Utilitarianism has a long and illustrious pedigree having gone through numerous permutations in the hands of philosophers, economists and politicians who have been attracted to its potential social reform (Oliver, 2006) Despite the idea of utilitarianism being a simple one that has been prevalent throughout our history since the time of Epicurus it’s intertwining in such things as social policy development in the modern welfare state where it begins to take on complexity.
Utilitarianism is the idea that the moral worth of an action is determined by its contribution to happiness. It is the happiness, or utility, of the collective that is the key to this idea especially since the time of its most famous promoter if not creator Jeremy Bentham. This can be viewed in his most famous saying “it is the greatest happiness of the greatest number that is the measure of right and wrong” the idea that an action can only be seen as morally correct if it increases the happiness of the majority rather than the minority.
He later reworked this phrase so that the principle of utility is “that principle which states the greatest happiness of all those whose interest is in question, as being right and proper… ” (Bentham, 1789) It was Epicurus who first touched on the idea of utilitarianism. He claimed that the purpose of philosophy was to attain the happy tranquil life characterised by aponia, the absence of pain and fear and by living a self sufficient life surrounded by friends. (http://classics. mit. edu/Epicurus/princdoc. html)
Plato expounded a similar idea of utilitarianism when he dealt with happiness and ethical value in Dialogues. He saw that the more “self controlled (man) is, the more happy he will be” Critically, at the same time Plato saw that wisdom must be appropriated if happiness is to be fully realised as a failure in this “may invite aggression from rough neighbours, or may…lead to a species of smugness” (Lodge, 1966) Here we already have two different types of utilitarianism arising. One that deals with the individual and one dealing with the collective.
Bentham was supported by other leading utilitarian’s of the time including Hume, James Mill and his son John Stuart Mill. Mill saw a higher and lower pleasure stating that some pleasures are “more valuable than others” (Mill, 1863) and claimed that true happiness can only be pursued by those who have experienced both ‘good’ and ‘bad’ things as those “who are ‘competent judges’ will make their decision on this basis” (Mill, 1863) It is this idea of collective happiness that I will be dealing with further when discussing formulation of social policy.
Where Plato saw happiness through restraint on a man’s behalf of the vices of this world, Bentham saw happiness through actions which are judged morally by the consequences they produce. Because of this idea utilitarianism is seen as a form of consequentialism or teleology, which is the idea that the moral worth of an action depends upon its outcome. Therefore a right action would create the greatest amount of happiness. For example if a man was to be given five hundred thousand pounds to spend and spent it on a sports car for himself would be extremely happy and would get a large amount of enjoyment from it.
Yet if that man was to give the five hundred thousand pounds to a charity it would create a greater amount of happiness, therefore being the morally right thing to do. In terms of moral consequence, Bentham argued that we had been placed ‘under two masters’ pain and pleasure and that it was them and them alone that pointed out what we ought to do as well as determining what we shall do (Bentham, 1789). When he speaks of ought and shall he speaks of what would be morally correct from a universal point of view and what we shall do from a ‘what we want to do’ perspective.
It was Kant who came up with the ‘Formula of Universal Law’ or ‘First Formulation’ as it is also known where the moral imperative “requires that the maxims be chosen as though they should hold as universal laws of nature” (Kant, p436) this principle is based on the law that “Always act according to that maxim whose universality as a law you can at the same time will” and is the “only condition under which a will can never come into conflict with itself” (Kant, p. 437) This means that one should try to universalise every decision they make before doing so and decide whether its right universally.
For example killing someone in revenge for a sibling may be considered ‘right’ from your point of view, but what if anyone else was to kill that person. Can it be universalised? One criticism of Bentham at this point is that he viewed man as being basically selfish. “Human beings always act in pursuit of what they think will give them the greatest balance of pleasure over pain”. This is known as hedonism (www. centreforsocialjustice. org. uk) Bentham’s is the simplest form of hedonism, if you have more ‘pleasantness’ you’ll be happier, if you have more pain you’ll be worse off which he measured in duration and intensity.
When it comes to welfare and wellbeing utilitarianism plays its role and can be considered an important part. Wellbeing also known as ‘quality of life’ is at it says concerned with the quality of life of citizens that are affected by the broad social policies of its national governments. Well being itself consists of a greater balance of pleasure over pain, an idea known as ‘evaluative’ or ‘prudential’ hedonism. Wellbeing also goes somewhat hand in hand with welfare.
