Utilitarian bioethics

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Utilitarian bioethics refers to the branch of bioethics that incorporates principles of utilitarianism to directing practices and resources where they will have the most usefulness and highest likelihood to produce happiness, in regards to medicine, health, and medical or biological research. [1] [2]

Contents

Utilitarian bioethics deals with whether or not decisions of biology or medicine are good based on the Greatest Happiness principle, and thus any action or decision that leads to happiness for the greatest number of people is good. [1] Many see problems with the morality of utilitarian bioethics, citing moral dilemmas in medical research and triage for example. Still, proponents for utilitarian bioethics look toward models like quality-adjusted life years (QALY) and medical policies like the Texas Advanced Directives Act (TADA) and euthanasia in the Netherlands as advancements in modern health care, while dissenting views argue of its devaluing of individual human life.

History

Although utilitarian philosophy traces itself back to the nineteenth century British thinkers John Stuart Mill and Jeremy Bentham, the application of utilitarianism in contemporary bioethics originated in the work of Peter Singer in the 1970s and 1980s. A second generation of utilitarian bioethicists, including Julian Savulescu, Jacob M. Appel and Thaddeus Mason Pope, advanced utilitarian ethics further in the 1990s and 2000s. A few applications of the utilitarian bioethics in policy are the Groningen Protocol in the Netherlands and the Advance Directives Act in Texas.

In the 1990s, backlash against utilitarian bioethics emerged, led by such figures as Wesley J. Smith and novelist Dean Koontz. [3] [4] Philosopher Bernard Williams was also critical of the utilitarian perspective.

Morality

Those against utilitarian principles in research, health care, or bio-medical fields suggest that the means to achieve an overall benefit for society is not justified and becomes immoral, and anyone who is part of the act or who is involved in it being allowed is complicit in its immorality. [5] They argue that utilitarianism fails to join itself with common morality, and thus the cannot be accepted as a moral, and any application of utilitarian principles are unethical. [6]

Those in favor of utilitarian principles in research, health-care, or bio-medical fields seek advancements in these areas for the benefit of all people and the collective happiness as a species. [1] They view, what those who are against utilitarian ethics would suggest as immoral acts, as good and necessary practices as a means to maximize total well-being, and the arguably controversial research and medical practices are good and beneficial to all people. [7] Many who argue for the morality of utilitarian principles in research and medical areas point to our already accepted model of disaster triage, inherently utilitarian, which seeks to do the greatest amount of good for the greatest number of people by foregoing treatment of those in critical conditions for those who have a higher chance to recover and those that can be quickly cared for to then help in the care effort. [8]

Resource distribution

The image shows children having fun, relating to quality of life. QALY is a measurement of how many quality years of life someone is expected to experience due to a particular choice from a number of choices. Happiness lies through the lens.jpg
The image shows children having fun, relating to quality of life. QALY is a measurement of how many quality years of life someone is expected to experience due to a particular choice from a number of choices.

Utilitarian bioethics is based on the premise that the distribution of resources is a zero-sum game, and therefore medical decisions should logically be made on the basis of each person's total future productive value and happiness, their chance of survival from the present, and the resources required for treatment. One way to grasp an effective way to distribute resources is by cost-effective analysis. Utilitarian bioethicists argue that cost-effective analysis is the most effective tool in distributing and utilizing resources so to maximize the best possible outcome with the idea that the outcome would lead to a benefit or increased happiness for society. [9] One example of cost-effective analysis in regard to health care is the concept of quality-adjusted life years or QALY. QALY is a measure of benefit from treating or allocating resources to individuals based on the comparison of each individuals alternative outcome. Although there is controversy in regard to the equality of persons in this concept, equality should be regarded as a separate issue, because if one uses a standard of measurement that produces the same amount of qalys for each individual, as proposed by G.W. Torrance one of the economist credited to the creation of the concept, then there is unfairness when we consider different age groups, with the elderly getting a lower amount of qalys. [10]

Some this method of resource allocation as mechanical and devoid of human emotion, and argue for an augmented form of cost-effective analysis which seeks to correct this, called the Kevany Riposte. The Kevany Riposte is similar to the traditional cost-effective analysis method in that it compares alternative choices and their cost-effective ratio, but adds and additional element to the equation which is called the diplomatic value. [11] This added element to resource allocation takes into account the future diplomatic and political effects of a decision, which shows how choices can have a future improvement and be more advantageous in the long run, though less cost-effective in the outset. [11]

For many resource allocation decisions, those involving the most rare and severe cases, medical culture and society are at odds and the choice of where to distribute resources will inevitably cause some ethical offense. [12]

Policy

Though not the principle moral framework for guiding laws, utilitarian ethics can be seen in a number of different areas of state and federal laws, especially those involving resource distribution and health policies.

