Presentation on theme: "Utilitarianism, Deontology and Confidentiality"— Presentation transcript:
1 Utilitarianism, Deontology and Confidentiality Andrew LatusEthics/Humanities/Health LawSept. 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 10-10:50Plenary session 11-11:50Read 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 uponApply the theories to Clinical Skills Case 1
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' EthicsDeontologists 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 theorye.g., The 'Golden Rule' - "Do unto others as you'd have them do unto you."
7 Kantian DeontologyImmanuel Kant ( ) 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 AutonomyA central element in many deontological theories is the idea of autonomyAutonomy = self + ruleRoughly, 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 Rationalityonly informed decisions are truly autonomousFreedom of Actionlack of coercionFreedom of Choiceavailability of alternative options
11 Problems with Deontology and Utiliarianism/Consequentialism Deontology: What if doing your duty has repugnant consequences?Kant on telling liesConsequentialism: 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 ChildressPrinciples of Biomedical EthicsThe ‘Georgetown Mantra’Now the dominant theory in medical ethicsUseful, but frustrating
13 Four Principles 1. Autonomy 2. Beneficence 3. Non-maleficence 4. Justice1 & 4 are deontological2 & 3 are consequentialistIt 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 importantThis is why Principilism annoys some people
15 Utilitarianism 1Focus on the consequences of maintaining confidentialityA tension: Should we focus onthe consequences of this case alone (act utilitarianism) oron general rules for maintaining confidentiality (rule utilitarianism)?
16 Utilitarianism 2Assessing consequences requires attention to the concrete details of the casee.g., the age of Aaron’s/Erin’s partnersyour assessment of how Aaron/Erin is likely to behave from here onwhat any test results might show
17 Deontology Asks us to focus on our duties Respecting the autonomy of the patientHelping the patientHelping others
18 Common Ground?In neither case is the duty to maintain confidentiality absoluteThe possible consequences of absolute confidentiality are too direOur duty to respect patient autonomy may be outweighed by our duty to help others (and the patient)