Welfarism is a sub section of welfare, an idea that Raz (1986) calls the ‘humanistic principle’, that is the “explanation and justification of the goodness or badness of anything that derives ultimately from its contribution, actual or possible, to human life and its quality. ” What is meant by this is that everything is considered in terms of how it affects human wellbeing. So if utilitarianism is the idea that the moral worth of an action is weighed in the consequences that it has and wellbeing is to do with the quality of someone’s life how does this affect social policy implementation.
First let us look at another concept of utilitarianism and wellbeing that of the objective list theory. One in particular influenced by Aristotle and developed by Thomas Hurka (1993) is that of the ‘good-maker’. Where what makes things constituents of wellbeing is their perfecting human nature, this can be said of social policies. Social policies are all pieces of government legislation which deal with the egalitarianism and wellbeing of citizens. It is a subject that “entails the study of the social relations necessary for human wellbeing and the systems to which wellbeing may be promoted. (Dean, 2006)
When coming to deal with social policy to do with health care provisions, the moral quandaries arise not in the question of whether to harm or benefit but how to harm and benefit: whom, how much, how certainly, in what ways” (Kelly and Giacomini 2005) The problems facing the public policy makers are how to “define, identify, justify and distribute inevitable benefits and harms, rather than simply striving to ensure benefit and avoid harm” (Kenny and Giacomini 2005, p. 54) If we were to look at immunisation the problems of utilitarianism and allocation can be seen quite clearly. Within the UK a huge amount of the health care expenditure is upon vaccination programmes. Yet these vaccination programmes are remaining a controversial issue on a large scale, look for example at the uproar around the MMR vaccine.
As well as this there is a difficulty for policy makers when it comes to trying to change such policies as immunisation is seen to confer popular belief (Hann and Peckham 2007) this uproar originally started in 1998 when it was “first suggest(ed) that the MMR vaccine might be linked to an increased risk of autism and bowel disorders (BBC NEWS) yet since there have been a variety of tests which show no evidence of this including a 2001 Autism Review which was commissioned by the Medical Research Council which looked at “MMR, amongst other possible factors, as a possible cause of ASDs” that is Autistic Spectrum Disorders The Council “It concluded that the current epidemiological evidence does not support the proposed link of MMR to ASDs. ” (www. nas. org. uk)
This can be directly related to Bentham’s ideas of utilitarianism whereby the greatest happiness comes from trying to vaccinate the greatest number of people. The vaccination is seen to provide the greatest happiness for everyone who is involved, yet at the same time with the furore surrounding MMR steps taken to change the MMR jab from being compulsory to being the individuals choice have a detrimental effect because more people will be affected by the virus despite them being given a small amount of happiness in the right to choose whether or not to have it.
In terms of provision and the “general happiness or benefit as a standard of right action, utilitarianism seems to satisfy the presumption that moral actions should be unselfish and fair” (Mackie, 1977) but how unselfish and fair is the decision making process when it comes to policy making for a system such as what we have in Britain. Dean (2006) addressed three interrelated questions of principles.
These were whether resources should be administered universally (that is on the same basis to everyone) or selectively (those who need or deserve them), whether it should be based on entitlement (with a system framework and rules) or discretion (as advised by experts and professionals) and finally whether it should be on a demand led (in response to public outcry) or rationed (where resources are limited) basis.
It is often the norm for countries to change each of these depending on unforeseen circumstances and newly elected governments and is often the case that governments will implement both factors too varying degrees within their health care provision. It is fair that everyone should be provided with the same basic level of provision, providing everyone with a minimum, an idea at the heart of the NHS with its ‘cradle to grave’ ‘safety net’ ideals. Yet at the same time some will be more deserving than others, dependant on age, level of need, or situation.
Utilitarianism clearly supports the ideal that everyone should be provided with the same basic level because it provides the greatest happiness for the greatest amount of people. But is this necessarily fair, after all would you provide the same level of care to some who didn’t need it as much as another.
In conclusion then despite the principle of utilitarianism being one of a seemingly philosophical nature dealing with the correct actions of man as Plato described the morality of universal law defining the consequences of action as seen in the works of Bentham and Kant, utilitarianism when evaluated in terms of the allocation and provision of health care services is actually both prominent and useful. Without the underlying idea’s of happiness of the greater number such services as provided by the NHS would not work efficiently or fairly, and would be controlled more in terms of a governments economy and expenditure plans.
Whilst these cannot be ruled out it is the fundamental idea of social justice and the quality of life that means its allocation and provision is much more effective and provides an overall universal happiness allowing it to deal with sudden rises in demand and obstacles as the furore around the MMR jab. Without utilitarianism these would not be considered and a much more wide ranging detrimental effect could be created.