The Utilitarian Lens evaluates ethical decisions by examining consequences and outcomes. According to the Markkula Center for Applied Ethics, utilitarianism asks decision-makers to choose the action that produces the greatest overall good while minimizing harm for the greatest number of people affected.

The Utilitarian Lens emphasizes:

• System-wide safety

• Risk reduction

• Efficiency

• Protection of vulnerable populations

Unlike the Rights Lens, which prioritizes individual autonomy, the Utilitarian Lens focuses more heavily on collective impact and overall outcomes. Decisions are considered ethical when they maximize benefits and reduce suffering across the larger system.

Applying the Utilitarian Lens

Using the Utilitarian Lens, the primary ethical responsibility becomes minimizing harm and promoting the greatest overall good for everyone affected by the decision.

This lens asks:

• Which decision results in the fewest preventable medical complications?

• Which approach protects the largest number of residents?

• What action creates the safest overall environment?

• What are the broader consequences of allowing high-risk swallowing behaviors?

Under this framework, administrators like Sofia may argue that enforcing texture-modified diets helps reduce:

• aspiration events,

• choking incidents,

• hospitalizations,

• pneumonia risk,

• staff distress,

• legal liability,

• and regulatory consequences.

The Utilitarian Lens also considers the impact on:

• nursing staff,

• other residents,

• families,

• facility operations,

• public trust,

• and healthcare resources.

From this perspective, preventing one severe adverse event may be viewed as benefiting the entire organization and resident community.

Administrators like Sofia are often motivated by:

• Beneficence (wanting to protect the patient)

• Nonmaleficence (do no harm)

• Fear of legal liability

However, the Utilitarian Lens can create ethical tension when collective safety goals begin to outweigh individual preferences and quality of life.

Examples of policies that may emerge from utilitarian reasoning include:

• strict adherence to dysphagia recommendations

• limiting access to non-recommended foods or liquids

• mandatory tube-feeding protocols

• discouraging resident refusal of treatment recommendations

These approaches may reduce institutional risk, but they may also unintentionally reduce resident autonomy, dignity, and satisfaction.

The Utilitarian Lens recognizes that healthcare leaders must consider the consequences of decisions across the entire system, not just for one individual resident. However, determining which outcomes matter most is not always straightforward.

Clinical ethics literature acknowledges that healthcare providers have ethical responsibilities to prevent harm and promote patient wellbeing. Administrators and clinicians may therefore feel ethically obligated to recommend the safest possible swallowing interventions based on current evidence and clinical guidelines.

At the same time, ethical decision-making becomes complicated because the harms associated with dysphagia management are not limited to aspiration risk alone. Restrictive diets may also contribute to:

• dehydration (Lim et al., 2016)

• malnutrition (Miles et al., 2020; Wu et al., 2022)

• social stigma (Archer et al., 2018; Smith et al., 2022)

• emotional distress (Archer et al., 2018)

• lower quality of life (Arigita et al., 2022; Lim et al., 2016; Shimizu et al., 2024)

Additionally, quantification of risk for aspiration pneumonia or choking is currently not possible. So it’s nearly impossible to determine whether an intervention will ACTUALLY result in patient illness or harm.

1. Is preventing aspiration and/or choking truly possible?

2. Is mitigating risk of medical complications always the most ethical outcome?

3. How should healthcare leaders weigh physical safety against emotional wellbeing and quality of life?

4. Can a decision still be ethical if it protects most residents but harms an individual resident’s autonomy?

5. What responsibilities do administrators have to the larger resident population versus a single resident?

6. Are healthcare facilities ethically justified in creating restrictive policies to reduce liability and regulatory risk?

7. How should “overall good” be measured in dysphagia care?

8. Should measurable outcomes like pneumonia rates carry more weight than resident satisfaction and dignity?

9. Can safety-focused policies unintentionally create other forms of harm?

10. What happens when the safest clinical recommendation is not the option the resident values most?

11. How can healthcare leaders balance efficiency, consistency, and individualized care in long-term care settings?