The problem of whether or not to push the person onto the tracks resembles the following problem.
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 (for them, not for him!), 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.
The most popular way I have seen utilitarians respond to this is to espouse what they call rule utilitarianism. They claim that according to rule utilitarianism, the healthy man should not be sacrificed to harvest his organs to save the five. (Rule utilitarianism is explained and the argument is briefly sketched at the same link.)
This causes me to wonder whether rule utilitarianism would tell us not to push the person in front of the trolley.
Another similar problem that I’ve encountered runs thus: suppose we’re in a scenario where it’s one person’s life against a million, or a billion, or all the people in the world. Suppose aliens are invading and will leave Earth be if we were to kill an arbitrarily-determined innocent bystander. Otherwise, they will choose an arbitrary person, take him to safety, and destroy Earth, along with everyone else. In that case, consensus seems to be that the lives of everyone on Earth far outweigh a healthy innocent’s rights.
The largest difference between the two cases is numbers: five people becomes six billion. If there is another difference, I have yet to find it. But if it is simply a difference in numbers, then whatever justification people use to choose the healthy man over five patients ought to apply here as well.
Within the thought experiment, the difference is simply numbers and people are giving the wrong answer, as long as you specify that this would increase the total number of years lived (many organ recipients are old and will die soon anyway). Outside the experiment in the realm of public policy, it is wrong to kill the “donor” in this one case because of the precedent it would set: people would be afraid to go to the hospital for fear of being killed for their organs. And if this was implemented by law, there would be civil unrest that would more than undo the good done.
It sounds like you’re saying that the thought experiment is unfixably wrong, since it can’t be made to match up with reality “outside the experiment”. If that’s the case, then I question whether people are “giving the wrong answer”. Morals are useful precisely for those cases where we often do not have enough facts to make a correct decision based only on what we know about a situation. For most people most of the time, doing the moral thing will pay off, and not doing the moral thing will ultimately not, even though it will quite often appear to for a short while after.
At a practical level, there’s another significant difference between the two cases: confidence in the probabilities.
As has been pointed out above, the thought experiment with the donors has a lot of utilitarian implications that are farther out than just the lives of the five people in the doctor’s room. Changing the behavior of doctors will change the behavior of others, since they will anticipate different things happening when they interact with doctors.
On the other hand, we haven’t got much basis for predicting how choosing one of the two scenarios will influence the aliens, or even thinking that they’ll come back.
I never got this example, it’s obvious to me that you should do the operation, and that the only reason not to is the dumbness of red tape and lynch mobs being extremely irrational.
If you learned that doctors actually regularly did this sort of thing, would that change the probability that you’d go and get a somewhat important but non-critical operation (i.e. wisdom teeth removal)?
Since the risk of that happening to me would be quite low (at least two times lower than the risk of needing a transplant myself, and probably much lower even than that) it wouldn’t be rational to alter the behaviour, but I would certainly feel nervous in the hospital.
You know what this made me think of? thopse people that say that if medical care was free there’d be no incentive not to go to the doctor for trivial things… >:D
What Alicorn said—most people aren’t going to overuse free medical care, at least not through that vector. And any deliberate, artificial “visit inflation” is going to be from doctors who order unnecessary visits in order to score extra fees, not from patients, who would generally not prefer to have to schedule around new appointments and spend a long time in the waiting room.
This kind of overuse does happen, of course, but it’s due to the tiny set of people (“hypochondriacs”) who do go to the doctor for every little thing, and raise costs for anyone pooled with them (via taxes or health insurance). Or from people who use the ER as their checkup and force others who are in severe pain but not “visibly dying” to suffer longer.
(I know you were joking but it needed to be said anyway.)
What Alicorn said—most people aren’t going to overuse free medical care, at least not through that vector.
The basics of economics are not suspended for medicine. “Overuse” is a judgment and therefore not useful for a dispassionate discussion, but people do commonly buy more (notice I say “more”, which is not a judgment) of something when it costs less. I do this all the time when shopping for food. Of there is a sale on a good brand of sardines, I might buy twenty cans at once (and I’ll go through them pretty fast too).
Now of course, if something is sufficiently inexpensive then a long queue will likely form, and once the queue is formed then that will limit consumption of the service or good, but does not bring the consumption back down to the original level. Consumption levels off but probably at a higher level.
