I was introduced to Utilitarianism and Jeremy Bentham via the great Harvard lecture series on Justice from Michael Sandel:
http://itunes.apple.com/us/itunes-u/jus ... d379064095

While I found all of the moral frameworks interesting, I remained (and remain) unconvinced that any seems to be fully "correct". Recently I ran across this Consequentialism FAQ, where Scott Alexander Siskind mentioned this forum:
http://www.raikoth.net/consequentialism.html#objections

I find his arguments quite convincing, with one caveat - section 7.5. This is also the main counterpoint Sandel provides in his lecture on Utilitarianism.

Forgetting anything else like the Hippocratic Oath or problems with transplant success rate, if a doctor has 5 people needing organs or they'll die, and has one otherwise healthy person with those needed organs, Consequentialism ( / Utilitarianism) seems to compel this doctor to kill that one person to save those other 5 peoples' lives.

Siskind's most non-"weasly" answer to this is:

But those answers, although true, don't really address the philosophical question here, which is whether you can just go around killing people willy-nilly to save other people's lives. I think that one important consideration here is the heuristic-related one mentioned in 6.3 above: having a rule against killing people is useful, and what any more complicated rule gained in flexibility, it might lose in sacrosanct-ness, making it more likely that immoral people or an immoral government would consider murder to be an option (see David Friedman on Schelling points).

This seems, to me, also, weasly. This seems to say that if we allow this murder in this case, though it may be just, we are causing less utility overall because the anti-murder heuristic is violated, and this makes an unjust murder more likely in the future by some person or entity unbound by these rules.

This, to me, is wholly unconvincing. If we're truly out to maximize utility, then we must judge based on the (hypothetical) facts at hand, not based on what choice others *might* make in the future. If those future choices are also justly decided using the same principles as the current one, then no principles have been violated.

I apologize if this has been re-hashed over and over and I missed the thread, or if I'm not explaining myself well. I'm no philosopher, just an ordinary guy trying to find answers.

Is there a more convincing answer to this somehow?

All else being equal, you should kill the person and take their organs.

The biggest reason not to is that people will be more scared of going to the doctor if you do this.

On the other hand, people don't really need to go to the doctor as often as they do, so maybe that's not such a good answer.

The premise is medically dubious, but that aside, it also takes this very local "saving lives" metric which I find questionable in itself. It doesn't tell me anything about the respective qualities of lives, life expectancies, rebound effects and externalities (regarding others).

DanielLC gave a good answer, the probability that you'll get caught is relatively high, the harm if you get caught comparatively high. Spreading the meme that it's ok to kill the patient is itself not beneficial.

For me and my significant self-bias, the main problem is that I wouldn't risk life in prison just to save four strangers. I might give up my freedom for thousands of strangers, but not for four. And even then, I'd have no way of knowing whether the world might actually be better off in the long run with these people dead. It's a mess.

My intuition has recently evolved more in the direction of simple local feedback loops on the one hand, and focus on very big numbers on the other hand. As for local, the best feedback mechanisms that I know to ensure people's well-being is to give them extensive personal rights and liberties. It may be a bit naive, but I think the best judge of what's good for an individual is that individual. I think there are many overlaps between the core values of utilitarianism and some of the deontological injunctions of libertarianism.

In contrast, the focus on the big numbers goes far beyond the individual, but is also far less likely to be influenced by individuals. That's where you end up in relatively abstract discussions with fuzzy data and questionable predictions. Despite these downsides, I think this is where utilitarianism really scores, compared to common sense morality or deontology. For instance, if you can contribute to a realistic solution that eventually removes all suffering from food production on the planet, all else equal, this will quantitatively outweigh all the local utility shifts you'll ever generate from pushing people off bridges or harvesting their organs. In this sense, those trolley/doctor hypotheticals are actually a misrepresentation of what really matters most to utilitarians, namely large scope and high utility shifts.

For me and my significant self-bias, the main problem is that I wouldn't risk life in prison just to save four strangers.

More importantly, it's life in prison during which you can no longer save people.

It seems like "You shouldn't do it because you'd get punished" sidesteps the whole moral issue. It just raises the question of whether or not it should be illegal.

I wonder how people would react to a similar dilemma where killing currently is legal.

The country is at war. There aren't enough soldiers to protect the civilians. If 1000 civilians are drafted as soldiers, most of them will die, but 5000 civilians will be saved. Should civilians be drafted?

