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

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 ( ) 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)