But key point: don’t use judgment terms like overuse unless you want to kill your mind. Did I buy “too much” sardines? Well, maybe I completely cleared out the shelf, or maybe I took half and some other person took the other half, leaving no sardines for anyone else. Who is to judge that I took “too much”? But we can describe what happened without passing judgment: at the sale price, the sardines were quickly cleared out, leaving no sardines for any further customers. That’s a shortage. Lowering the price below the market level may create a shortage—which is not a judgment, it is a description of what happens. Alternatively, lowering the price may create a queue. Offloading the price to a third party may, rather than creating a shortage or queue, lead to increased use and thus an increase in price. And so on. Immediately jumping in with judgment words like overuse triggers the emotions and makes thought difficult.
You’re right, I did use the wrong term there, and in a way that encourages sloppy thinking. I was just trying to dispel the vision some people have of the population being ultra price-sensitive to doctor visit payments and are therefore just inches away from overloading the system this way if it became free, which I think is a common but unrealistic model of the dynamics of health care decisions, in particular the non-monetary costs of doctor visits.
And since you bring up the topic, the health care sector is many, many degrees removed from market-based identification of efficient production/consumption levels, in some ways intractably (because of public unwillingness to let people go without certain kinds of care on the basis of not affording it, for example).
I find going to the doctor massively inconvenient in terms of scheduling, having to interact with people to make an appointment, trying to convey the six hundred things that are wrong with me to a doctor who only wanted to spend ten minutes with me, etc… if I didn’t have to cough up a small co-pay after every visit this would affect my finances but I doubt it would make me actually go to the doctor more often.
Yea, I were just telling a joke. I personally live in a place where it’s free for most things and we don’t have a problem with that etc. But let’s not get into mindkiller territory.
Assuming I believe that doctors do this by themselves rather than hiring goons to help them, I’d go, but bring a friend or relative—ideally one of the doctors I’m related to so he could better notice anything dodgy going on, and take over without killing me in a pinch if he had to tackle the doctor who was about to harvest my organs.
On the doctor’s home territory, though, that would be tricky; they might easily have a half-dozen nurses standing by with tranquilizers ready to knock out any potential interferers.
This would eventually lead to medical force escalation, and then medical feudalism. You go to your “own” hospital knowing for sure that the doctors there will not take out your organs without permission, since you’re part of their tribe. However, that hospital has to put in place a strong defensive perimeter to stop any task forces from the hospital tribe down the street from breaking in and stealing organs for themselves.
And of course, if you turn out to need an organ, then your hospital would deploy its own tribal ninja doctors to sneak into the enemy hospital and retrieve whatever is needed...
The problem of whether or not to push the person onto the tracks resembles the following problem.
The most popular way I have seen utilitarians respond to this is to espouse what they call rule utilitarianism. They claim that according to rule utilitarianism, the healthy man should not be sacrificed to harvest his organs to save the five. (Rule utilitarianism is explained and the argument is briefly sketched at the same link.)
This causes me to wonder whether rule utilitarianism would tell us not to push the person in front of the trolley.
Another similar problem that I’ve encountered runs thus: suppose we’re in a scenario where it’s one person’s life against a million, or a billion, or all the people in the world. Suppose aliens are invading and will leave Earth be if we were to kill an arbitrarily-determined innocent bystander. Otherwise, they will choose an arbitrary person, take him to safety, and destroy Earth, along with everyone else. In that case, consensus seems to be that the lives of everyone on Earth far outweigh a healthy innocent’s rights.
The largest difference between the two cases is numbers: five people becomes six billion. If there is another difference, I have yet to find it. But if it is simply a difference in numbers, then whatever justification people use to choose the healthy man over five patients ought to apply here as well.
Within the thought experiment, the difference is simply numbers and people are giving the wrong answer, as long as you specify that this would increase the total number of years lived (many organ recipients are old and will die soon anyway). Outside the experiment in the realm of public policy, it is wrong to kill the “donor” in this one case because of the precedent it would set: people would be afraid to go to the hospital for fear of being killed for their organs. And if this was implemented by law, there would be civil unrest that would more than undo the good done.
It sounds like you’re saying that the thought experiment is unfixably wrong, since it can’t be made to match up with reality “outside the experiment”. If that’s the case, then I question whether people are “giving the wrong answer”. Morals are useful precisely for those cases where we often do not have enough facts to make a correct decision based only on what we know about a situation. For most people most of the time, doing the moral thing will pay off, and not doing the moral thing will ultimately not, even though it will quite often appear to for a short while after.
At a practical level, there’s another significant difference between the two cases: confidence in the probabilities.
As has been pointed out above, the thought experiment with the donors has a lot of utilitarian implications that are farther out than just the lives of the five people in the doctor’s room. Changing the behavior of doctors will change the behavior of others, since they will anticipate different things happening when they interact with doctors.
On the other hand, we haven’t got much basis for predicting how choosing one of the two scenarios will influence the aliens, or even thinking that they’ll come back.
