Today is World Philosophy Day: Should we kill healthy people for their organs?
Today is World Philosophy Day (initiated by UNESCO in 2005), which gives University of Glasgow philosophy lecturer David Bain an occasion to ask one of these questions that generations of teachers have given their students for exams in moral philosophy: Should we kill healthy people for their organs?
Suppose Bill is a healthy man without family or loved ones. Would it be ok painlessly to kill him if his organs would save five people, one of whom needs a heart, another a kidney, and so on? If not, why not?
Consider another case: you and six others are kidnapped, and the kidnapper somehow persuades you that if you shoot dead one of the other hostages, he will set the remaining five free, whereas if you do not, he will shoot all six. (Either way, he’ll release you.)
If in this case you should kill one to save five, why not in the previous, organs case? If in this case too you have qualms, consider yet another: you’re in the cab of a runaway tram and see five people tied to the track ahead. You have the option of sending the tram on to the track forking off to the left, on which only one person is tied. Surely you should send the tram left, killing one to save five.
But then why not kill Bill?
Are students in medical ethics also asked that kind of questions? Or is it considered inappropriate in a Medical School?
(thanks to Tim Lewens for the tip)
20 Nov 2008 Thomas
Well, the differences between the choices to make in these three cases are obvious, so I hope that David Bain’s students had passed their exams successfully.
Please, enlighten a medical ethical ignorant — why are the differences between these three cases so obvious?
Moral questions should relate to realistic contexts, otherwise it is mental onanism of no use to anyone. The three questions given are essentially non-questions… Setting aside possible organ-farming in the Third World, kill a healthy person to help others who are ill, maybe terminally? And if the transplants are rejected? It’s too theoretical. Next, the kidnappers… I mean, you’d trust these people to keep their word? On which planet? They’re kidnappers, for goodness sake, who, according to the question, seem to regard murder as a kind of a joke! Finally, the tram… I mean, an out-of-control tram careering down tracks to which people just happen to have been tied??? What the heck kind of situation is this?
Maybe philosophers who believe these are genuinely philosophical questions should consider a career move…
I’m not a philosopher, but these questions have made me think, and it doesn’t bother me that the situations are a bit contrived. It’s the ethical reasoning that matters, and being able to say what in principle is morally acceptable, and what isn’t, and more importantly, why. I found the dilemmas presented really tough. I felt that with the hostages and the train, the initiative was not my own. I was being forced to make a decision. If you’d asked “Is it okay to go and pick Bill up off the street, shoot him and offer him dead to the kidnapper in return for the other hostages?” Or if you’d asked “Is it okay to throw Bill in front of the train if you know that he will derail it and save the other five people?” then the initiative would have been my own and the last two questions would have been more like the first question. And I would have said no. And yet, the outcome is not different. One person dies so that 5 people don’t. What is different is the nature of the decision, and the blood on my hands.
Will be very interested to see what others say who have actually studied ethics. Hope there are some thoughtful replies. Not just complaints about how easy the question is!
I dare say Bill is feeling rather nervous…
Well, what scares me most about David Bain’s case story is that both supervisors of his DPhil thesis at Oxford in 1999 were Bills (Bill Brewer and Bill Child) (http://homepage.ntlworld.com/dtbain/#research)
I couldn’t agree with Lizzy more. The situations are contrived but with reason. Their utility consists not in their resembling situations that we’ve routinely encountered or are likely to encounter, but in their forcing you to articulate carefully WHY it is wrong (assuming it is) to kill the healthy person for organs, given it is not wrong (assuming it isn’t) to kill the person on the left track instead of the five straight ahead.
Raising complications with the cases that could easily — even if rather artificially — be stipulated away is, to my mind, to duck the difficult questions of principle (which is understandable, since they are frustratingly hard). You might, for example, point out that, once you get the gun, you could shoot the kidnapper, but clearly I could set up the case so that that is impossible.
I confess I am not sure what to say about these cases myself. Often doctors and others draw a distinction between killing and letting die, and argue that there are circumstances in which, although the latter is permissible, the former still isn’t. But that doesn’t seem to be the point here. If you send the tram left, that is a case of killing, yet many of us would prefer it over letting the five ahead die.
I suspect some would invoke the doctrine of double effect. They would, to cut a long story short, point out that, in a certain causal sense, the death of the one person in the tram case is not a MEANS to saving the five lives; the means to saving the lives is switching to the left track, and the death of the one is a forseen consequence of that. By contrast, killing Bill is a MEANS to saving the five lives, not merely a consequence.
So some would say. I myself am not sure I want to explain my intuitions in that way, since in other contexts I find the doctrine of double effect suspect. (But if I don’t invoke the DDE, I need some other explanation of course!) Moreover, intuitions differ about the kidnapping case, but notice that shooting dead the one IS in that kidnapping case a means to saving the five, and to that extent the case looks more like the organ case than the tram case.
