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

 http://www.ucs.mun.ca/~alatus/BSM1.html
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)