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This entry offers a historical overview and a theoretical discussion of the main features of the utilitarian approach to ethics and their relevance for the contemporary bioethical debate. Despite having a well-recognizable philosophical nucleus (the emphasis on the promotion of well-being, a teleological theory of the good in terms of pleasure or preference satisfaction, the distrust for any appeal to moral absolutes), utilitarianism greatly differs in its various versions and formulations. This entry aims at presenting this common nucleus as well as the lively debate internal to utilitarianism. After sketching a historical overview of the origins and developments of utilitarianism from the late eighteenth century up to the present day, the entry will survey some of the utilitarian analyses and solutions to bioethical problems and dilemmas.
Utilitarianism is one of the most important normative theories of ethics, and in the context of bioethical discussion, it offers some powerful answers to the main problems concerning human birth, medical treatments, sexuality, and death, as well as to the challenges facing our ways of treating animals and the environment. As against natural law theory, virtue ethics, and deontological ethics, all variously interested in the motives and intentions of the moral agent, utilitarianism looks at the outcomes of her choices and actions. The morally right thing to do would thus be the one realizing the greatest practical good in the world rather than the one springing from the appropriate motives or moved by the noblest intentions. Much of the discussion internal to utilitarianism revolves around how to best characterize the notions of consequence, well-being, pleasure, and satisfaction, as well as the activities of confrontation and calculation of goods. In the bioethical domain, utilitarianism seems to be well placed to productively address the many questions concerning our ways of dealing with human ﬁnitude and contingency.
History And Development Of Utilitarianism
Utilitarianism is among the most important ethical theories employed in bioethical reﬂection. Utilitarianism holds that morally right actions – that is, those actions we should be recommending – are the ones producing the greatest quantity of pleasure or well-being for the greatest number of people. The promotion of pleasure and the computation of the consequences can be found in authors spanning the whole history of ethics, starting with Epicurus and continuing to aspects of the works of John Locke, David Hume, and Francis Hutcheson. It is however with Jeremy Bentham and John Stuart Mill that we ﬁnd the utilitarian ethical theory, as well as the very name utilitarianism, developed as a comprehensive normative theory.
Bentham claims that the measure of right conduct is the greatest happiness for the greatest number. As he writes in the Introduction to the Principles of Morals and Legislation (2007 ), the principle of utility approves or disapproves any action according to its tendency to increase or decrease the happiness of those whose interests are at issue and the number of interests involved. According to Bentham’s framework, the main scope of application of the principle of utility is the institutions and the laws, whose confusions and lack of rationality were evident to his enlightenment mindset, even though he never neglected private morality. The activity of the government aims at promoting the happiness of society, and in order to accomplish this goal, it enforces penalties and punishments affecting those motives of action related to pleasure and pain.
With respect to pleasure, Bentham offers a reﬁned quantitative metric (sorting pleasures according to their intensity, duration, certitude, proximity, fecundity, and purity), which he uses to account for the various sorts of pleasures. With respect to the motives of action, two aspects deserve consideration. The government intervenes not only by coordinating the egoistic drives (so that the greatest happiness as such would itself become an integral part of the interests of each individual) but also by modifying them in order to equip us with new incentives by means of sanctions. Furthermore, Bentham lists non-egoistic motives as well, namely, those sympathetic sentiments that under appropriate circumstances enable to put us in touch with ever greater spheres of humanity, even though he acknowledges that in the present condition egoistic motives prevail. Lastly, for what regards the implementation of the principle of utility, Bentham holds that such principle should not be applied directly to actions but rather via four “subordinate objects,” deduced from the empirical observation of their tendency to promote the greatest happiness and of their connection with the natural motives of individuals. They are subsistence, abundance (understood as what is superﬂuous as against what is necessary to subsistence), equality, and security (under which he lists liberty).
