There is something very attractive about the straightforward idea that morality is all about maximising happiness and minimising misery: that one's actions are right insofar as they tend to that end, wrong insofar as they tend to decrease happiness or increase misery and morally neutral insofar as they tend to do neither. This idea, encapsulated in the Benthamite slogan "the greatest happiness of the greatest number," is the basis of all utilitarian theories of ethics, which, though they have their origins at least as early as Epicurus, were developed by Bentham, Sidgwick, and Mill in the 18th and 19th centuries and have been elaborated and refined extensively by a variety of recent philosophers. In my last article I discussed several sorts of ethical theory that reject the premise that ethics can be reduced to considerations of the consequences of actions, notably their effects on overall happiness and misery.
Whether or not these considerations should be a necessary part of an adequate theory of ethics, the common theme of what I called deontological theories was that they were certainly not sufficient. Some of these theories, notably Kant's, were, like utilitarianism, monist theories in that they relied (or purported to rely) on a single moral principle. Others-pluralist theories-relied on more than one, potentially conflicting, fundamental moral principle. Moreover, some were absolutist theories in that at least one moral principle was held to apply categorically and without exception while others were non-absolutist in that the principles were, as Ross put it, prima facie. At first sight medical ethics, as reflected in the codes of such bodies as the World Medical Association, seem to fit well into an absolutist deontological ethical system for they contain some moral rules that apply without exception and that explicitly or implicitly reject considerations of overall happiness and suffering.
For instance, the Declaration of Tokyo categorically rejects doctors taking part in torture. Some medical practitioners, on the other hand, see medical ethics as being basically utilitarian,' sometimes ruefully.2 In the rest of this article I shall try to outline the pros and cons of utilitarianism. Whether one ultimately accepts the theory (and I am inclined to reject even the most attractive version) it is important to understand
(1) that utilitarianism has become a complex cluster of moral theories based on the principle ofmaximising welfare and that simplistic criticisms based on simplistic accounts of the theory are inappropriate and
(2) that contemporary utilitarianism in several of its variants purports to encompass the ordinary prima facie "deontological" moral principles used in everyday moral and medicomoral decision making.