The organ bank

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.

17 thoughts on “The organ bank

  1. Exactly! It depends on whether you’re short term or long term in your utilitarian thinking. A utilitarian concerned about the long run sustainability of institutions will rationally develop a rule which says in effect that people have property rights in their own bodies – subject to extreme cases such as conscription where the alternative is everyone dies because the enemy is at the doorstep. The alternative to consequentialism is the stupid rule that that you adhere to rule A even if the ‘heavens fall from the skies’. The problem with non consequentialist thinking is that there are varieties of them each with their own ultimate objective which trumps other objectives whether it be ‘negative liberty’, ‘autonomy’, ‘human flourishing’ or whatver and there can be no intersubjective persuasion among these – each camp can only fight to the death with the other. The other aspect of this is of course once you have consequentialis, things start getting bogged down into the details of policy analysis, something which philosophers have little to contribute to. Anti-consequentualism is essentially a philosophers’ job racket

  2. Why is it less ad hoc to assume the five sick patients’ organs are compatible amongst themselves than to assume they are not, as we are obviously meant to?

    It’s not clear what the thrust of yur objection is. Are you saying that the standard objection to consequentialism – that it is hard to reconcile with individual rights – is generally overstated?

    In any case this seems a different issue from that which first prompted you to denounce the Stanford Encylopaedia, namely the one about actual versus probable consequences.

  3. James, if the healthy patient’s tissue is compatible with that of all the sick patients, aren’t we justified in thinking all the sick patients are compatible amongst themselves?

  4. Ogged,

    I don’t know if organ compatibility is mutual or transitive, but will consult the first immunologist I meet.

    John seems to be objecting to a whole style of reasoning based on what he calls toy examples.

    But surely the point of these examples is just to clarify ideas. The organ bank story is meant to show starkly that an ethics based on aggregate utility alone would be abhorrent to most of us. John complains that ‘it’s based on so many counterintuitive assumptions that it’s hard to believe that intuition is going to be a reliable guide’. But his first use of the word intuitive, to mean realistic, is not legitimate, and therefore the contradiction is a manufactured one. The assumptions are unrealistic to be sure, but they help lay bare the essentials of the issue. Economists reason like this all the time.

    The second use of intuitive is the apt one: a strong intuitive or gut reaction to an example is a signal that an ethical rule is problematic and may need to be refined if not abandoned. Furthermore, examples like this enhance communication. If the case is a simple one, it is more liklely that our gut reactions are reactions to the same thing, so we know what we are talking about.

  5. All right, consequentialists, especially you, Jason Soon, try this one out.

    Two people are trapped inside a burning house. You only have time to save one, and you must decide which one.

    One person is a scientist who, if she lives, will find a cure for cancer, end world hunger and bring about world peace.

    The other person is your mother.

    Who do you save? If you are a utlitarian, the answer is easy. You save the scientist, and you let your mother get barbequed.

    But what reasonable person would make this choice?

  6. Dave, as I pointed out in my first post on utilitarianism, this kind of example explains why utilitarianism is not useful as an individual theory of ethics – it demands an impossible degree of altruism with no preference for self, kin etc. Utilitarianism only makes sense as a public philosophy.

    Your argument doesn’t work against consequentialism as opposed to utilitarianism – it just says that, personally, most people would choose the consequence “mother saved” over the consequence “scientist saved and does great things”.

  7. James, I don’t object to thought experiments/toy examples as such. My points have been
    (i) they are useful as initial stimuli to thought on new topics, but less so on topics that have already been analysed extensively e.g. food safety, especially if they are discussed without reference to this analysis

    (ii) as you say they should “help lay bare the essentials of the issue”. My objection to the transplant example is precisely that it fails to do this. We don’t like the idea of killing patient 6, but we don’t know why

  8. John,

    Then what is the democratic basis for choosing policies based on a public philosophy that, as individuals “most people” would find abhorrent. Utilitarianism then simply becomes a euphemism for benevolent dictator.

