Bentham, Mill, and Utilitarianism
Jeremy Bentham (1748–1832) was a one man social revolution. He was a lawyer who sought to reform the penal code. He designed the first high surveillance jail. He founded University College London. He drafted the first new South American constitutions for his friend Simon Bolivar. And when he died his will stated that his body should be stuffed and dressed in his clothes so that he could still preside over College Council at UCL (he was minuted as ‘present but not voting’). And he completely reinvented morality.
Bentham was an Enlightenment man. Morals must come not from authority or tradition, not from religious commands, but from reason. Bentham thought he had it sorted. He famously stated:
‘Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do. On the one hand the standard of right and wrong, on the other the chain of causes and effects, are fastened to their throne.’
Bentham's measure of morality therefore is whatever will lead to ‘the greatest happiness of the greatest number’ — Utilitarianism. To determine what is right we should simply aggregate the total pleasures and subtract the total pains reasonably foreseeable from any course of action. This is of course still the main criterion used in much public policy, including public health. Bentham believed it may be possible to construct a ‘felicific calculus’ by assigning values to pleasures that measure their intensity, their duration, their certainty, immediacy, tendency to lead to further pleasure, purity (from pain), and the number of people likely to benefit.
Maximising the public good is certainly an important part of public policy but it has two major problems. First, who is to say what is the greatest good? Bentham was never able to provide figures to put into his felicific calculus. Furthermore, to Bentham one pleasure is as good as another — ‘the quantity of pleasure being equal push-pin [a child's game] is as good as poetry’. Stuff opera, let's all watch X-Factor. Or why should we not just live on cocaine and care not for the consequences? John Stuart Mill therefore sought to modify Utilitarianism by recognising ‘higher’ pleasures as of greater value than ‘lower’ pleasures. But isn't that just upper class snobbery?
Also Utilitarianism has no time for justice. If the majority can find maximum total pleasure by steamrollering over the interests of a small minority then so be it: according to Utilitarianism it's moral. The trouble is we just know that it's not! So there must be something in us that accepts Utilitarianism only within certain limits, say in the overall allocation of resources, and yet sees that we need to ‘correct’ Utilitarianism when it is unjust or ignores the rights of minority groups. If you have to ‘correct’ an equation to get the right answer then perhaps there's something wrong with your theory!
CPD further study and reflective notes
The notes in Boxes 1 and 2 will help you to read and reflect further on any of the brief articles in this series. If this learning relates to your professional development then you should put it in your annual PDP and claim self-certified CPD points within the RCGP guidelines set out at http://bit.ly/UT5Z3V.
Box 1. Reflective notes
What are the advantages of a Utilitarian ethic in general practice?
What are the disadvantages of a Utilitarian ethic in general practice?
Box 2. Further reading
Primary source
Bentham J. An introduction to the principles of morals and legislation. Oxford: Clarendon Press, 1780. Reproduced by Kessinger Publishing.
Suggested reading: chapters 1 and 4 (pages 1–7 and 29–32 in Kessinger reprint.)
Further study
Stanford encyclopedia of philosophy.
Consequentialism http://plato.stanford.edu/entries/consequentialism/ (accessed 7 Jan 2013).
If your reading and reflection is occasional and opportunistic, claims in this one area should not exceed 10 CPD credits per year. However if you decide to use this material to develop your understanding of medical philosophy and ethics as a significant part of a PDP, say over 2 years, then a larger number of credits can be claimed so long as there is evidence of balance over a 5-year cycle. These credits should demonstrate the impact of your reflection on your practice (for example, by way of case studies or other evidence), and must be validated by your appraiser.
- © British Journal of General Practice 2013