Mill reprises and amends Bentham’s framework (Mill 2008). In the ﬁrst place, Mill is dissatisﬁed with the quantitative metric of pleasure and advances a qualitative hedonism marking a qualitative difference among pleasures. According to this picture, pleasure is experienced differently depending on the speciﬁc activity undertook: the sensation of pleasure is in fact transformed by the kind of activity associated with it. Mill thus argues that the pleasures of imagination, of moral sentiments, or those sensible pleasures that are passive, such as the enjoyment of the heat and the pleasure of the body in sunbathing, say, are pleasures of a different kind. Bentham envisioned a sophisticated quantitative metric through which accounting for the different kinds of pleasure, while Mill goes back to the Greek and Hellenistic tradition in holding that the various pleasures are qualitatively different from each other as the kinds of goods are. Judgments can thus be grounded in the psychology of sensation on the condition that among the materials of such psychology there ﬁgures the experience we have of these activities as well as the experience of the weighting of the associated pleasures. In short, Mill inscribes within the psychology and hedonism of utilitarianism the point of view of the educated, experienced human being, the competent judge as he calls her, which goes back to the ancient philosophical tradition.
With respect to motives, Mill once again reprises Bentham while twisting his line of thinking. Mill in fact agrees with Bentham in denying that in acting we do not have to constantly apply the principle of the greatest happiness for the greatest number but holds that the subordinate objects, that is, the rules of action, refer directly to the experience humanity has accumulated with regard to the tendencies of the various actions. In this way it makes little sense to ask each and every time if murder and robbery are detrimental to human happiness, as we know that already by partaking to a certain human form of life. Mill’s approach thus amounts to an empiricist account of rules, different in kind from the Kantian a priori test. Rules reveal the tendencies of discrete actions, and when in doubt (in a real, empirical doubt encountered in practice rather than a sophistic, speculative one) we should try to foresee the consequences of the single action at stake.
Twentieth-century developments of utilitarianism have introduced several changes. In the ﬁrst place, starting with the utilitarianism employed by economists such as John Harsanyi and moral philosophers such as Richard Mervyn Hare, utility is considered not in terms of pleasure anymore but rather with reference to satisﬁed preferences, a theory of value usually called welfares, even though there have been authors who kept defending some variety of hedonism (e.g., J. J. C. Smart). Furthermore, these authors illustrate and distinguish the various indirect levels of the principle of utility that we found in Bentham and Mill. In the ﬁrst place, they distinguish act and rule utilitarianism. Act utilitarianism holds that the single action is to be judged by looking at the consequences it produces. Rule utilitarianism, on the other hand, holds that the produced consequences are to be assessed by taking into consideration the (empirically reliable) hypothesis that such an action would be generally followed, thus focusing on the rule under which that single action falls. It is in fact rules (general principles, rights, maxims of conduct, and so on), working under the assumption that they will be generally observed, which should be measured in the light of their consequences and with reference to the satisfaction of the preferences involved.
Contemporary Utilitarianism: Some Varieties
In the light of these innovations, in the contemporary ethical debate, we ﬁnd three criteria or features of utilitarian theory: consequentialism, welfarism, and aggregation (Sen and Williams 1982). Consequentialism consists of a theory about what makes a certain action right. It holds that an action is to be judged according to the consequences it produces. This might appear obvious, considered the difﬁculty in thinking the moral weight of what we do as disjoined from its consequences, from its effects, and from the good and bad that it brings about. But since utilitarianism claims that the rightness of actions depends exclusively on their consequences, this criterion might conﬂict with other moral considerations that seem just as obvious, such as the thought that certain actions, because of their very nature, are wrong in every possible situation, even if in a determinate context they might be the only way out. Among these actions there is murder. This problem simply did not arise in Mill’s version of utilitarianism, because the fact that murder was morally prohibited in itself was indisputable – with the same holding for the basic rules that Mill laid the foundations for the sphere of justice – though this does not waive us from carefully examining the cases in which the single action of killing is permissible. In contrast, contemporary utilitarianism completely shifts the moral weight to consequences, separating actions from their consequences, where Mill held that some consequences can be read in a certain kind of actions (e.g., murder has the tendency to produce social harm because of its very nature). The contemporary separation is radical and makes contemporary consequentialism incompatible with an ethics investing duties with an intrinsic character and weight (e.g., Elizabeth Anscombe’s). However, it has to be noticed; the conﬂict with consequentialism arises for issues of lesser import as well, such as lying or failing to keep one’s promises. Issues such as hiding the truth from the patient so to avoid her psychological discomfort or betraying the conﬁdentiality with one’s patient for the good of third parties (such as in the case of genetic information relevant for future researches or of sexually transmittable diseases) show the limits of the narrow focus on consequences. In these situations it might in fact be noticed that one should speak truthfully and keep one’s obligation of conﬁdentiality because otherwise the trust of the patient would be betrayed and her autonomy undermined and this independently from the consequences of these actions, which very likely will be bad as well.
