Repost on organ banks
Over at CT, I’ve reposted this piece from 2003 on thought experiments in ethics.
I mentioned recently the gratuitously violent nature of lots of philosophical examples. Here’s another one quoted by Walter Sinnott-Armstrong in the Stanford Encyclopedia of Philosophy and also alluded to by Eric Tam in his criticism of one of my earlier posts
Another problem for utilitarianism is that it seems to overlook justice and rights. One common illustration is called Transplant. Imagine that each of five patients in a hospital will die without an organ transplant. The patient in Room 1 needs a heart, the patient in Room 2 needs a liver, the patient in Room 3 needs a kidney, and so on. The person in Room 6 is in the hospital for routine tests. Luckily (!), his tissue is compatible with the other five patients, and a specialist is available to transplant his organs into the other five. This operation would save their lives, while killing the “donor”. There is no other way to save any of the other five patients (Foot 1966, Thomson 1976; compare related cases in Carritt 1947 and McCloskey 1965).
We need to add that the organ recipients will emerge healthy, the source of the organs will remain secret, the doctor won’t be caught or punished for cutting up the “donor”, and the doctor knows all of this to a high degree of probability (despite the fact that many others will help in the operation). Still, with the right details filled in, it looks as if cutting up the “donor” will maximize utility, since five lives have more utility than one life. If so, then classical utilitarianism implies that it would not be morally wrong for the doctor to perform the transplant and even that it would be morally wrong for the doctor not to perform the transplant. Most people find this result abominable. They take this example to show how bad it can be when utilitarians overlook individual rights, such as the unwilling donor’s right to life.
I don’t know if it’s been pointed out before, but this example doesn’t work as claimed. The proposal of killing the test patient is dominated by the following alternative: With the agreement of the five needy recipients, draw lots. The unlucky one is cut up (but of course, they would have died anyway) and their healthy organs are transplanted into the others. The number of lives saved is the same as in the proposed case, no rights are violated, it’s a Pareto-improvement on the status quo ante and so on. We even save one transplant operation relative to the proposal.
Of course, you can impose some sort of ad hoc assumption to rule this out, but this just points up the other flaws of this example.
First, it’s an appeal to intuition, but it’s based on so many counterintuitive assumptions that it’s hard to believe that intuition is going to be a reliable guide. As Sinnott-Armstrong notes, utilitarian critics have already made this point.
An equally serious problem is that the example is like a bad cryptic crossword clue – you know what answer you’re supposed to get, but not exactly how you got there. Is the problem that an innocent person is killed in order to preserve the lives of others? If so, why not look at conscription or war in general? Or is it some sort of claim about rights to bodily integrity? In that case, why not ask about a nonlethal violation of this right e.g. a compulsory blood donation to save a life? Or is the problem that explicit and active agency of the doctor? After all, implicit decisions to sacrifice one life in order to save others are made in hospitals every day.
FWIW, I’d suggest that the core problem is that we know that it would be a very bad idea [from a consequentialist or any other viewpoint] to let doctors kill people for their organs , and that no amount of counterfactual assumptions is going to shake this belief.
PS Coincidentally, Maureen Dowd has an excellent piece on this topic in today’s NYT.