It depends what you consider the starting point for building the scenario. If you start by taking the story seriously as a real-world scenario, taking place in a real hospital with real people, then these are relevant considerations that would naturally arise as you were thinking through the problem, not additional factors that need to be added on. The work comes in removing factors to turn the scenario into an idealized thought experiment that boxes utilitarianism into one side, in opposition to our intuitive moral judgments. And if it’s necessary to make extensive or unrealistic stipulations in order to rule out seemingly important considerations, then that raises questions about how much we should be concerned about this thought experiment.
It depends what you consider the starting point for building the scenario. If you start by taking the story seriously as a real-world scenario, taking place in a real hospital with real people, then these are relevant considerations that would naturally arise as you were thinking through the problem, not additional factors that need to be added on. The work comes in removing factors to turn the scenario into an idealized thought experiment that boxes utilitarianism into one side, in opposition to our intuitive moral judgments. And if it’s necessary to make extensive or unrealistic stipulations in order to rule out seemingly important considerations, then that raises questions about how much we should be concerned about this thought experiment.