Welfarism consists instead in a theory of the good and speciﬁes what makes some state of affairs good. Welfarism holds that the good consists in the well-being of the people involved and that this well-being is to be judged in the light of their preferences and desires. Once again, a theory of the good of this kind might seem obvious to most. However, some shared, commonsensical convictions seem to be clashing with it. In some cases one might want to argue that a certain lifestyle meets one’s preferences and yet it is a miserable or shameful lifestyle. In order to meet this challenge, the strategy of utilitarianism has been that of working on the very notion of preference, arguing how preferences should be informed (e.g., Harsanyi and Hare). Some authors go as far as to claim that preferences should pass some sort of psychological test (e.g., Richard Brandt). Furthermore, according to some utilitarian thinkers, only moralized preferences should be taken into account, for example, by excluding antisocial preferences : such as sadism, envy, resentment, and spitefulness (e.g., Harsanyi), while for others there should be no such limits (e.g., Hare). But, in any case, whatever the ﬁlter, a non-welfarist theory will eventually ﬁnd a way to insist that we should be in a position to judge someone’s life on a basis that is independent from her preferences , no matter how reﬁned – an external basis grounded on a criterion different from that of preferences – that is on a certain objective conception of the good.
Both consequentialism and welfarism hold that a certain action is good if it promotes the wellbeing of individuals. Consequences should thus be understood in terms of the well-being (or of its contrary and degrees of such well-being or discomfort) of a certain individual, of another individual, of yet another one, and so on. The criterion of aggregation holds that this multiplicity of wellbeing should be added together. They should not be judged singularly and independently from each other but rather summed so as to gauge which course of action produces the best possible outcome in terms of overall well-being – that is, the action which maximizes the well-being of all the people involved in the course of action under consideration.
In this case as well, the idea of adding up might look like an obvious one. It is in fact an integral part of common sense to consider certain personal sacriﬁces as justiﬁed because they guarantee the well-being of a great number of people (so that, e.g., in a war of defense, the sacriﬁce of some is aimed at – and justiﬁed by – the production of consequences of well-being for all). It is in fact unthinkable that numbers do not matter in ethics: numbers and proportionality represent a constitutive and unavoidable component of moral thought as well as of the law. However, the idea of adding well-being together clashes with widespread convictions about the very distribution of well-being: the welfare systems of the European countries, for example, are founded on the idea that we should never allow nor tolerate the possibility of having some individuals falling below a certain threshold of individual well-being, even though this would increase the well-being of the majority. Taking this objection seriously, some thinkers endorsed the idea of a threshold and incorporated it into utilitarianism (e.g., Peter Singer). A difﬁculty facing the criterion of aggregation is that it is not always possible to sum the various goods, because they could be incommensurable or run the risk of being distorted if subjected to a unitary metric (e.g., a monetary metric, sorting goods according to ﬁnancial considerations). This is a serious, important objection, and yet it is true that in their ordinary moral life, individuals make comparisons and take choices between rather disparate goods all the time (think, e.g., to the classical – and somewhat dull – example of the choice between going to watch a movie from which we get aesthetical or intellectual pleasure, or even only amusement, and paying a visit to an elderly aunt who we would bless with the beneﬁt of our visit). Such comparisons are an integral part of the common moral life, and the existence of uncertain and unsettling situations resisting plain resolution does not jeopardize the fact that individuals are normally able to handle such comparisons and doubts by choosing, that is, by living.
For what regards the criterion of aggregation, utilitarianism faces the criticism leveled against its capacity to address problems of distributive justice. The way in which utilitarianism tackles the issue of the allocation of healthcare resources is in fact disputable. Some authors have claimed that the aggregation of the individual preferences about which therapies to privilege would necessarily end up damaging the interests of those affected by rare diseases or those social minorities lacking the possibility to give expression to their interests (Charles worth 1993). However, others have argued that an adequate comprehension of general wellbeing, understood against the wider background of our capacity for human improvement, justiﬁes a right to a decent minimum of healthcare within a utilitarian framework (Lecaldano 2009).
