Bioethics

Consequentialism is the view that the rightness of an action depends on its consequences. The best‐known form of consequentialism is utilitarianism, developed in the late eighteenth century by Jeremy Bentham and popularized in the nineteenth century by John Stuart Mill. They held that an action is right if it leads to a greater surplus of happiness over misery than any possible alternative, and wrong if it does not. By “greater surplus of happiness,” the classical utilitarians had in mind the idea of adding up all the pleasure or happiness that resulted from the action and subtracting from that total all the pain or misery to which the action gave rise. Naturally, in some circumstances, it might be possible only to reduce misery, and then the right action should be understood as the one that will result in less misery than any possible alternative.

The utilitarian view is striking in many ways. It puts forward a single principle that it claims can provide the right answer to all ethical dilemmas, if only we can predict what the consequences of our actions will be. It takes ethics out of the mysterious realm of duties and rules, and bases ethical decisions on something that almost everyone understands and values. Moreover, utilitarianism’s single principle is applied universally, without fear or favor. Bentham said: “Each to count for one and none for more than one.” By that he meant that the happiness of a peasant counted for as much as that of a noble, and the happiness of an African was no less important than that of a European – a progressive view to take when English ships were engaged in the slave trade.

Some contemporary consequentialists agree with Bentham to the extent that they think the rightness or wrongness of an action must depend on its consequences, but they deny that maximizing net happiness is the only consequence that has intrinsic value. Some of them argue that we should seek to bring about whatever will satisfy the greatest number of desires or preference. This variation, which is known as “preference utilitarianism,” does not regard anything as good, except in so far as it is wanted or desired. More intense or strongly held preferences would get more weight than weak preferences. Other consequentialists include independent values, like freedom, justice, and knowledge. They are sometimes referred to as “ideal utilitarians” but it is better to think of them, not as utilitarians at all, but as pluralistic consequentialists (because they hold several independent values, rather than just one).

Consequentialism offers one important answer to the question of how we should decide what is right and what is wrong, but many ethicists reject it. The denial of this view was dramatically presented by Dostoevsky in The Karamazov Brothers :

Imagine that you are charged with building the edifice of human destiny, the ultimate aim of which is to bring people happiness, to give them peace and contentment at last, but that in order to achieve this it is essential and unavoidable to torture just one little speck of creation, that same little child beating her chest with her little fists, and imagine that this edifice has to be erected on her unexpiated tears. Would you agree to be the architect under those conditions? Tell me honestly! 3

The passage suggests that some things are always wrong, no matter what their consequences. This has, for most of Western history, been the prevailing approach to morality, at least at the level of what has been officially taught and approved by the institutions of Church and State. The ten commandments of the Hebrew scriptures served as a model for much of the Christian era, and the Roman Catholic Church built up an elaborate system of morality based on rules to which no exceptions were allowed.

Another example of an ethic of rules is that of Immanuel Kant. Kant’s ethic is based on his “Categorical Imperative,” which he states in several distinct formulations. One is that we must always act so that we can will the maxim of our action to be a universal law. This can be interpreted as a form of Hare’s idea of universalizability, which we have already encountered. Another is that we must always treat other people as ends, never as means. While these formulations of the Categorical Imperative might be applied in various ways, in Kant’s hands they lead to inviolable rules, for example, against making promises that we do not intend to keep. Kant also thought that it was always wrong to tell a lie. In response to a critic who suggested that this rule has exceptions, Kant said that it would be wrong to lie even if someone had taken refuge in your house, and a person seeking to murder him came to your door and asked if you knew where he was. Modern Kantians often reject this hardline approach to rules, and claim that Kant’s Categorical Imperative did not require him to hold so strictly to the rule against lying.

How would a consequentialist – for example, a classical utilitarian – answer Dostoevsky’s challenge? If answering honestly – and if one really could be certain that this was a sure way, and the only way, of bringing lasting happiness to all the people of the world – utilitarians would have to say yes, they would accept the task of being the architect of the happiness of the world at the cost of the child’s unexpiated tears. For they would point out that the suffering of that child, wholly undeserved as it is, will be repeated a million fold over the next century, for other children, just as innocent, who are victims of starvation, disease, and brutality. So if this one child must be sacrificed to stop all this suffering then, terrible as it is, the child must be sacrificed.

Fantasy apart, there can be no architect of the happiness of the world. The world is too big and complex a place for that. But we may attempt to bring about less suffering and more happiness, or satisfaction of preferences, for people or sentient beings in specific places and circumstances. Alternatively, we might follow a set of principles or rules – which could be of varying degrees of rigidity or flexibility. Where would such rules come from? Kant tried to deduce them from his Categorical Imperative, which in turn he had reached by insisting that the moral law must be based on formal reason alone, which for him meant the idea of a universal law, without any content from our wants or desires. But the problem with trying to deduce morality from reason alone has always been that it becomes an empty formalism that cannot tell us what to do. To make it practical, it needs to have some additional content, and Kant’s own attempts to deduce rules of conduct from his Categorical Imperative are unconvincing.

Others, following Aristotle, have tried to draw on human nature as a source of moral rules. What is good, they say, is what is natural to human beings. They then contend that it is natural and right for us to seek certain goods, such as knowledge, friendship, health, love, and procreation, and unnatural and wrong for us to act contrary to these goods. This “natural law” ethic is open to criticism on several points. The word “natural” can be used both descriptively and evaluatively, and the two senses are often mixed together so that value judgments may be smuggled in under the guise of a description. The picture of human nature presented by proponents of natural law ethics usually selects only those characteristics of our nature that the proponent considers desirable. The fact that our species, especially its male members, frequently go to war, and are also prone to commit individual acts of violence against others, is no doubt just as much part of our nature as our desire for knowledge, but no natural law theorist therefore views these activities as good. More generally, natural law theory has its origins in an Aristotelian idea of the cosmos, in which everything has a goal or “end,” which can be deduced from its nature. The “end” of a knife is to cut; the assumption is that human beings also have an “end,” and we will flourish when we live in accordance with the end for which we are suited. But this is a pre‐Darwinian view of nature. Since Darwin, we know that we do not exist for any purpose, but are the result of natural selection operating on random mutations over millions of years. Hence there is no reason to believe that living according to nature will produce a harmonious society, let alone the best possible state of affairs for human beings.