I never got this example, it’s obvious to me that you should do the operation, and that the only reason not to is the dumbness of red tape and lynch mobs being extremely irrational.
If you learned that doctors actually regularly did this sort of thing, would that change the probability that you’d go and get a somewhat important but non-critical operation (i.e. wisdom teeth removal)?
Since the risk of that happening to me would be quite low (at least two times lower than the risk of needing a transplant myself, and probably much lower even than that) it wouldn’t be rational to alter the behaviour, but I would certainly feel nervous in the hospital.
You know what this made me think of? thopse people that say that if medical care was free there’d be no incentive not to go to the doctor for trivial things… >:D
What Alicorn said—most people aren’t going to overuse free medical care, at least not through that vector. And any deliberate, artificial “visit inflation” is going to be from doctors who order unnecessary visits in order to score extra fees, not from patients, who would generally not prefer to have to schedule around new appointments and spend a long time in the waiting room.
This kind of overuse does happen, of course, but it’s due to the tiny set of people (“hypochondriacs”) who do go to the doctor for every little thing, and raise costs for anyone pooled with them (via taxes or health insurance). Or from people who use the ER as their checkup and force others who are in severe pain but not “visibly dying” to suffer longer.
(I know you were joking but it needed to be said anyway.)
The basics of economics are not suspended for medicine. “Overuse” is a judgment and therefore not useful for a dispassionate discussion, but people do commonly buy more (notice I say “more”, which is not a judgment) of something when it costs less. I do this all the time when shopping for food. Of there is a sale on a good brand of sardines, I might buy twenty cans at once (and I’ll go through them pretty fast too).
Now of course, if something is sufficiently inexpensive then a long queue will likely form, and once the queue is formed then that will limit consumption of the service or good, but does not bring the consumption back down to the original level. Consumption levels off but probably at a higher level.
But key point: don’t use judgment terms like overuse unless you want to kill your mind. Did I buy “too much” sardines? Well, maybe I completely cleared out the shelf, or maybe I took half and some other person took the other half, leaving no sardines for anyone else. Who is to judge that I took “too much”? But we can describe what happened without passing judgment: at the sale price, the sardines were quickly cleared out, leaving no sardines for any further customers. That’s a shortage. Lowering the price below the market level may create a shortage—which is not a judgment, it is a description of what happens. Alternatively, lowering the price may create a queue. Offloading the price to a third party may, rather than creating a shortage or queue, lead to increased use and thus an increase in price. And so on. Immediately jumping in with judgment words like overuse triggers the emotions and makes thought difficult.
You’re right, I did use the wrong term there, and in a way that encourages sloppy thinking. I was just trying to dispel the vision some people have of the population being ultra price-sensitive to doctor visit payments and are therefore just inches away from overloading the system this way if it became free, which I think is a common but unrealistic model of the dynamics of health care decisions, in particular the non-monetary costs of doctor visits.
And since you bring up the topic, the health care sector is many, many degrees removed from market-based identification of efficient production/consumption levels, in some ways intractably (because of public unwillingness to let people go without certain kinds of care on the basis of not affording it, for example).
I find going to the doctor massively inconvenient in terms of scheduling, having to interact with people to make an appointment, trying to convey the six hundred things that are wrong with me to a doctor who only wanted to spend ten minutes with me, etc… if I didn’t have to cough up a small co-pay after every visit this would affect my finances but I doubt it would make me actually go to the doctor more often.
Yea, I were just telling a joke. I personally live in a place where it’s free for most things and we don’t have a problem with that etc. But let’s not get into mindkiller territory.
Assuming I believe that doctors do this by themselves rather than hiring goons to help them, I’d go, but bring a friend or relative—ideally one of the doctors I’m related to so he could better notice anything dodgy going on, and take over without killing me in a pinch if he had to tackle the doctor who was about to harvest my organs.
On the doctor’s home territory, though, that would be tricky; they might easily have a half-dozen nurses standing by with tranquilizers ready to knock out any potential interferers.
This would eventually lead to medical force escalation, and then medical feudalism. You go to your “own” hospital knowing for sure that the doctors there will not take out your organs without permission, since you’re part of their tribe. However, that hospital has to put in place a strong defensive perimeter to stop any task forces from the hospital tribe down the street from breaking in and stealing organs for themselves.
And of course, if you turn out to need an organ, then your hospital would deploy its own tribal ninja doctors to sneak into the enemy hospital and retrieve whatever is needed...
Definitely a good enough premise for satirical science fiction.
Or as an in-universe explanation for the heavily armed doctors in Team Fortress.