Utilitarianism, Deontology and Confidentiality

1. Utilitarianism, Deontology and Confidentiality Andrew Latus Ethics/Humanities/ Health Law Sept. 26/02

2. 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

3. 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

4. Course Web Page • http://www.ucs.mun.ca/~alatus/BSM1.html

5. 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

6. 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."

7. 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."

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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?

14. 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

15. 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)?

16. 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

17. Deontology • Asks us to focus on our duties • Respecting the autonomy of the patient • Helping the patient • Helping others

18. 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)