Running head: DEONTOLOGY, ACT UTILITARIANISM AND THE PURSUIT OF AUTONOMY
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Deontology, Act Utilitarianism and Pursuit of Autonomy
Mina Pichtikova
McMaster University
Deontology, Act Utilitarianism and Pursuit of Autonomy
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Olive is a healthy 12-year-old girl, caught in the midst of a complicated ethical dilemma.
Her 10-year-old sister Nancy is at the end-stage of renal failure and requires a kidney transplant.
Upon conducting medical tests, it is determined that Olive is a donor match for her sister.
Initially, Olive is unwilling to donate her kidney. However, Olive’s parents Sylvia and Jack use
emotional pressure to eventually coerce her into agreeing to be a donor. Was the behaviour of the
parent’s ethical? Situations involving minors as live kidney donors for siblings are ethically
complex, as the donor receives no therapeutic value from the procedure and the term minor
encompasses a wide range of maturity levels (Kim, 2003). Deontology and Act Utilitarianism
ethical theories can be used to tackle this complicated dilemma, however, they come to different
conclusions. Deontology argues that the parents’ actions of coercing Olive into donating her
kidney were unethical, whereas Act Utilitarianism argues that they were ethical. However, Act
Utilitarianism overlooks one incredibly important ethical consideration: Olive’s autonomy.
Deontology is a non-consequentialist theory of obligation proposed by Immanuel Kant.
He proposes that what determines whether an action is moral or immoral is not the consequence
it leads to, but rather whether the general principle, or maxim, the action itself conforms to is
“right” or “wrong” under his formulations. The maxim is composed of the action one wishes to
undertake, followed by the reason to do so (Boetzkes & Waluchow, 2000). In this case, the
maxim would be “I may coerce someone to help someone else”. Kant provides three
formulations necessary to determine whether or not it is moral for Sylvia and Jack to act on their
personal maxim. In order to be moral, an action must pass all three formulations. The first
formulation, logical consistency, requires that one universalizes their personal maxim and then
Deontology, Act Utilitarianism and Pursuit of Autonomy
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assess it (Boetzkes & Waluchow, 2000). Upon acting on a personal maxim, Sylvia and Jack
theoretically agree that it should be a universal law, and thus generalizable to all other
individuals across similar situations. According to Kant, immoral maxims can never pass the first
formulation, because if they were to become universal laws they would lead to a contradiction
(Boetzkes & Waluchow, 2000). The maxim, in this case, leads to a contradiction because, in a
world where everyone coerced one another, free will would cease to exist. The second of Kant’s
formulations states that you must never treat people as a mere means, but always at the same
time as your ends (Boetzkes & Waluchow, 2000). Sylvia and Jack’s actions also fail the second
formulation, as they are using Olive as a means by coercing her into donating her kidney in order
to save their daughter Nancy. Furthermore, Kant emphasizes that treating an individual as an
ends means to treat them as a rational being. Sylvia and Jack’s actions also violated this by not
allowing Olive to make her own life choices and by not being willing to exchange and respond to
Olive’s reasons (Boetzkes & Waluchow, 2000). The final formulation requires that we always
respect the freedom and autonomy of rational agents, and allow them to act freely on their own
reasons. Sylvia and Jack’s actions also do not pass the third formulation, as they prevent Olive
from effectively exercising her reason by guilting, shaming, and coercing her into donating her
kidney (Boetzkes & Waluchow, 2000). In this case, all three of the formulations demonstrate that
Sylvia and Jack’s moral obligation is to refrain from acting on their personal maxim “I may
coerce someone to help someone else”, thus rendering their actions unethical. However, it is
important to note that deontology only applies to rational beings. Thus, I argue that at 12 years
old, Olive is a rational being. I do so on the bases that Piaget suggests that by 12 years old,
children are able to think logically in abstract ways (Piaget, 1972). In addition, medical literature
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provides empirical evidence that children approaching adolescence are already mature enough to
make decisions about their medical care (Council on Ethical and Judicial Affairs,1994).