TADA and Futile Care

In 1999, with the passing of the TADA, Texas became the first state to have a law on the books that deals directly with futile medical care. Section 166.046, Subsection (e) of the law states physicians have the right to refuse any intervention they deem as inappropriate. Utilitarian ethics would allow for such a decision given that if there is no benefit from the intervention, than resources as being used ineffectively and therefore effecting others in society, decreasing overall happiness. Some argue that the law is inherently flawed, in that what some physicians find futile-care, others might not agree. [13] And even more, some argue that the very law itself demeans the value and dignity of human life. [14] There have also been cases where the physicians who determined that treatment being done was futile-care were actually not so, which lead to possibly avoidable death. [14] Given its criticisms, many applaud TADA for its groundbreaking development into medical policy and see it as a step forward to better health care.

The Groningen Protocol and Neonatal Euthanasia

Euthanasia in the Netherlands has been legal for sometime, albeit not for infants. However, neonatal euthanasia still occurs in the Netherlands with a general tolerance by society and no physicians or associated parties going to trial. [15] The Groningen Protocol sought to provide an ethical framework to allow for euthanasia of infants with severe medical diagnosis and prognosis. [15] Many believe that the protocol cannot be followed because the criteria of the protocol cannot be met by neonates, namely the quality-of-life and pain and suffering criteria. [15] [16] Those against the protocol believe in the value of principlism, that of beneficence and non-maleficence, and that the physician should care for the infant with the best of their ability. [16] Proponents of the protocol argue that if there is unanimous agreement for the euthanizing of the neonate among those who are in the best position to make that decision, the parents and physicians, then euthanizing is in severe cases is a good and not immoral. [17]

See also

Related Research Articles

Applied ethics refers to the practical aspect of moral considerations. It is ethics with respect to real-world actions and their moral considerations in the areas of private and public life, the professions, health, technology, law, and leadership. For example, the bioethics community is concerned with identifying the correct approach to moral issues in the life sciences, such as euthanasia, the allocation of scarce health resources, or the use of human embryos in research. Environmental ethics is concerned with ecological issues such as the responsibility of government and corporations to clean up pollution. Business ethics includes questions regarding the duties or duty of 'whistleblowers' to the general public or their loyalty to their employers.

Euthanasia is the practise of intentionally ending life to eliminate pain and suffering.

In ethical philosophy, utilitarianism is a family of normative ethical theories that prescribe actions that maximize happiness and well-being for all affected individuals.

Bioethics is both a field of study and professional practice, interested in ethical issues related to health, including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine, ethical education in science, animal, and environmental ethics, and public health.

Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.

This Index of ethics articles puts articles relevant to well-known ethical debates and decisions in one place - including practical problems long known in philosophy, and the more abstract subjects in law, politics, and some professions and sciences. It lists also those core concepts essential to understanding ethics as applied in various religions, some movements derived from religions, and religions discussed as if they were a theory of ethics making no special claim to divine status.

The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of this right is often understood that a person with a terminal illness, incurable pain, or without the will to continue living, should be allowed to end their own life, use assisted suicide, or to decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

Stephanie Keene, better known by the pseudonym Baby K, was an anencephalic baby who became the center of a major American court case and a debate among bioethicists.

Futile medical care is the continued provision of medical care or treatment to a patient when there is no reasonable hope of a cure or benefit.

<span class="mw-page-title-main">Quality-adjusted life year</span> Measure of disease burden

The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0 (dead). QALYs can be used to inform health insurance coverage determinations, treatment decisions, to evaluate programs, and to set priorities for future programs.

Eduard Verhagen is an attorney and the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG). He is mainly known for his involvement in infant euthanasia in the Netherlands.

Voluntary euthanasia is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years.

The Groningen Protocol is a medical protocol created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG) in Groningen, the Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" without fear of legal prosecution.

<span class="mw-page-title-main">Julian Savulescu</span> Australian philosopher and bioethicist

Julian Savulescu is an Australian philosopher and bioethicist of Romanian origins. He is Chen Su Lan Centennial Professor in Medical Ethics and director of the Centre for Biomedical Ethics at National University of Singapore. He was previously Uehiro Chair in Practical Ethics at the University of Oxford, Fellow of St Cross College, Oxford, director of the Oxford Uehiro Centre for Practical Ethics, and co-director of the Wellcome Centre for Ethics and Humanities. He is visiting professorial fellow in Biomedical Ethics at the Murdoch Children's Research Institute in Australia, and distinguished visiting professor in law at Melbourne University since 2017. He directs the Biomedical Ethics Research Group and is a member of the Centre for Ethics of Pediatric Genomics in Australia. He is a former editor and current board member of the Journal of Medical Ethics, which is ranked as the No.2 journal in bioethics worldwide by Google Scholar Metrics, as of 2022. In addition to his background in applied ethics and philosophy, he also has a background in medicine and neuroscience and completed his MBBS (Hons) and BMedSc at Monash University, graduating top of his class with 18 of 19 final year prizes in Medicine. He edits the Oxford University Press book series, the Uehiro Series in Practical Ethics.