Utilitarianism At The Beginning And At The End Of Life
The examination of the relevance of utilitarianism in bioethics would bring us to examine and discuss the whole range of bioethical problems at the beginning and at the end of life, as well as problems concerning sexuality and the way human beings treat nonhuman animals and the environment. Traditionally, utilitarianism has been a reformatory philosophical tool, even though in the twentieth century it has somehow lost this character. Utilitarianism employed in bioethical thought reprised its original reformatory role. The changing circumstances at the beginning and end of human life and the major progress and changes in biology and in medicine called into question the received codes and the wider anthropological conception sustaining them and which in turn they are an expression of. In this shifting context, utilitarianism appears as the best equipped theoretical instrument for handling these new moral problems, because it gets rid of a priori duties and of a conception of the good impermeable to empirical changes. Utilitarianism’s empirical orientation (the attention to expected consequences, a conception of value grounded in pleasures and preferences :, the emphasis on the confrontation and sum of goods) puts it in a position of privilege in this new context full of empirical and conceptual changes.
Independently from the substantial positions held by utilitarian thinkers on bioethical matters, it is hard to deny that utilitarianism has had a crucial role in interrogating patterns of thinking which were taken for granted and in offering a contribution in reshaping moral thought. This is tied to the freedom of this theory from established moral traditions and traditional anthropological conceptions (e.g., the centrality of human beings in the cosmos; the centrality of certain moments such as birth, death, and sexuality; and the centrality of established codes which articulate the moral grammar of this anthropological picture).
This does not mean that utilitarianism in bioethics is free from preconceptions. Human and animal life and the world and the universe strike our individual and collective imagination and enter in the wider texture of our moral thought and of our moral actions also in the new setting in which we got rid of the old spell and past mysteries. Utilitarianism tends to overlook this dimension, the imaginative dimension of the vulnerability, ﬁnitude, and mortality of life and more generally the conditions of human life, that is, the background of facts, activities, and practices that give sense to our moral evaluations, showing their point.
The remaining of this entry will present some representative issues at the beginning and at the end of life, highlighting the appeal and the controversial aspects of utilitarianism alike with reference to its three constitutive criteria discussed above.
With respect to the notion of consequences, utilitarianism grants no importance to those moral distinctions grounded in the nature of actions with no repercussion on consequences. With regard to this, a ﬁrst issue is the distinction between actions and omissions. If omitting to do something has the same consequences than positively doing something else, from an ethical point of view action and omission are indistinguishable from each other. This point may be argued as follows: actions and omissions concern the conduct of the agent, while consequences typically concern those subjected to such conduct. Therefore, a too narrow focus on agents might make one lose sight of the very object of conduct altogether.
This is exactly what happened with euthanasia, where a distinction has been introduced between active and passive euthanasia, with the former referring to the positive pursue of the death of the terminally ill patient and the latter to the omission of determinate therapies, for example, mechanical ventilation. However, if the problems revolving around euthanasia were seen in this light only, ethical deliberation would appear more as the surreptitious search for a justiﬁcation of a particular medical practice rather than as the clear and honest search for the good of the patient. In its underestimation of the intrinsic importance of actions, utilitarianism thus encourages individuals to free from this kind of indulgence of the agent in relation to her moral purity, hence, possibly from the related self-deception and hypocrisy. However, this does not mean that utilitarianism is right in claiming that there is never any distinction between action and omission. Yet, even if there are plausible ways of – and reasons for – establishing such distinction, utilitarianism would still seem right in insisting on either its moral irrelevance for the most part of cases or the distorted and instrumental use usually made of it in the context of hospitals and medical care.