Act Utilitarianism is a consequentialist theory proposed by John Mill, which argues that
an action is morally correct only if it produces the greatest possible degree of happiness (utility),
or the least degree of unhappiness (disutility) for all those affected by the action. In order to asses
this case through an Act Utilitarianism framework, we must first calculate the utilities and
disutilities for each possible action, for all those affected by the decision of the parents (Boetzkes
& Waluchow, 2000). All those affected are considered the “stakeholders”, they include Sylvia
and Jack, Olive, Nancy, non-immediate family members, and other individuals who require
medical services. If the parents coerced Olive into donating her kidney she would experience
short and long-term disutility, as she would undergo an invasive procedure and potentially suffer
psychological and physical side effects. However, all other stakeholders would experience
long-term utility, as Nancy would get to live, the parents would save their daughter,
non-immediate family members would not endure the burden of death, and valuable medical
resources such as energy, money, equipment, and time would become available to other patients
in need. In contrast, if the parents were to not coerce Olive into donating the kidney, Olive would
be the only one experiencing utility, whereas everyone else would experience disutility.
Therefore, we conclude that utility would be maximized for all stakeholders, on balance, if the
parents coerced Olive into donating her kidney. Thus, according to Act Utilitarianism, Sylvia and
Jack’s actions are ethical.
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Deontology and Act Utilitarianism leave us at a crossroad of contradiction—were the
actions of the parents ethical or unethical? Deontology claims that the actions of the parents were
unethical as they violated the three formulations, whereas Act Utilitarianism claims that they are
ethical as they yield the greatest degree of utility for all those involved. I argue that Deontology
arrives at the correct conclusion, as it manages to consider Olive’s autonomy, something that is
neglected by the Act Utilitarian theory (Boetzkes & Waluchow, 2000). Act Utilitarianism places
emphasis in maximizing the good consequences rather than maintaining the autonomy of the
individuals involved, thus only valuing autonomy as a means to maximizing happiness rather
than a fundamental principle of medical ethics (Murgic, Hébert, Sovic & Pavlekovic, 2015).
Thus, cases such as Olive’s demonstrate that in its pursuit of maximum utility, Act Utilitarianism
takes rights, such as the right to bodily autonomy, too lightly. Philosophers have even gone as far
as to say that autonomy has been fatally wounded by utilitarianism (Smart & Williams, 1973). In
contrast, Deontology is committed to maintaining the autonomy of individuals when considering
the morality of an action. It highlights the importance of treating others as rational beings who
have the right to exercise their autonomy (Boetzkes & Waluchow, 2000). Furthermore,
Deontology even recognizes that if one does anything that effectively stops a person from
exercising their reason, such as shaming, manipulation or coercion they are essentially
compromising the individual’s autonomy (Boetzkes & Waluchow, 2000) and thus acting
unethically. Thus, I assert that Deontology arrives at the correct conclusion as it considers
Olive’s autonomy and maintains her fundamental medical rights.
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Ultimately, both Act Utilitarian and Deontological ethics are relevant in medical practice
and must be considered through the lens of the context. Some ethical dilemmas have simple
solutions, whereas others such as Olive’s, serve to remind us of both the complexity and
necessity of medical ethics. Overall, such case studies demonstrate that patients’ lives depend not
only on the scientific understanding of their doctor, but also largely on the ethics which govern
them.
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References
Boetzkes, E., & Waluchow, W. J. (Eds.). (2000). Readings in health care ethics . Broadview
Press.
Council on Ethical and Judicial Affairs AMA. (1994). The use of minors as organ and tissue
donors. Code Med Ethics Rep , 5, 229-242.
Kim, C. (2003). Children as Live Kidney Donors for Siblings. AMA Journal of Ethics , 5(8),
240-242.
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: views
of patients and providers in a transitional (post-communist) country. BMC medical ethics ,
16(1), 65.
Piaget, J. (1972). Intellectual evolution from adolescence to adulthood. Human development,
15(1), 1-12.
Smart, J. J. C., & Williams, B. (1973). Utilitarianism: For and against. Cambridge University
Press.
