Utilitarian Principlism as a Framework for Crisis Healthcare Ethics

Abstract

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics-autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician-patient relationship is a deontological construct in which the physician's primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.

The role of patients in the governance of a sustainable healthcare system: A scoping review

“…The rational choice theory was also identified; this theory states that individuals depend on rational calculations to make rational choices that result in outcomes aligned with their own interests [ 37 , 52 ]. Utilitarian and deontological principles are essential to defining accountability, as these approaches emphasize concepts that encourage patient autonomy, such as informed choices and discussions of risks and benefits [ 57 ]. Much of this literature debated the most appropriate approach for patient responsibility for healthcare.…”

Civil servants’ integrity in public sector: the case of Nepal

“…Utilitarianism, often known as consequentialism, is a moral theory that argues that morally good action yields satisfaction and pleasure. Utilitarianism determines morality based on the outcome of the intervention, and states that the moral course maximizes value over non-value and seeks the most significant benefit for the greatest number of people ( Vearrier and Henderson, 2021 ). Whether an action is right or wrong depends on the ability of that action to maximize positive outcomes ( Tseng and Wang, 2021 ).…”

“…An action is deemed ethical if it has more positive consequences than negative ones. It states that an action is moral if it maximizes the happiness of many individuals ( Tzoanou, 2013 ), suggesting that harm to some may be acceptable concerning the overall net benefit to the group as a whole ( Vearrier and Henderson, 2021 ). An action is morally justifiable if it maximizes many people’s happiness and minimizes their harm ( Lawton et al., 2013 ).…”

“…(2017) ; Hubert and Van Montfort (2020) Utilitarianism An action is morally justifiable if it maximizes many people’s happiness and minimizes their harm Action is right or wrong depends on whether that action can maximize positive outcomes Maximizes value over non-value and seeks the greatest benefit for the greatest number of people Lawton et al. (2013) ; Vearrier and Henderson (2021) ; Tseng and Wang (2021) Kantian deontology ethics Emphasize the wrongness or rightness of behavior and actions rather than the rightness or wrongness of their consequences Evaluate actions by loci to duty and obligation Comply universal moral rules Action is ethically and morally commendable when it is performed for a sense of duty than self-interest Amundsen and Pinto De Andrade (2009) ; Tzoanou (2013) ; Lawton et al. (2013) ; Yuan et al.…”

Reduced utilitarian willingness to violate personal rights during the COVID-19 pandemic

“…It is important to contextualize our main finding, i.e., participants during the COVID-19 pandemic gave fewer utilitarian judgments in personal rights dilemmas. Meanwhile, another observed moral trend was broad adoption of utilitarian principles in facets of the healthcare domain [35], suggesting a shift from a more individualistic, notably deontological (non-utilitarian) medical approach to a focus on the net health benefit to populations (i.e., overall welfare). Our finding and this trend might not be mutually exclusive.…”