He believes that people generally would choose the former. They would prefer, as he puts it, “to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied.”15 Socrates was often frustrated in his attempts to know certain things. He struggled to get a grasp on true beauty and true justice. Because human beings have greater possibilities for knowledge and achievement, they also have greater potential for failure, pain, and frustration. The point of Mill's argument is that the only reason we would prefer a life of fewer net pleasures (the dissatisfactions subtracted from the total satisfactions of human life) to a life of a greater total amount of pleasures (the life of the pig) is that we value something other than the amount (quantity) of pleasures; we value the kind (quality) of pleasures as well.16 When considering this argument, you might ask yourself two questions. First, would people generally prefer to be Socrates than a pig? Second, if Mill is correct in his factual assessment, then what does this fact prove? Could it be that people are mistaken about what kinds of pleasures are the best, as Socrates himself often implied? This points us back to the question of whether happiness is merely a subjective preference or whether happiness resides in a more objective standard.
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