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# Utilitarianism in medicine

- Theory

Utilitarianism judges acts by their consequences: what produces the greatest total well-being is right.

Updated Nov 13, 2026

## Key points

- Right is what maximises total well-being; each person counts equally (impartiality).
- Bentham (1789): pleasure and pain; Mill (1861): there are higher and lower pleasures.
- Act utilitarianism assesses each action; rule utilitarianism assesses general rules.
- In medicine: public health, vaccination, disaster triage, resource allocation and cost-effectiveness analysis.
- Classic criticism: the transplant case (killing one to save five) shows it can override rights.

## What it is

Utilitarianism is the best-known form of consequentialism: an act is right if it produces the best outcome for everyone affected, counting each person's well-being equally. Jeremy Bentham (An Introduction to the Principles of Morals and Legislation, 1789) based it on pleasure and pain, and proposed measuring them by intensity, duration, certainty, propinquity, fecundity, purity and extent. John Stuart Mill (Utilitarianism, 1861) added that pleasures differ in quality, not only in quantity. Henry Sidgwick (1874) systematised it. Today act utilitarianism, which assesses each action, is distinguished from rule utilitarianism, which assesses the rules whose general acceptance would give the best results. In medicine, utilitarian reasoning dominates public health, triage and health technology assessment. This page goes deeper than the summary in «Ethical theories in brief».

## Core ideas

- Consequentialism: only outcomes determine whether an act is right.
- Well-being: the good being measured (pleasure, preference satisfaction or health).
- Aggregation: the well-being of everyone affected is added up.
- Impartiality: a stranger's well-being weighs the same as a relative's.
- Maximisation: the option with the greatest balance of good over bad is chosen.

## Act and rule utilitarianism

| Aspect | Act | Rule |
| --- | --- | --- |
| What it assesses | Each concrete action | The rules whose general acceptance gives the best results |
| Transplant case | Seems to allow killing one to save five | Forbids it: the rule would destroy trust and cause more harm |
| Criticism | Overrides individual rights | May collapse into act utilitarianism or follow a rule that makes things worse in the case |

## In clinical practice

- In a mass-casualty disaster, triage prioritises those who benefit most from the available resources: this is utilitarian reasoning.
- Vaccination programmes justify small individual burdens by a large collective benefit.
- Quality-adjusted life years compare interventions to get more health from the same budget.
- Rule utilitarianism explains why organs are not taken from a healthy patient: such a rule would destroy trust in doctors and cause more harm.

## Criticisms and limits

- It can justify sacrificing one person or a minority if the total improves (the transplant case).
- It is indifferent to distribution: a larger sum can hide that a few bear all the harm.
- Measuring and comparing different people's well-being is hard and can discriminate against older or disabled people.
- It is very demanding: almost any everyday act could be wrong if another one has better results.
- In Colombia, the Constitution mentions the prevalence of the general interest (art. 1), but within respect for human dignity, which limits the utilitarian calculation.

## Test yourself

Think of the answer, then tap the question to see it.

## What makes an act right according to utilitarianism?

Producing the greatest total well-being for everyone affected, counting each person equally.

## How did Mill differ from Bentham?

Mill held that pleasures differ in quality, not only in quantity; intellectual pleasures are higher than merely sensual ones.

## How does rule utilitarianism answer the transplant case?

It forbids killing the healthy patient because a rule allowing it would destroy trust in doctors and cause more harm.

## Which medical decision is a typical example of utilitarian reasoning?

Triage in a mass-casualty disaster, which prioritises those who benefit most from the available resources.

## What criticism does distributive justice make of utilitarianism?

That it looks only at the total and can hide that a few bear all the harm.

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## Connections

## Related 4

- [Ethical theories in brief: duty, consequences, virtue, casuistry, care](https://durgical.com/en/medical-ethics/ethical-theories-in-brief-duty-consequences-virtue-casuistry-care/)
- [Allocating scarce resources and triage](https://durgical.com/en/medical-ethics/allocating-scarce-resources-and-triage/)
- [Justice: fair distribution and equal treatment](https://durgical.com/en/medical-ethics/justice-fair-distribution-and-equal-treatment/)
- [Kantian ethics: duty and persons as ends](https://durgical.com/en/medical-ethics/kantian-ethics-duty-and-persons-as-ends/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [The History of Utilitarianism](https://plato.stanford.edu/entries/utilitarianism-history/) (Stanford Encyclopedia of Philosophy, 2025); [Consequentialism](https://plato.stanford.edu/entries/consequentialism/) (Stanford Encyclopedia of Philosophy, 2023); [Constitución Política de Colombia 1991](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=4125) (Función Pública, Gestor Normativo, 1991).

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