Utilitarianism for Physicians

Last week, we examined modern medical education through a Kantian lens. This week, we turn towards utilitarianism for another philosophical viewpoint.

If Kant asks whether a system is morally permissible based on how it treats individuals, utilitarianism asks a different question: does the system work?

Utilitarianism is the second major pillar of Western moral philosophy and stands in sharp contrast to Kant and deontological ethics. Rather than focusing on duties, universal rules, or the intrinsic worth of people as individuals, utilitarianism evaluates actions and systems by their consequences; a system is morally right if it produces the greatest overall good for the greatest number of people.

The core tenants of this ethical approach were first established by Jeremy Bentham (1738-1832) and later refined by John Stuart Mill (1806-1873). At its core, utilitarianism is consequentialist: outcomes matter more than intentions. It defines “good” in terms of overall well-being and treats each person’s happiness as equally important. Benefits and harms are added together across everyone affected to determine whether a system is justified.

In this framework, individuals matter, but primarily as contributors to a larger sum.

Viewed through a utilitarian lens, therefore, I believe modern residency training is morally permissible: a relatively small, temporary workforce provides continuous, life-saving care to millions of people. Residents knowingly enter the system, receive a salary, health insurance, structured paid time-off, and formal training, and emerge as fully credentialed physicians. The collective benefit to society, far outweighs the hardship experienced by any individual trainee.

From this perspective, the system does not need to be kind, it needs to be effective.

Utilitarianism does not ask whether long hours erode individual well-being, only whether those hours produce competent physicians and acceptable patient outcomes. It does not ask whether suffering is formative, only whether it is functional. Hardship is justified if it serves the greater good. Character is not the goal, output is.

This is why utilitarian reasoning would look favorably upon modern medicine. It aligns cleanly with metrics such as mortality rates, efficiency, coverage needs, and throughput. In utilitarian terms, benefits and harms are implicitly tallied as hedons and dolors: tens of thousands of lives saved, suffering alleviated, and access expanded annually are counted against exhaustion, burnout, and attrition among trainees. If residents burn out but patients receive healthcare, the balance still tips positive. If some leave the profession but the system continues to function, those losses are absorbed into the aggregate.

Where utilitarianism diverges most sharply from other ethical frameworks is not in its concern for outcomes, but in what it is willing to sacrifice to achieve them. It does not require that the process itself be morally enriching, only that it be net beneficial to society. Whether a system forms good people is secondary to whether it produces good results. This somewhat cold or callous stance is noted by utilitarianism's critics. 

This leaves an open question that utilitarianism itself cannot resolve: is medical training merely a system for delivering outcomes or is it also a moral practice concerned with who physicians become in the process? 

By its own standards, residency training may pass the utilitarian test. The numbers add up; the system functions; the public is served. And yet something feels incomplete. A purely consequential calculus may justify outcomes, but it does not necessarily capture the humanity, tenderness, and moral formation many of us believe medicine requires.

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