Because of its attention to individual consequences and preferences , utilitarianism widens the sphere and range of moral responsibility: it in fact claims that the physician is responsible not only for attending to her duties but also for what follows from her actions. Behind this observation there lies an important idea, namely, that one’s duties, while shaping one’s identity, can also narrow one’s responsibility. Duties connect one’s responsibility to some circumstances while leaving others to constitute the background of what merely happens and thus lies outside the scope of one’s moral attention. Utilitarianism widens the extent of one’s responsibility as it suggests we don’t look at actions themselves, at the way they might fulﬁll a principle or not, or at the way they might follow a duty or not, but rather at their consequences. An author such as Peter Singer (e.g., Singer 1993, 2004) implemented this idea in his writings on animal ethics as well as on world hunger and international justice. His work can, in fact, be read as an attempt to expand the range of individual and collective responsibility in these different (yet also intertwined) ﬁelds.
Another important point follows from this: duties like that of non-killing or that of the physician not harming the patient, and such important distinctions as that between actions and omissions, usually ﬁgure in traditional contexts. But in the context of the hospital, with, e.g., a person in intensive care and depending on machines, the meaning of the distinction between actions and omissions starts to fade and is not so clear anymore. Another distinction often called in cause in such contexts, that is, between ordinary and extraordinary means, which is congenial to deontological ethics as it allows it to rule out the duty to intervene with extraordinary means (hence securing the very ediﬁce of deontology), is borrowed from everyday contexts, where we seem to be prone to accept that there is a difference between denying food and water (the ordinary duty of the Good Samaritan) and denying breathing (perceived as extraordinary). But in the context of the hospital, these distinctions lose their hold and importance. In such contexts the very notion of killing loses its intensity, with the clarity associated with its prohibition fading away. In hospitals one’s life might in fact become profoundly artiﬁcial, and thus, it is not clear anymore if a certain action leading to death should be considered as a positive instance of killing. Utilitarianism is thus signiﬁcant in this sense: it seems able to account for the fact that in bioethics we have to do with technological innovations challenging and jeopardizing traditional ethical conceptions, traditional duties, and traditional ethical distinctions.
Analogous considerations hold for the problems surfacing at the beginning of life. In this area there has been a widespread appeal to nature in order to argue that human intervention interests biological processes that carry an intrinsic significance, which should be respected (see e.g., Jurgen Habermas, Ronald Dworkin). If the way in which we are born (but the same holds for other areas of human life such as dying) is radically altered, beyond a certain threshold, this is not a case of mere intervention to improve human life by freeing it from a certain disease or promoting new interests and thus well-being but rather amounts to a change in the background against which individuals judge something as good or bad – that is, the human life form – which might bring about the loss of the very capacity to judge in the ﬁrst place. However, this alternative approach underestimates completely the space of human individuality, that is, the space of the inventive ways in which human beings carved out some room from the magical and sacred power of nature. Nowadays, the creative and profoundly personal role of women in procreation, which ﬁnds in abortion the most dramatic pitch of the sovereignty over one’s body, gained currency by putting the point of view of women at the center of the stage. Furthermore, the very idea of a reproductive responsibility, extended to the issues of demography and to the wider social consequences of reproduction, has acquired an equally deﬁnite physiognomy by stressing its consequences for the shared life. In both cases utilitarianism had an important role. An author such as Mill wrote clearly that procreation cannot be left to chance but should rather be related to the responsibility of individuals, hence to the consequences of their actions. Now it is clear that this sense of responsibility has been earned by relocating the aura of sacredness of the biological processes leading to birth into that of the moral salience that they might have from the personal point of view.
Once again, there is a point about the actual situation and the latest developments of medical technology. Nowadays, when contemplating the possibility to intervene actively to facilitate birth, to nurse, and so on, utilitarianism seems to be the most promising approach. In fact it holds that there is nothing sacred in nature and that we should look at the consequences for human beings, for the ones involved, and for the community, even for the future one which we might anticipate. As absolute duties seem apt to account for past settings, the idea of paying respect to nature expresses a moral approach that does not seem able to keeping up with the ever new possibilities to know and intervene in nature. As a matter of fact, if one intends to derive an absolute inviolability from the sense of sacredness of certain natural processes, it would follow the illegitimacy of all medical practices involved in giving birth: but, evidently, a position of this kind would amount to giving up any moral advice in this sphere of human activity. By throwing away the very notion of absolute inviolability, utilitarianism has the resources to advice us about the various medical practices surrounding human birth and their moral stakes. Once again, utilitarianism looks like a much more promising ethical perspective to tackle bioethical issues than its competing normative theories.
