The Basics of Theory
Michael A. Gillette, Ph.D.

Over the past several months, in dealing with the ethical issues involved in the allocation of scarce resources, I have made mention of several approaches to ethical decision making that rely on specific ethical theories. I realize now that I have not taken time in this newsletter to provide a quick overview of basic ethical theory since July of 1994. To remedy that lapse, I now provide a reprint of the 1994 article.

In discussing issues in medical ethics it is routine to mention that some particular action is wrong because it ignores someone's rights, or that some other action is obligatory because someone has a right to be treated in a certain way. We often become so engaged in the practical discussion that we take "rights-talk" for granted, without ever wondering what "rights" are, where they come from, or even if they actually exist.

There are many ethical theories that support a belief in rights. It is important to note, however, that one of the most significant and influential ethical theories has denied the existence of any sort of natural rights.

Utilitarianism is based on the view that what makes an action right is the good consequences it creates. The utilitarian believes that it is always right to do the greatest good for the greatest number. 'Good' is usually understood to mean 'happiness', so utilitarianism has often been referred to as the greatest happiness principle. If the world is a happier place, the utilitarian reasons, it is a better place. Therefore, we should always try to increase happiness and decrease unhappiness in the world. That is all there is to ethics, according to this view, and the notion that people have natural rights is incorrect.

Utilitarianism has its advantages. It is simple, intuitively plausible, and we use it all the time. Every time we make a cost-benefit analysis we are being utilitarians. Every time a soldier dies for the greater good, or we build a new highway while knowing that traffic fatalities will result, we are judging that the sacrifice is worth making and that the greatest good will follow. Utilitarianism also allows that the ends can justify the means, however, and this seems dangerous. Are there no limits on our search for happiness? Are there no rights that we must respect regardless of the consequences?

Many have argued that utilitarianism cannot be correct since it treats people as things to be used to increase happiness. According to utilitarianism, a lie is morally justified, a killing is morally required, and intentionally causing suffering to innocent people is acceptable if, in the long run, the ends will justify these actions. This can't be right, many have reasoned. People are more than mere things to be used, we are autonomous beings with feelings and desires that must be respected. This way of thinking has led to the development of many non-utilitarian moral views that recognize human rights that can act like trump cards when pitted against utility.

Rights theories come in many shapes and sizes but one of the most popular versions is based on the dictate that we must always treat people as ends in themselves, objects with intrinsic value, never only as means to something else, like tools that can be used up and then thrown away. This way of thinking is attractive. It elevates people to a higher moral level. But is it true that we can never use other people to satisfy our needs? If we could never use other people how can we justify drafting people for war, killing in self-defense, entering into favorable business deals or even paying someone to serve us food in a restaurant? It seems that a middle-of-the-road approach between utility and rights theory is needed. The following example illustrates one possible alternative.

Suppose that my child is the type of person who would benefit from a good college education. In fact, we might suppose, she could really benefit most from a small college atmosphere that can be found at a private liberal arts college that is very expensive. Why is it that I must be the one to arrange to pay for that education? Why can't I prevail upon my neighbor, who has known my child since her birth, to contribute to the education fund? The answer is simple. I must provide for my child because she is my child. As her father I have some special obligations to my daughter that no one else has, except perhaps her mother.

This example shows that many of our moral obligations depend upon the relationships that we have to others. Much of what we need to do is based on the roles we play in life. Why must a ship captain go down with the ship? Why must a doctor treat the sick? Because these people have accepted the duties which their professions entail.

Virtue theory says that people must always act consistently with the roles they play in life. As citizens, family members, professionals, and friends we play certain roles that place special obligations upon us. If we can tell the stories of our lives and thus identify our own roles, we will know what it is right for us to do.

This theory is strong. But just like each of the other theories which I have just described, it does have its problems. From which roles am I allowed to choose? Who defines a role? How do I know when it is time to abandon a particular role in order to satisfy another role that I play? These are just a few examples of the types of questions which a discussion of Virtue Theory will raise.

As the above discussion shows, the theoretical view that one holds is very likely to impact in important ways the practical approach that one takes to specific problems. Depending on which view a person adopts, the central ethical issues involved will be defined differently. The value of theory is not just to be a direct guide to action, but also to be a tool for framing problems. Next month, we will see how these views can help us deal with the problem of gossip.