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Repost on organ banks

May 5th, 2006

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.

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  1. May 5th, 2006 at 22:03 | #1

    When it comes to making assesments about what is moral and what is not I must admit that I am much more inclined towards rights based ethics (ie human rights and all that) than toward utilitarianism (ie democratic majorities can do what they please).

    Still I think that it is possible that such a rights based outlook might originate from a consequentialist product of utilitarianism.

    The problem with rights based systems of ethics is in deciding who defines the rights. Can a minority of wise scholars impose the answer on the majority?

    The problem with utilitarian based systems of ethics is who defines the boundaries of society for which the greater good should apply. When three men and a women on a remote island decide on the virtues of non-consensual sex is the greater good limited to the pleasures of four people or should it be expand to include the views of six billion?

  2. avaroo
    May 6th, 2006 at 01:42 | #2

    “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?”

    I dont think conscription would be a viable comparison. People aren’t conscripted to kill other people. You join the military to defend something larger than yourself, normally your country. Most people in the military, conscripted or otherwise, never kill anyone. Even in war, the point is not to kill the other guy. If that was the point, there would be no such thing as prisoners of war.

    “Or is it some sort of claim about rights to bodily integrity?”

    That’s certainly valid. And what if the 5 people who would be saved by the killing of one healthy person are all criminals? Would the case be more difficult then to make?

    “In that case, why not ask about a nonlethal violation of this right e.g. a compulsory blood donation to save a life?”

    Interesting dilemma. What circumstances would have to be in place for this to occur? Assuming there isn’t a blood type that only 2 people share? The deserted island scenario with only 2 people, one of them needing the blood of the other to survive?

    “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.”

    Say the case is a comatose pregnant woman, who is going to die anyway, wouldn’t the decision by made by her next of kin, making the decision on her behalf, rather than the doctor or hospital making the decision?

  3. Ernestine Gross
    May 6th, 2006 at 18:26 | #3

    Utilitarianism and Pareto improvement.

    Pareto-improvement: i.f.f. at least one person is made better off without anybody being made worse off (in terms of individuals’ subjective preferences, ie ‘utility’).

    Hence, w.r.t. the “Transplant example”, the idea of cutting up 1person to save the lives of 5 is not a Pareto-improvement.

    However, if the 1 person strictly prefers to die (for whatever reason) rather than live, and wishes to donate his or her organs, then the term Pareto-improvement would make sense.

    PS: Wilfredo Pareto, 1848-1923, is post-classical, ie. ‘neo-classical’

  4. Michael Harris
    May 6th, 2006 at 19:06 | #4

    John

    I’ve only ever seen this ethical hypothetical discussed in contrast with another one, which is about a train approaching a switch point on the track — both tracks run through tunnels up ahead, one of which is currently undergoing works, with one workman in there right now. As the train is coming, you notice 5 children playing in the other tunnel that the train is going to enter.

    Your only choice is to switch the train to run through the other tunnel, and kill the workman in there, or to leave it as is and let the train run through the tunnel it’s meant to go through, killing the children. That is, the thought experiment prevents you warning anyone and getting them out safely.

    When contrasted with the surgery example (where “you” are the surgeon), one finds that often people choose to take the action to save the children in the train example, but people don’t choose to save the five organ recipients (even if you present them as all being children). The idea is that people often make a raw “utilitarian” calculation in one setting, but qualify it in another setting because it violates an overarching ethical rule (that doctors should not make decisions against the welfare of the patient they are immediately attending).

    In that context, it’s interesting to see how people qualify their ethical framework depending on context.

  5. May 8th, 2006 at 00:30 | #5

    I think I would not divert the train. The duty of care to the worker is greater.

    The worker has every reason to be confident that their will be no trains coming through his tunnel. The kids have every reason to expect that a train will come soon or later.

    Of course stopping the train might seem like “Pareto improvement”.

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