    What’s more, utilitarianism as a basis for public policy assumes that no one has inviolable rights. Suppose society would unarguably be a better place by locking up without trial everyone called Quiggin. Should we do it? A stupid example, you might say. Suppose society would be a better place by not allowing Alan Jones on the air. What’s one man’s right to free speech set against the bnefits of cleaning the airwaves of his ignorant but influential tirades? Let’s do it!

  9. It’s a long time since I undertook my (rather useless) University education in immunology, but on the basis of what I learnt then, John’s alternative suggestion is entirely plausible. If the prospective recipients are all immunologically compatible with the prospective donor, there’s good reason to suppose that they’re immunologically compatible with eahc other – or some are at least. You could always specify that the donor was O Rh- with fairly “bland” HLAs and all the recipients were in various combinations A, B and AB blood groups with all kinds of other histocompatibility problems.

    Of course, once you go to all that trouble, it becomes pretty obvious how far-fetched the whole situation is, and how little serious attention these toy examples deserve. Especially when there are perfectly good real world and historical examples that ethicists could be mulling over, like those famous hypothermia experiments.

  10. The broader objection to Dave’s argument is that, as we learn in law school, tough cases don’t make good law. ‘Lifeboat ethics’ type objections like the burning house with the scientist and the mother can be easily constructed for any normative system but is not by itself a good objection to the normative system. Especially when in the case of public philosophies, these normative systems are meant to deal with general everyday situations. If consequentialism is vulnerable to lifeboat ethics examples, then non consequentialism ethics are vulnerable to simply going against common sense – for instance the conscription case. As a general thing slavery is a bad thing and conscription is almost a form of State-enforced slavery yet would you as a matter of ‘individual rights’ oppose conscription if the Nazis were at the front door so to speak?

  11. Dave
    Re your Alan Jones example I happen to be extremely pro free speech without being anti consequentialist. Am I cutting off my own legs in so doing? No, there are more than enough good consequentialist cases that taken together suggest that one should be very careful before restricting free speech – for instance the ‘who guards the guardians?” argument, the ‘slippery slope’ argument, the ‘politicisation’ argument, the ‘it is good to have our beliefs challenged’ argument, the ‘censorship only drives things underground’ argument. Do all of these provide a foolproof argument against censoring Alan Jones or anyone else? No. But is that really what we want? Furthermore does such an argument even exist withour preaching to the converted? e.g. there may well be a minority of people who believe no exceptions can be made at all to restricting free speech. I am pretty hard core free speech – from a *rule* utilitarian perspective but even I don’t fit into that category. To be non-consequentualist means to rule something out of a pragmatic weighting – perhaps there are some things we should be *reluctant* to apply a pragmatic weighting too but more often than not this is because it is *pragmatic* not to apply too calculative a procedure to e.g. becase it is ‘the wisdom of the ages’, because we don’t have enough data anyway, etc. But the point is that this sort of consideration is still consequentialist. A non consequentualist one is foolish in not even wanting to pragmatically consider whether something should be pragmatically weighted and quite likely the absolutist weight given to the object – in this case free speech – quite possibly is not very compelling except to people who already accept the a priori premises.

  12. i was bored, so:

    in response to dave ricardo:

    fictional you = fictional dave ricardo
    utilitarian = me pretending to be a utilitarian

    FYI: i’m not an expert on utilitarianism or any other topic (still working on a degree, haven’t even declared my major yet)

    fictional you: utilitarianism could justify human rights abuses

    utilitarian: what if you’re focusing on a narrow set of consequences? maybe I would advocate human rights because human rights would in the average case maximize well being? by the way, i presume you would object to the detention of arabs in guantanimo bay, cuba

    fictional you: but what about the fire example. if you had a choice between the life of your mother and the life of a scientist who will cure cancer, which would you choose

    utilitarian: first, how would i know that the scientist will cure cancer? i’m a utilitarian, not god…

    fictional you: wait wait, you’re cheating! lets say this doctor is a hot shot MD who does 20 heart transplants a week at a local hospital. you can expect she will contribute more to the good than your mother

    utilitarian: but what if that doctor has a rivalry with the doctor who will eventually cure cancer? they have a series of arguments that cause him or her to wake up on the wrong side of the bed and contaminate whatever experiment he or she is working on, causing them not to cure cancer

    fictional you: well that’s the point! you don’t know that! utilitarianism doesn’t work!