Hi John Stewart.
I'm glad you used the word weasly to describe your feelings about the answer you recieved. Because that's similar to what I've asked myself about this question in the past. Is considering possible precedent-setting 'weasly'? This is part of a more general problem: to what extent should we evaluate the indirect consequences of our actions? Indirect consequences of our actions include:
> creating a mental habit within ourselves
> causing ourselves to feel guilty or, to the contrary, feeling proud
> setting a role-model for others
etc.

Consequentialism means maximising the value of all the consequences of our actions, not just those that are most salient. So someone who ignores all these indirect consequences is being a 'naive' consequentialist. They are behaving contrary to proper consequentialism. On the other hand, it is clearly possible to give these indirect consequences more than their due, overemphasising them so as to rationalise a preferred behaviour. Ultimately, we have to carve a middle path between being 'naive' and being 'weasely'.

I think the situation is pretty clear cut in the case of the surgeon. At face value, performing the surgery on this patient could have good consequences. But when the possibility of arrest, the poor mental habit that is established, the poor role-modelling, the degree of secrecy that one would have to maintain about future relationships, the extent to which the credibility of the medical profession could be undermined in the case of arrest, etc. are taken into account, the surgery is clearly not useful on balance. Ultimately, if the mental precedent could be eliminated (e.g. I, the surgeon, know I will die immediately after performing this surgery) and the possibility of getting arrested could be eliminated (e.g. I have some time machine with which I can undo any eventuality in which I find myself getting caught), then I should perform the surgery. But this is a fantasy. To refuse to perform this surgery on consequentialist grounds does not seem weasely to me.

I hope that answer helps, I think it's a fair question that a lot of people ask themselves.

Thanks for the replies. Very interesting, and good points.

Perhaps my biggest adjustment to Consequentialism is the lack of foundational, inviolate precepts.

The idea of a doctor not taking someone's life to save others is not explicitly disallowed by either a libertarian ideal of the inviolate person, or even a categorical imperative.

It does jibe much more with (my own) human intuition, but it does seem to have a lack of comfortable edicts or axoims!

Much to think on; thank you, all.

Perhaps my biggest adjustment to Consequentialism is the lack of foundational, inviolate precepts.

It has one. No matter what you do, do not make a choice that fails to maximize utility. It can't have another one, since they would contradict.

Besides, if you decide that, say, murder is Wrong, and you can never do it, you run into the problem that no matter what you do, someone will commit murder, and it's presumably just as Wrong when they do it. The best you could do is try to make sure that there's as little murder as possible, in which case you can't afford to be picky about who commits it.

Welcome to Felicifia, johnstewart! Is your name taken from the 19th century philosopher or the 21st century comedian? I'm guessing the latter, because the former's name is spelled with 'u' instead of 'ew'.

johnstewart wrote:If we're truly out to maximize utility, then we must judge based on the (hypothetical) facts at hand, not based on what choice others *might* make in the future. If those future choices are also justly decided using the same principles as the current one, then no principles have been violated.

If you knew everyone would do the right thing and not abuse the precedent in the future, then you should kill the patient. But that's not close to our actual world, as RyanCarey says.

Heck, if we're talking about an ideal world where everyone follows the principles correctly, then the single patient would volunteer to be an organ donor for the rest.

Peter Singer made a similar point with regard to the objection that utilitarians might occasionally lie if the outcome is for the best. Another philosopher claimed that a society full of utilitarians would break down, because no one would know if anyone else was telling the truth. Singer replied that, to the contrary, there would be almost no lying at all in that society, because if everyone was aiming to do the utilitarian thing, they wouldn't need to deceive each other in order to accomplish the right ends.

DanielLC wrote:Besides, if you decide that, say, murder is Wrong, and you can never do it, you run into the problem that no matter what you do, someone will commit murder, and it's presumably just as Wrong when they do it. The best you could do is try to make sure that there's as little murder as possible, in which case you can't afford to be picky about who commits it.

I agree with your intuition, but non-consequentialists don't see it that way. They think it's wrong for you to commit murder, but not wrong for you to fail to prevent the maximal number of murders possible through whatever means. The goal is not to optimize an aggregate metric.

Alan Dawrst wrote:Welcome to Felicifia, johnstewart! Is your name taken from the 19th century philosopher or the 21st century comedian? I'm guessing the latter, because the former's name is spelled with 'u' instead of 'ew'.

Neither. It's my name. =)

DanielLC makes an interesting point about conscription. People are happy to accept the state randomly selecting and sacrificing young men in war time. Why wouldn't they accept "medical conscription" -- the sacrifice of a few healthy innocents to save many more -- where the utilitarian gains are much more certain?