The Rule of Rescue is a term coined by A.R. Jonsen in 1986 that is used in a variety of bioethics contexts:

<span class="mw-page-title-main">Ezekiel Emanuel</span> American oncologist and bioethicist

Ezekiel Jonathan "Zeke" Emanuel is an American oncologist, bioethicist and senior fellow at the Center for American Progress. He is the current Vice Provost for Global Initiatives at the University of Pennsylvania and chair of the Department of Medical Ethics and Health Policy. Previously, Emanuel served as the Diane and Robert Levy University Professor at Penn. He holds a joint appointment at the University of Pennsylvania School of Medicine and the Wharton School and was formerly an associate professor at the Harvard Medical School until 1998 when he joined the National Institutes of Health.

Non-voluntary euthanasia is euthanasia conducted when the explicit consent of the individual concerned is unavailable, such as when the person is in a persistent vegetative state, or in the case of young children. It contrasts with involuntary euthanasia, when euthanasia is performed against the will of the patient.

<span class="mw-page-title-main">Philosophy of healthcare</span>

The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of their life. This perennial concern is especially prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life.

Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country since the end of the Third Reich to decriminalize euthanasia for infants with hopeless prognosis and intractable pain. Nine years later, Belgium amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. Like euthanasia, there is world-wide public controversy and ethical debate over the moral, philosophical and religious issues of child euthanasia.

Critics of euthanasia sometimes claim that legalizing any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.

References

  1. 1 2 3 Broome, John (1999). Ethics out of Economics. Cambridge, United Kingdom: Cambridge University Press. p. 19. ISBN   0-511-03657-4.
  2. ↑ "Definition of BIOETHICS". www.merriam-webster.com. Retrieved 2019-05-01.
  3. ↑ Harris, Kathy. One Door Away From Heaven', Fort Worth Star-Telegram , Feb 14, 2002
  4. ↑ Colon, Alicia. "When Killing An Ill Infant 'Is Not Wrong, The New York Sun, December 3, 2004
  5. ↑ Sullivan, Dennis; Costerisan, Aaron (2008). "Complicity and Stem Cell Research: Countering the Utilitarian Argument". Ethics & Medicine. 24 (3): 151–158, 131 – via EBSCO.
  6. ↑ Strong, Carson (2006). "The Limited Utility of Utilitarian Analysis". The American Journal of Bioethics. 6 (3): 65–67. doi:10.1080/15265160600686141. PMID   16754461. S2CID   13156908.
  7. ↑ Savulescu, Julian; Birks, David (2012). "Bioethics: Utilitarianism". eLS. doi:10.1002/9780470015902.a0005891.pub2. ISBN   978-0470016176.
  8. ↑ Wagner, Jacqueline M. (2015). "Nursing Ethics and Disaster Triage: Applying Utilitarian Ethical Theory". Journal of Emergency Medicine. 41 (4): 300–306. doi:10.1016/j.jen.2014.11.001. PMID   25510208.
  9. ↑ Lamb, Emmet J. (2004). "Rationing of Medical Care: Rules of Rescue, Cost-Effectiveness, and the Oregon Plan: Presidential Address". American Journal of Obstetrics and Gynecology. 190 (6): 1636–1641. doi:10.1016/j.ajog.2004.02.054. ISSN   0002-9378. PMID   15284761.
  10. ↑ Broome, John (1999). "QALY". Ethics out of Economics. Cambridge, United Kingdom: Cambridge University Press. ISBN   0-511-03657-4.
  11. 1 2 Kevany, Sebastian; Matthews, Marcus (2017). "Diplomacy and Health: The End of the Utilitarian Era". International Journal of Health Policy and Management. 6 (4): 191–194. doi:10.15171/IJHPM.2016.155. PMC   5384981 . PMID   28812802.
  12. ↑ Boyd, Kenneth M. (1983). "The Ethics of Resource Allocation". Journal of Medical Ethics. 9 (1): 25–27. doi:10.1136/jme.9.1.25. ISSN   0306-6800. PMC   1060847 . PMID   6834399.
  13. ↑ Kapottos, Michael; Youngner, Stuart (2015). "The Texas Advanced Directive Law: Unfinished Business". The American Journal of Bioethics. 15 (8): 34–38. doi:10.1080/15265161.2015.1047998. PMID   26225515. S2CID   41691307.
  14. 1 2 Capone, Ralph A.; Grimstad, Julie (2014). "Futile-Care Theory in Practice". National Catholic Bioethics Quarterly. 14 (4): 619–624. doi:10.5840/ncbq201414465. ISSN   1532-5490.
  15. 1 2 3 Debois, B.; Zeegers, J. (2015). "Euthanasia of Newborns and the Groningen Protocol". European Institute of Bioethics.
  16. 1 2 Vizcarrondo, Felipe E. (2014). "Neonatal Euthanasia: The Groningen Protocol". The Linacre Quarterly. 81 (4): 388–392. doi:10.1179/0024363914Z.00000000086. PMC   4240050 . PMID   25473136.
  17. ↑ Tedesco, Matthew (2017). "Dutch Protocols for Deliberately Ending the Life of Newborns: A Defence". Journal of Bioethical Inquiry. 14 (2): 251–259. doi:10.1007/s11673-017-9772-2. PMID   28220355. S2CID   13782975.


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