Abstract
Despite the prevalence of the terms utilitarianism and utilitarian in the health care and health policy literature, anecdotal evidence suggests that authors are often not fully aware of the diversity of utilitarian theories, their principles, and implications. Further, it seems that authors often categorically reject utilitarianism under the assumption that it violates individual rights. The tendency of act utilitarianism to neglect individual rights is attenuated, however, by the diminishing marginal utility of wealth and the disutility of a protest by those who are disadvantaged. In practice, act utilitarians tend to introduce moral rules and preserve traditional rules. At the same time, the tenability of rule utilitarianism is limited because it ultimately collapses into act utilitarianism or a deontological theory. Negative utilitarianism is a viable utilitarian variant only if we accept complete aversion to suffering, ie, if we disregard any forgone opportunities to increase pleasure. Finally, the adoption of preference utilitarianism requires us to accept the subjectivity of individual claims which may be perceived as unfair.
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Andrews, J. (accessed on May 30, 2003) Ethics: concepts and definitions. http://alumni.imsa.edu/∼jason/ethics_topics/definitions.html.
Arras, J. and Hunt, R. (1983) Ethical issues in medicine (p. 12). Palo Alto, California: Mayfield Publishing.
Bentham, J. (1776) A fragment on government.
Bentham, J. (1789) An introduction to the principles of morals and legislation.
Birnbacher, D. (1989) Neue Entwicklungen des Utilitarismus. In B. Biervert and M. Held (Eds.), Ethische Grundlagen der ökonomischen Theorie: Eigentum, Verträge, Institutionen. Frankfurt/Main, Germany: Campus Verlag.
Buchanan, J. (1981) Justice: a philosophical review. In: E.E. Shelp (Ed.), Justice and health care. Dordrecht, Netherlands: D. Reidel Publishing Company.
Cole, J.C. (accessed December 29, 2002) Objections to utilitarianism. www.cohums.ohio-state.edu/philo/people/gradstud/cole.253/130Lec9.rtf.
Dworkin, R. (1977) Taking Rights Seriously. Cambridge, Massachusetts: Harvard University Press.
Field, M.J., and Lohr, M.J. (1990) Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press.
Frankena, W. (1973) Ethics (pp. 87-8), 2nd ed. Englewood Cliffs, New Jersey, Prentice-Hall.
Gandjour, A. (2001) Is subjective well-being a useful parameter for allocating resources among public interventions? Health Care Analysis 9, 437–47.
Gauthier, D. (1986) Morality by agreement (p. 105). Oxford, England: Oxford University Press.
Hardin R. (1988) Morality within the limits of reason (p. 21). Chicago, London: The University of Chicago Press.
Harris, J. (1986) The survival lottery. In P. Singer (Ed.), Applied Ethics. Oxford: Oxford University Press.
Harsanyi, J.C. (1953) Cardinal utility in welfare economics and in the theory of risk-bearing. The Journal of Political Economy 61, 434–35.
Harsanyi, J.C. (1955) Cardinal welfare, individualistic ethics, and interpersonal comparisons of utility. The Journal of Political Economy 63, 309–21.
Harsanyi, J.C. (1982) Morality and the theory of rational behavior. In: A. Sen and B. Williams (Eds.), Utilitarianism and beyond. Cambridge, England: Cambridge University Press.
Harsanyi, J.C. (1998) A preference-based theory of well-being and a rule utilitarian theory of morality. In W. Leinfellner and E. Köhler (Eds.), Game theory, experience, rationality: foundations of social sciences, economics and ethics (p. 293). Dordrecht, Netherlands: Kluwer Academic Publishers.
Hausman, D.M. (1995) The impossibility of interpersonal utility comparisons. Mind 104(415), 473–90.
Hausman, D.M. and McPherson, M.S. (1996) Economic analysis and moral philosophy (p. 107). Cambridge, England: Cambridge University Press.
Hutcheson, F. (1755) A system of moral philosophy.
James, W. (1890) The principles of psychology. Cambridge, Massachusetts: Harvard University Press.
Kodoma, S. (accessed November 26, 2002) http://www.ethics.bun.kyoto-u.ac.jp/∼kodama/ethics/wordbook/rule_utilitarianism.html.
Locke, J. (1690) Two treatises of government. London, England.
Lyons, D. (1965) Forms and limits of utilitarianism (p. 137). London, England: Oxford University Press.
Lyons, D. (1976) Mill's theory of morality. Nous 10, 101–20.
Mautner, T. (accessed August 24, 2002) The Penguin Dictionary of Philosophy: consequentialism. http://www.utilitarianism.com/conseq.htm.
Mill, J.S. (1859) On liberty.
Mill, J.S. (1863) Utilitarianism.
Moore, A. (accessed December 29, 2002) Objections to utilitarianism. www.emich.edu/public/history/moore/phil100/objections%20to%20utilitarianism.htm.
Narveson, J. (1993) Moral matters. Peterborough, Ontario: Broadview Press.
Nozick, R. (1974) Anarchy, state and utopia. New York, New York: Basic Books.
Pindyck, R.S. and Rubinfeld, D.L. (1995) Microeconomics (pp. 433-7), 3rd edit ion. Englewood Cliffs, New Jersey: Prentice Hall.
Rawls, J. (1971) A theory of justice. Cambridge, Massachusetts: Harvard University Press.
Richardson, J. and Hall, J., Salkeld, G. (1996) The measurement of utility in multiphase health states. International Journal of Technology Assessment in Health Care 12(1), 151–62.
Robinson, J. (accessed August 8, 2002) Luck, duty and benevolence. http://www.elec.york.ac.uk/ visual/jar11/ethics/luckduty.html.
Roemer, J. (1998) Equality of opportunity. Cambridge, Massachusetts: Harvard University Press.
Rothbard, M.N. (1956) Toward a reconstruction of utility and welfare economics. In Sennholz M, ed. On freedom and free enterprise: the economics of free enterprise. Princeton, New Jersey: D. Van Nostrand Company.
Rothbard, M.N. (1962) Man, economy, and state. Princeton, New Jersey: D. Van Nostrand Company.
Ryan, R.M. and Deci, E.L. (2001) On happiness and human potentials: a review of research on hedonic and eudaimonic well-being. Annual Review of Psychology 52(1), 141–66.
Scanlon, T.M. (1991) The moral basis of interpersonal comparisons. In J. Elster and J.E. Roemer (Eds.), Interpersonal comparisons of well-being. Cambridge, New York: Cambridge University Press.
Sen, A. (1989) Rawls versus Bentham: an axiomatic examination of the pure distribution problem. In N. Daniels (Ed.)Reading Rawls: critical studies on Rawls's “A theory of justice.” Stanford, California: Stanford University Press.
Singer, P. (1986) Applied Ethics. Oxford: Oxford University Press.
Smart, J.J.C., and Williams, B. (1973) Utilitarianism for and against (p. 30). London, England: Cambridge University Press.
www.faithnet.freeserve.co.uk. (accessed February 20, 2003) http://www.faithnet.freeserve.co.uk
The Internet Encyclopedia of Philosophy (accessed November 26, 2002) http://www.utm.edu/research/iep/.
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Gandjour, A., Lauterbach, K.W. Utilitarian Theories Reconsidered: Common Misconceptions, More Recent Developments, and Health Policy Implications. Health Care Analysis 11, 229–244 (2003). https://doi.org/10.1023/B:HCAN.0000005495.81342.30
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DOI: https://doi.org/10.1023/B:HCAN.0000005495.81342.30