    utilitarian: ok, here’s an alternative argument: what if taking into consideration the consequences of human nature, most people will not give up the life of their mother for the life of a superscientist who will, in the future, cure cancer? a utilitarian can only consider possible consequences. it’s not like i can say that i must have sex with supermodel heidi klum, because our lovechild will bring 1000 years of peace to the planet earth – that’s just silly. so, assuming i’m an act utilitarian, i have to be able to do the act, and i better have good reasons based on good information.

    fictional you: i knew utilitarians were stupid. you say you want to maximize good consequences and yet you use “human nature” as a scapegoat. if you were /really/ a utilitarian you would have chosen to sacrifice you mother in the first place

    utilitarian: well i’m not a robot. i can’t replace my brain with an artificially intelligent computer that does utilitarian calculus. and i’m not omniscient, so i can’t take into consideration every possible consequence of an act or rule. Cognitive psychologists have found that our moral intuitions are subject to illusions. for example, people ascribe virtue to charismatic and attractive individuals, and condemn practices that viscerally disgust them, like homosexuality. so reasoning about the positive and negative consequences of an act, rule, or law is probably a good idea. but in addition to being a utilitarian, i am also a human. nobody’s perfect.

    fictional self: you haven’t told me how utilitarians measure utiles, or hedons and dolars, or whatever you want to call them anyway. arent they really just a placeholder for whatever moral values and intuitions someone has

    utilitarian: you’re right, if it’s necessary for utilitarianism to be systematic in that regard it does fail as a philosophy.

    fictional self: so we do agree that utilitarianism is problematic.

    utilitarian: yes; but i lied, i’m not a utilitarian, i’m a consequentialist

    fictional self: whatever that means…

    THE END?


    There’s a response regarding the fire example in the Stanford Encyclopedia of Philosophy article “William Godwin” (no judgement whether it’s successful)

    refs (loosely):

    Hinman on Utilitarianism (powerpoint)

    Horton, Keith. The Limits of Human Nature
    in 452 The Philosophical Quarterly, Vol. 49, No. 197 (1999)

    Kunda, Ziva. Social Cognition course page

  13. Dave , you are also presuming that a good personal philosophy also makes a good political/public philosophy. By that logic then the most enlightened regime in the world was Saddam Hussein’s regime which could be best described as Tikriti i.e. he gave privileges to his immediate family and to his relatives in Tikrit. Surely only an inhuman person would give equal weight to non relatives as to relatives?

  14. The compatibility issue:
    Assume that the healthy patient is at (0,0) and the unhealthy patients are in a ring of radius 1, and evenly spaced apart. Assume that the closer their ‘compatability’ points are, the more compatible they are. For less than 6 patients, the healthy patient will always be the most ‘compatible’, that is, the closest to all the other patients.
    (Yes, I realise that this is not realistic.. πŸ™‚ )

    Hmm this dilemma shows to me that humans value morality as well as utility. After all, is not the morality of a society an important aspect?
    Also, when making public policy one has to consider that the public has to actually go along with the policy to make it effective (at least in a modern democracy), and I could see alot of non-cooperation happening with the example policy. πŸ™‚

  15. Being a devils advocate is fun, but I’ll be serious for a moment. This is my last comment on this problem, I promise!

    So here’s my personal position:

    (1) utilitarianism and consequentialism are a “thin” rather than “thick” ethical philosophy

    id est, they tell you to maximize x, e.g. the “good” but they don’t tell you what it is, or how to do it

    on the possibility of consequentialism or utilitarianism as a personal philosophy:

    (2) maximizing good consequences doesn’t mean you don’t take thick ethical concepts like respect, or autonomy, or life seriously

    e.g. without respect there is a tendency to treat other people as objects, rather than subjects, a la Jurgen Habermas. Additionally, impartiality requirements tend to dehumanize the person doing the reasoning.

    e.g. Richard A Posner, in his book “The Problematics of Moral and Legal Theory” citing a study, states that “morally reflective
    people were less likely to be rescuers [of jews]than morally unreflective people.” during World War II. The argument is tendentious, but something similar might apply to consequentialism. Even if the first rule of consequentialism is to maximize good consequences, the socratic doubt in the process might make it easy to select actions or rules that benefit oneself to the detriment of others.