Two quick final points. (1) My supervisors, though indeed called Bill, were excellent and still have all their organs! (2) Although I’ve suggested realism is irrelevant, notice cases structurally similar to the ones I described do arise, e.g. I think I am right in saying that the British War Cabinet in the mid-1940s discussed the strategy of giving the Germans the impression that their V-rockets were overshooting London (which they weren’t), so that the Germans would shorten their range and land south of London, killing fewer and different people their than they would have otherwise. That’s rather like the tram case. As for the organ case, why “set aside organ farming in the Third World”?
I remember going to a phd-course on medical ethics years ago at the Faculty of Health at the University of Copenhagen. I was the only participant who had not been medically trained, and that probably accounts for why I do not think back on the course as a pleasant experience. I arrived with the relativist/humanist expectation that we were to discuss the implications, relations, and inherent contradictions of different ethic standpoints. Yet I quickly discovered that the course was about learning what was ethical and what was not, thus equipping future medical researchers with a list of do’s and dont’s. We ended up in some very intense and non-productive arguments during that long week.
Anyway, the point I wanted to make was that at some point during the course, someone made a reference to the dilemma of killing one to save many. Whether he had been exposed to the question during his medical training I don’t know, but somewhere he had definitely learned that the answer to it was that sacrificing one for the benefit of many was not allowed.
I agree with that, but I agree even more with Zygmunt Bauman who argues that the posing of these kinds of questions, i.e. playing number games with human beings, is characteristic of the kind of rationalist bureaucratic approach which underpins the mass societies of the western world as well as the mass murders of the Holocaust. I guess recent-day discussions about whether you can torture one terrorist in order to save a million people shows how grounded we still are in that tradition.
The medical ethics course Soren speaks of does sound dull, and not what I think a medical ethics course should be. And I agree with Soren that certain kinds of numerical trade-offs with people’s lives are abhorrent. But two things. 1. It is not clear that all are. (Would you, Soren, *not* steer the tram onto the left track? Would you not invest the medical budget in the technology that would help the *most* people?) 2. The best bulwark against the use of sophistical moral arguments that might be used to justify abhorrent policies such as the Holocaust is to think very carefully about what is wrong with them, about what, for example, is the difference between the organ case and the tram case. That’s one of the values of philosophy.
This is no doubt a simplistic response from me, as I have studied neither philosophy nor ethics. However I see a distinction between the ‘Bill’ scenario and the two others.
Bill is healthy and will possibly remain so for many decades. He may have children and friends in the future. Therefore killing a healthy person for the benefit of unhealthy people who may or may not survive transplants - there is no dilemma here.
In the other examples, at least one person will die within a relatively short period of time. This is inevitable, given the facts as presented – the only question here is whether or not killing one person is better than killing five or six. And the answer to that is fairly obvious, I would think.
To me the choice is acceptable to kill one to allow others to live, I have to make that choice because there is no actual difference between the tram and the organ donor.
The examples are contrived to clarify the choice being made, and you can look at our current society. We often sacrifice soldiers for the greater good of society.
Society seems to make the choices with the following artificial divisions:
We are unwilling to cause *certain* death to save any number of lives. ( suicide bombers and Kamakazi pilots not withstanding) Hence we are unable to kill to obtain organs, or kill to free the hostages.
We are willing to *risk* death to save lives (Think of the D-Day invasion, where it was understood that many would die, we just didn’t know who) Which allows us to throw the switch, with the thought that *something* would stop the tram.
But the hypothetical examples show us our inconsistencies, and should be understood to allow
To me it should be acceptable to kill one to allow many more to live.
The examples are contrived to clarify the choice being made and extend the situation to absurd limits. However it seems that our society seems to make the choices with the following artificial divisions:
We are unwilling to cause *certain* death to save any number of lives. ( suicide bombers and Kamakazi pilots not withstanding) Hence we are unable to kill to obtain organs, or kill on hostage to free the remaining hostages.
We are willing to *risk* death to save lives, even almost certain death to save lives. (Think of the D-Day invasion, where it was understood that many would die, we just didn’t know who). This allows us to throw the switch, with the thought that *something*, no matter how remote the chance, could possibly stop the tram.
But the hypothetical examples clearly shows the inconsistencies and helps us to distill the reasons that one choice is acceptable, while a seemingly similar situation is different.
I agree with Zygmunt Bauman playing number games with human beings, is characteristic of the kind of rationalist bureaucratic approach which underpins the mass societies of the western world as well as the mass murders of the Holocaust. This guest book is good to post our phylosophy.
What is funny is that you didn’t never choose the choise: killing yourself to save the 6 others. An human without a too big Ego would probably prefer to die instead of having a murder on the mind.