We have brought up, in the last couple of posts, the classic anti-utilitarian thought experiment of the "murderous doctor". The basic point is that this is a straw man - a misrepresentation of a utilitarian position. Still we want to investigate the possibility of other thought experiments that are not, or at least not obviously, straw men. Here we will do a straightforward desire utilitarianist analysis but one that is a deliberately more detailed examination, than is required to demolish this thought experiment, in order to prepare the ground for examining other such thought experiments.
So, let us trouble ourselves with this fictional case -that of the "murderous doctor" (see Utilitarianism versus Common-sense Morality for a full description of this thought experiment), We stipulate that an argument has already been made, in desire utilitarian terms, for an aversion to murder (the argument is made elsewhere and will not be repeated here for brevity - although a more detailed analysis of this will be explored in the future) and note that the phrasing (strong) "aversion to murder" is better than "Don't Murder" in our terms. We will look at this in terms of desire utilitarianism, specifically the desire fulfilment theory of value, what is the value of the murderous doctor's desire?
In order to establish the desirability of a desire we first need to know what the desire under investigation is. Here it is the doctor's desire to murder the healthy patient. There are other desires that serve to justify and provide reasons for this desire (that is reasons for this reason to act) such as to save the lives of the unhealthy patients - but these other desires are not in dispute, we expect, if not demand, any doctor to have such desires. The problematic desire is specifically the desire to murder the healthy patient, that the doctor is considering as a means to fulfil his and his unhealthy patient's desires to regain their health and avoid death.
We evaluate this desire by turning it into a means and see its effect on all other desires that could reasonably be affected, these other desires treated as ends for this analysis - that is not just the aforementioned desires of the unhealthy patients and the doctor's desire to cure them.
We first investigate the affect of this desire on the doctor's other desires, and on the unhealthy patients and on their friends and relatives.
How the unhealthy patients' friends and family desires are affected can, for the sake of simplicity here cancel out. They might be happy but still be repulsed or, oppositely, endorse the actions of the doctor - in the means they used of murdering an innocent healthy patient - in saving their loved one's life - but, at the same time, the fear of this happening to them - as a healthy patient increases, regardless or in spite of their personal indirect involvement. Whatever your take on this, I hold that this is not a substantive issue for this argument since this is covered in looking more closely at the doctor's and unhealthy patients' desires below.
Remember the basic presumption behind this thought experiment is to find and justify this desire as morally right (and thereby show its clash with common sense morality). Therefore the default is to presume that the doctor and the unhealthy patients both do want to behave ethically here, and given that presumption can utilitarianism provide them with an ethical justification? Now if either do not care about what is morally right, they will or might seek any justification to suit this action but that is not what the thought experiment is about because then that presumption does not apply.
In the doctor's case it would be expected that he otherwise still has an aversion to murder, and he would know that in fulfilling this desire that this both contradicts that desire and weakens this aversion in himself and others and also now has the same issues as the general population too.
Similarly for the unhealthy patients, who we can presume would be glad to survive we cannot also presume that they endorsed the doctors' actions. Individuals could, if any have an aversion to murder - the default presumption here - be horrified at the cost taken to ensure their survival. They may not have endorsed it given a choice, or if given a choice, they might not be in the position of being "cool, calm and collected".
As an aside, I am pretty damn sure that if I found myself the beneficial recipient of such action I would be horrified but, if presented with this choice in advance of treatment - in stress, pain and under medication and so on - I cannot honestly say I would say no. I would like to believe I would say no and I imagine most of you would too but if we are honest, we do not really know what actually would occur. However this is not a dilemma but makes the point that there is a deep conflict between our various desires, especially our good desires and this must be the same for those unhealthy patients. Remember what any individual does in any situation is to seek to fulfil the more and stronger of their desires - so, for sure, these other desires in conflict may not be strong enough in this situation but that does not alter the conflict that everyone would go through, however it is actually resolved.
If we focus on the general population, what happens regarding an aversion to murder? If we use the principle of universilisability we can asks what would we want anyone else who was in the doctor's position to do? In the real world we all have an interest in encouraging an aversion to murder and this implies we have also an interest in discouraging a weakening of such an aversion. Now the only way that anyone in the doctor's position could carry out the action of killing the healthy patient would be to have a weaker aversion to murder - regardless of somehow seeing this as an exception with some sort of justification - saving the lives of the other patients. Now do we want everyone else, in the real world, having such a weaker aversion to murder? Well if this aversion was weakened, to enable justification of such actions as that of the murderous doctor, then the amount of actual murder would increase therefore such a desire tends to thwart other desires - namely the aversion to murder.
Now we have already established from the previous post, that there would be an increase in ill health should such a policy be endorsed. Now we can see that, apart from this, there will likely be an increase in other murders - as they are more or less similar, in some sense, to this fictional scenario.
So we can now say that
1. So if this desire is fulfilled then
a) it would directly thwart the desires - whatever they are - of the healthy patient
b) it would tend to thwart various desires of the general population, that is most everyone's desire to be healthy, desire not to have their lives prematurely ended and desire not to live in fear of their lives being prematurely ended - an aversion to murder - would all tend to be thwarted.
c) it would partly indirectly fulfil the desires of the unhealthy patients - indirect because the doctor still has to treat them and this is another (and unproblematic) desire, (we are not disputing he would not fulfil these too, of course) and it would partly thwart desires of the patients in common with interests of the general population
d) it would indirectly fulfil the desire of the doctor to save the unhealthy patients but it would thwart her aversion to murder (if she has one) and confuse a desire to save lives (what one generally expects of a doctor).
2. If this desire not acted upon - it is important to note that it is then not thwarted since only desires that are acted upon could be fulfilled or thwarted, we are not looking at that alternative, just its presence or absence - then
a) the healthy patient's desires are not thwarted
b) the general populations' desire to be healthy, desire not to have their lives prematurely ended and desire not to live in fear of their lives being prematurely ended - a stronger aversion to murder - would not be thwarted.
c) the unhealthy patients desires to live are thwarted
d) it would thwart doctor's desire to save the unhealthy patients but would not weaken an aversion to murder nor her desire to save patient's lives.
Now we have enough information to determine the value of the murderous doctor's desire. It fulfilment is more likely to thwart and tend to thwart an aversion to murder and a desire for health leading to an increase in murder and ill health. It absence fulfils the desires of the healthy patient and the general population and does thwart the desire of the doctor to cure the unhealthy patient and the desire to live of the unhealthy patients. Overall, considering the alternatives in scalar terms and impartially - not black and white - but better or worse comparisons - it is a desire that more thwarts and tends to thwart other desires than its absence. That is it is a morally bad desire to carry out.
Now various anti-utilitarians might dispute the relevancy and comparison of all these desires - this would be an internal critique of the above analysis. They would object to the addition of features they have excluded by stipulation. But this is exactly Hare's point, in the process of creating more realistic details to a fictional thought experiment, often the difference between the two opposite positions dissolve away.
More detail was provided here than strictly necessary as has already been shown previously but the above will serve us usefully as we examine a far better anti-utilitarian argument we will examine next. Still one can complete this by saying, far more simply, that, for all parties concerned, aversions to murder would be weakened - with detrimental affects against most everyone's interests and the aversion to ill health would be eroded - with increasing overall ill health of most everyone. If the doctor and/or the unhealthy patients do not care about these ethical and health issues then, either the thought experiment fails, since without this no-one concerned is looking for a moral justification or, we can still judge these actions immoral as this question is of concern, to us. However looked at, to fulfil the desire to kill the healthy patient is not the utilitarian conclusion.