    (4) all the standard objections

    see the Hinman powerpoint linked in my other post

    (5) it’s only a style of reasoning

    in many moods it may seem misguided or silly, sometimes it may be useful, or optimal (note to self: not during sex). I think I’ve made it silly now, so there it is.

  16. Political liberalism has always straddled two major justificationary ethical theories: consequentialist utilitarianism and contractarian proprietarianism. In practice both more or less imply observance of the same rules/promulgation of the same policies.

    Utilitarianism is a species of consequentialist, or teleological (end-state), ethics that happens to focus on the maximisation of human happiness. In consequentialist-teleological systems, the rules are instrumentally good only in so far as they advance us to the telos. Other forms of consequentialist-teleological arrangements might be the maximisation of economic equity celebrated by financial consultants or biological fertility enjoined by Nazis.

    Proprietarianism is a species of contractarian, or deontological (process-observant), ethics that happens to focus on the enjoining the observance of individual rights to person and property.
    In contractarian-deontological systems, the rules are intrinsicly & absolutely “good in themselves”, “sacred” needing no further justification. Other forms of contractarian-deontological arrangements might include the Mosaic subordination to God’s will expressed in the covenant, or the pacifist unconditional abnegation of violence.

    I will run with the Mill/Hayek utilitarian justification of absolute rights for personal liberty. The core of this argument is that the indiduals know their own interests, and “circumstances of time and place”, better than others or central authorities. Therefore, in matters of that effect their personal spaece, such as the use of their body for sex or organ donation, it is good public policy to grant persons absolute rights to contractarian privacy/autonomy. Hence compulsory organ conscription, per the organ bank, clearly violates the default contractarian rule that protects personal space.
    As one goes up the scale of social organisation, to professional matters effecting ones occupation,
    utilitarian and contractarian considerations contend. Hence coercive invasions of professional privileges maybe in the public interest, although the presumption is now on self-regulation.
    At the top level of social organisation, the state, the whole mechanism of individualistic contract gives way to the social contract b/w the individual and the state. This authorises the state to intervene and promote acts consequential to “the public interest” to maximise jurisdictional welfare.

    Both Utilitarian-conseqentialist and Proprietarian-contractarianist schemes are absolutist ie rules, however conceived or explicated, are absolutely binding for all citizens regardless.
    The flaw in both utilitarian and proprietarian treatment of political power should be obvious from the conduct of the recent war.
    Although both liberal ethical systems generate absolutely binding regulations for their own jurisdictions, they tend to break down when in contention with other jurisdictions.
    Thus where the writ of the civil state ends, the law of the jungle begins.
    Hence political ethics tend to be:
    – absoultely binding – within a sympathetic jurisdiction
    – relatively flexible – between alien jurisdictions
    Here we have the entry point for “amoral” machiavellians, whose moral relativism is time and jurisdiction-contingent – the bane of the moral absolutist.
    This because, in real power politics, states have interests not duties, “things change” and international politics deals in the currency of violence. This gives ultilitarianism it’s local bias, since it is the nation state that is the executive agency for the political jurisdiction.
    The goal for “global utilitarians” then becomes to widen the sphere of political jurisdiction, through extending international law and empowering multilateral agencies.
    All very well and good, but what happens when we have a hegemon executive, some free-riding legislators and a major conflict of interest between jurisdictions?
    Not much help appealing to mutually incompatible ethical schemes.
    So Kant-Mill move over, here comes Machiavelli-Hobbes, with an assist from von Clausewitz!
    Ultimately the only resolution of this “jurisdiction dilemma” is to make the hegemons jurisdiction coextensive with the whole world – enacting global civil government through the forceful act of Leviathan.

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