One reason, I think, is that suffering caused by an act of violence is much more salient than the suffering caused by disease, due to the availability heuristic. Most of us don't know anyone on dialysis or suffering liver failure, so we don't rated it highly as a problem or consider ourselves at risk from it.

Speaking of transplants, check out this story in yesterday's NYT: a chain of 30 kidney transplants among 60 people, all made possible by one altruist who gave up their kidney willingly. Essentially, friends and family of those with kidney disease were donating kidneys to strangers on the other side of their country, in exchange for the promise of a kidney from another stranger in the chain.

The transplants were obviously not contemporaneous, though, which gave some donors the opportunity to pull out of the operation after their loved one had already received a kidney. Most didn't, though (one woman says that the threat of "karma" prevented her).

spindoctor wrote:People are happy to accept the state randomly selecting and sacrificing young men in war time. Why wouldn't they accept "medical conscription" -- the sacrifice of a few healthy innocents to save many more -- where the utilitarian gains are much more certain?

I suggest two main reasons:

• Status-quo bias. If we grew up in a society with forced organ transplants but no military conscription, we probably would accept the former and not the latter.
• Conscription is "official" in the sense of being done by a formally democratic government, whereas the doctor's actions are in private and illegal. If the thought experiment were instead about a government policy of required organ donation, people would probably respond somewhat more favorably.

Perhaps a final intuition against organ conscription is that its naive form is suboptimal. Rather than killing some random healthy person, it might make more sense to take organs from death-row prisoners, etc.

spindoctor wrote:Essentially, friends and family of those with kidney disease were donating kidneys to strangers on the other side of their country, in exchange for the promise of a kidney from another stranger in the chain.

What an awesome idea.

Another distinction between the conscription and the mandatory organ sacrifice is that the physical killing is done by an enemy in the conscription case, while it is done by the moral agent in the organ case - and a doctor no less, whom we are supposed to trust with our lives in any other situation.

I'm not sure the numbers make a difference here. If a natural disaster (no enemy) would threaten to kill 5000 people unless we perform a ritual that involves cutting out the guts of 1000 non-consenting people, intuitions would be less clear.

It doesn't seem fair to send men at the enemy with guns and blame them for killing them.

Also, what if the enemy also has a draft? In that case, the enemy soldiers are innocent. Do you blame their government for sending them out to war?

Daniel, I wasn't stating my opinion but completing the explanation why people see it differently. I personally think conscription is evil in almost all circumstances.

from the original post:

johnstewart wrote: If we're truly out to maximize utility, then we must judge based on the (hypothetical) facts at hand, not based on what choice others *might* make in the future.

First, you might find that it is an ongoing process to define and understand your own criteria of what comprises "utility." Do you value the feeling of happiness, how about physical health or strength right now, how about happiness or health in the future, how about a feeling of security from violent attack or intrusion...

To deny the relevance of what people might do in the future is to either declare a disregard for what happens in the future or to declare that events today do not influence what happens in the future. If you want to be alive tomorrow and you think that a given event today will decrease your chance of being alive tomorrow, then you might at least consider that the event could be worth analyzing.

People (especially in the West) often like to envision themselves as directing their behavior with pure reason combined with an accurate understanding of the world around them, but many behaviors are nearly entirely determined by social influence (e.g. events and experiences on one day affect behaviors on another day independently of pure reason and accurate perception of the world). When people meet, should they bow, shake hands, kiss each other on each check, raise one hand, ignore each other, nod, or something else? When somebody steals your girlfriend should you meditatively experience the emotions and then move on (a possible Buddhist approach), beat up your ex-girlfriend (a possible red-neck approach), kill the guy, or something else? One's perception of social norms in these areas can be highly influential.

If the social norm becomes one of randomly killing people to steal their organs, it would not be implausible that people everywhere would live in a state of fear to the point where they might not trust the general public enough to send their kids to school or to otherwise maintain civilization as we know it. Perhaps it is easy to forget the 3rd—5th centuries in Europe (and other times and places) when hoards of barbarians followed what they perceived as social norms in their culture that dictated that powerful leaders took whatever they wanted (property, women, slaves, lives...). If you think that social norms do not influence society, think of the dark ages, then think again.

If the social norm becomes one of randomly killing people to steal their organs, it would not be implausible that people everywhere would live in a state of fear to the point where they might not trust the general public enough to send their kids to school or to otherwise maintain civilization as we know it.

How? The amount of killing for finding organs would be significantly less than the variations of murder in different places.