Utilitarianism, equality, and public health in a world in turmoil

One of the ethical conflicts facing public health is that which pits utilitarian ethics against egalitarian ethics, that is, the principle of maximizing aggregate health against the principle of moral equality. Public health codes and guidelines usually incorporate both of these principles because the ethical objectives of public health pursue the greatest health for the population and respect for the equality of all people and greater equity in health. The conflict between the two is particularly evident in contexts of health care rationing. In such contexts, the utilitarian ethic is the winner, contrasting with equality and equity in public health. The thesis I defend here is that this conflict stems from a deficient interpretation of both ethics, which should be corrected as follows: on the one hand, utilitarianism should be interpreted on the basis of the principle of equality and not against it, and, on the other, egalitarianism should include utilitarian decisions when these are the best way to interpret the principle of equality. By way of conclusion, public health codes and guidelines should incorporate this reconciliation between utility and equality in order to better guide ethical decisions in public health, including tragic choices in contexts of rationing and disasters.