The fundamental feature of the ethical theory of utilitarianism states that moral behavior is that which promotes good and minimizes harm. 2 In writings based on public health, utilitarianism is widely recognized as a fragment in the ethical 'scheme' of public health, 3 but it is not afforded a stronger role for two primary reasons: first, considering its extreme position, utilitarianism is morally problematic, 4 as it could literally permit anything in the name of the 'greatest good to the greatest number,' and second it is virtually impossible to live a moral life under the most extreme forms of utilitarianism, because the obligations are too difficult to discern (the 'what' of promoting the good) and impossible to execute (the 'how'). 5 Utilitarianism, in a moderate form, used in public health ethics, means that our actions and policies should be focused on increasing the total 'net' goodness rather than an average 'net' good for each person. The institutions of individual rights and the recognition of patient autonomy are not contradictory to this, but are believed to serve the overall good, as individual benefit increases the total good, and serves as a preventative measure of unjustified majoritarian actions against smaller groups.