However, despite having the conceptual resources to critically address the latest scientiﬁc changes and anthropological chances, contemporary utilitarianism does not always write compellingly about bioethical problems. What is somewhat lacking in the utilitarian thinkers writing on bioethics nowadays is the breadth and depth of a Mill, who thought that individual conduct should not be judged from the narrow moral point of view alone but should rather be assessed against the wider background of what makes human life signiﬁcant and worth living. Mill was a utilitarian thinker who did not want to repudiate the wide reaches and profundity of human imagination and judgment: his understanding of the principle of utility is informed by considerations about the admiration of human individuality, the appreciation of the depth of situations, and the capacity for sympathy featuring human relationships. These sorts of range and depth of human judgment seem lacking in utilitarian bioethics.
Utilitarianism And The Good
The idea that morality has to do with such modest things as expectations, joys, and individual suffering is an element of proximity of utilitarianism with one of the most signiﬁcant outcomes of modern moral culture: namely, the advent of the ordinary and the everyday life of normal – and, as such, equal – individuals. The idea according to which human beings are united and bonded in suffering and in joy is a revolutionary theme that modern moral culture has gradually imposed on the image of humanity as divided into ranks and categories, representing models of excellent life as set against the ordinary life. All great modern thinkers (Thomas Hobbes, John Locke, Baruch Spinoza, Jean-Jacques Rousseau, Immanuel Kant, John Stuart Mill) have been vindicating (in very different ways) the value of the ordinary life and the point of view of common people as against the scholarly knowledge of the few, the abuses of language and of reasoning pursued by the learned, and the reference to notions and visions disjoined from ordinary experience. Utilitarianism develops a version of this crucial line of modernity, putting at the center of the scene individuals and their preferences and interests.
Utilitarianism questions what is the good from the point of view of the individual actors involved. In the case of a patient with her capacity for choice, it is her preferences and expectations alone that matter from a moral point of view. This is the case, for example, with euthanasia, in which utilitarianism privileges the judgment of the individuals involved about the quality of their life. In other cases, such as that of assisted reproduction, what should be taken into consideration, apart from the woman’s (or the couple’s) preferences , are the hypotheses and previsions about the expected quality of life of the newborn. Whatever the considerations at stake, utilitarianism would dismiss the attempts to introduce in such previsions the image of such newborn that others might picture from their external point of view. Some might in fact hold that certain nontraditional forms of birth cast a bad light on the life of the newborn. But such considerations introduce from the outset personal elements affecting the judgment on the quality of life that the newborn might eventually want to reject later on. In these cases utilitarianism introduces an evaluation of the good life that gets rid of the idea that situations are noble and elevate, or rather shallow and disgraceful, independently from the judgment of the individuals involved. Utilitarianism simply does not admit the coherence and the very possibility of such judgments.
Things might be seen differently though. Objective judgments about goods might be coherent, but in refuting them utilitarianism is guarding us against the typical deformation that they might take: ﬁrstly, that of believing that it is always legitimate to express judgments about the good for others, hence assuming a hyper-moralistic conception of life rather than leaving the various spheres of life to the competence of those leading them and, secondly, the tendency to voice such judgments without the necessary affective grasp and knowledge of the circumstances, which requires the identiﬁcation with the perspective of the person involved. In this way, the sole appeal to the preferences of the person involved clears the ground of the problem from the outset.
Utilitarianism has been among the most powerful engines of philosophical reﬂection in bioethics thanks to its critical nature and goals. In this light utilitarianism can be read as a critical engine of our moral culture. If compared with the contemporary liberal paradigm, which ﬁnds its clearest expression in John Rawls (1971, 1993), understood in terms of the neutrality with respect to comprehensive moral cultures, utilitarianism stands out as a program characterized by the critique of moral culture. At the beginning as well as at the end of life, it in fact promotes a revision of the inherited moral culture, of traditional duties, and of the very picture of human nature. In doing so it also shows that it is illusory to believe that one can get clear about bioethical problems and suggest ways of conduct independently from the criticism (and the defense) of comprehensive moral visions.
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