"The end justifies the means" - the morally right action is one that gives rise to the best consequences or outcomes. The action taken is justified as long as the consequences are for the greater good, so for example, lying might be okay in some situations if it promotes a much better outcome than the truth.

However, this ethical theory is incomplete. How does one define what the best outcome is? Examples of the different types of consequentialism aims at defining what the best outcome is:-

  • Utilitarianism
  • "The best outcome is one which promotes the most happiness, pleasure, and the absence of pain.
  • Egoism and Altruism
  • "Ethical egoism (selfishness) - choosing the action that is best for oneself. This can have a positive, negative or neutral effect on the welfare of others.
  • "Ethical altruism (selflessness) - choosing the action that benefits other's well-being apart from oneself.
  • Rule consequentialism
  • "Consequentialism at its core in promoting maximum good, but with certain fundamental rules that are seen as being important to follow. However, such rules that are chosen to follow will be based on the consequences that the selected rules will have.

- In some ways, rule consequentialism is essentially what a combination of consequentialism and duty-based ethics is.

Duty-based theories: Deontology
These are fundamental rules and duties to follow. This is because certain acts are seen as wrong no matter the consequences. E.g. Killing someone for their organs for transplantation in many other individuals. The killing is wrong. But conflicts occur when one has multiple duties to follow in a given scenario.

Different types of ways in dealing with conflicts:-

  • Kant's Moral theory
  • Modern duty-based theories
  • Prima Facie duties
Framework for Biomedical Ethics: Principlism
A more practical approach to ethical decision making. Four principles widely used to deal with ethical scenarios:-

  • Autonomy -
    Freedom of the patient to choose and be an advocate for their own health
  • Beneficence -
    What is considered to be of the patient's best interest
  • Non-maleficence -
    A counterbalance to beneficence. All treatments can in some way cause harm. The benefits of certain actions should be balanced against the amount of harm it can do. It has long been considered to be part of a doctor's duty of "first do no harm".
  • Justice -
    Equity and avoidance of unjustifiable discrimination.

In some ways, one might describe it as a combination of consequentialism and deontology; in essence, a rule consequentialism.

  • Autonomy and Justice
    consequentialism in what makes the patient and everyone else happy with the outcome, and societal impacts with regards to the distribution of resources and the overall positive outcome to society.
  • Beneficence and non-maleficence
    to weigh out the benefits and the duty of doing no harm to subsequently consider what is in the patient's best interest.
Dynamism is something which many medical students and doctors forget. It is the concept that scenarios and situations are forever changing, and the best interests or ideal decisions made at a particular time may not apply at a later time.

Care should always be taken when considering what the best course of action should be. Not doing anything can sometimes be ideal. As one famous saying goes, "It is better to do nothing than to do what is wrong". It may be that the decisions become easier to make when one returns to a problem or situation later on, or more often, that patients change their minds once they have had time to digest the information given to them, or when their disease process has progressed.

Try not to forget about dynamism.