Utilitarianism in Public Health
How can we perceive and address ethical challenges in public health practice and policy? One way is by using ethical concepts to shed light on everyday practice. One does not have to be a specialist in ethics to do so. This document is part of a series of papers intended to introduce practitioners to some concepts, values, principles, theories and approaches that are important to public health ethics.
Many authors argue that public health interventions and programs are rooted in utilitarian ethics (Holland, 2007; Horner, 2000; Nixon & Forman, 2008; Rothstein, 2004; Royo‑Bordonada & Román-Maestre, 2015). For example, Royo-Bordonada and Román-Maestre write that “public health is in essence [...] utilitarian because it seeks to preserve the health status (something that contributes to the well-being of persons) of the maximum number of individuals possible, ideally the entire population” (2015, p. 3). Roberts and Reich (2002) also assert that the utilitarian perspective seems particularly intuitive to those working in public health. According to these authors, utilitarian ethics would therefore seem to be well suited as a theory for evaluating and justifying the morality of public health interventions and programs and, by extension, for determining what we should and should not do in the area of public health.
But what is utilitarianism? What are its main strengths? What are the main ways in which it has been critiqued? And what role should utilitarianism play in public health? In this short document, we will try to respond briefly to these four questions, showing, in particular, that the presumed link between public health practice and utilitarian ethics is not as evident as it may seem at first glance. Since utilitarianism is a normative ethical theory, we will begin by discussing what that means.