"Suppose one is a surgeon. Six patients enter one's office at once. Five of them unfortunately are gravely ill. Each of the five must receive an organ transplant very soon or he will die. One needs a heart, one needs a kidney, etc.--five different organs are needed. But fortunately, the sixth man who wandered into the office has all the healthy organs needed. The surgeon faces a choice between killing the healthy patient in order to save the five, and refusing to kill the healthy patient, thereby letting the five die. (In the example these are the only possible choices--it won't work to wait till one of the diseased patients dies, then cut up his corpse and use his organs to save the four who are threatened. By the time the first threatened person dies, his organs will be useless for transplant purposes.) What should the surgeon do? The common-sense moral rule "Don't murder" tells her that she should refrain from cutting up the one even in order to save the five. But it appears that by act-utilitarian calculation five deaths are worse than one death, so in this situation the doctor ought to kill the one in order to save the five. Common-sense morality and utilitarianism appear to be in sharp disagreement."[from A Note on Utilitarianism and Consequentialism for Philosophy]Interestingly R.M. Hare, one of the founders of modern Preference Satisfaction, in How to Argue with an Anti-Utilitarian, uses a version of this challenge as an illustrative example. Now there is much to agree with (well, at least, I do) in Hare's note but I have two caveats. The first is that the main point he makes can be made clearer using Desire Utilitarianism - or, at least, the same points can be made easily and more straighforwardly within Desire Utilitarianism and, more significantly, that this particular example is hopelessly flawed. (It is this latter point I want to explore today and will touch on these other issues in future posts). Maybe Hare agrees in general - that is the plausible thrust of his note - but there is a specific refutation that can be derived from any version of Utilitarianism and that Hare, maybe, did not cover.
Another Preference Satisfaction Utilitarianian, Peter Singer, in one of the most widely read books on ethics - Practical Ethics - provides a happiness based Utilitarian argument addressing a basis for the common sense moral principle of 'Don't Murder' in the chapter "What's wrong with Killing":
I know I have a future. I also know my future existence could be cut short. If I think this is likely to happen at any moment, my present existence will be fraught with anxiety, and will presumably be less enjoyable than if I do not think it is likely to happen for some time. If I leanr that people like myself are very rarely killed, I will worry less. Henc the classical utilitarian can defend a prohibtion on killing persons based on the indirect ground that it will increase the happiness of people who would otherwise worry that they might be killed.[p. 91]This argument can also apply to the classic challenge quoted above. The implications of the action of doctors killing healthy patients will affect others outside the 7 people in the example - and not just hospital staff and the doctor's and patients' friends and relations. That is the challenge fails as it creates an invalid restriction or application on whom to apply a "utilitarian calculus" to. It is an unsound assumption that only the six patients and the doctor are affected by the action of the doctor. Further, once you drop this restriction, it is quite clear to see that if healthy patients are not only worried about their lives - reducing overall happiness and increasing fears - they will also be less likely to attend a hospital until they are very ill and so the overall health of everyone will be adversely affected (and that too will reduce overall happiness).
I do not think that Hare would disagree with the above, it is just that he does not make this specific argument in his example, possibly because he was focused more on a canonical strategy of dealing with such challenges and Singer's indirect argument may not apply in general.(Alternatively maybe he has already generalized Singers indirect argument, his note can be read either way and we will explore this in futire posts as already noted). The issue here is that many utilitarians do not use a Singer-like indirect argument for this example when they should.
Anyway a likely riposte might be that we are looking at an example to help understand and criticize utilitarianism s and that examining only the doctor and six patients is a stipulation to make the challenge and nothing more. Well yes it is but it is an unacceptable stipulation as it does such violence to the concept of utilitarianism that the example is not about utilitarianism at all!
The underlying point of the challenge can be preserved by making it more isolated - hence others' happiness, preferences or desires are, indeed, unaffected and so can be ignored - but only at the cost of making it more extreme, so that common sense morality no longer applies.
For example, what if the 7 are the passengers and crew of a plane, which is damaged and crashes but is repairable? The 5 pilot, navigator and engineers can fix the plane and get them to safety, however they are all injured. There is doctor who can tend to them but only by taking organs and so on from the one healthy passenger, who has no abilities to fix or fly the plane. If the plane is not fixed they will most likely not be rescued and die shortly thereafter. It is a choice between them all dying or only one dying. Now in this scenario, however tortuous it may appear compared to the original example it has a very similar - and, yes, since the doctor can die it is not quite the same - structure and it is quite clear that a utilitarian conclusion would unlikely differ, however difficult it would be to accomplish should one be in that extreme situation, from what anyone, utilitarian or not, would conclude.
We can add, from a specifically Desire Utilitarian perspective, the following, but, in all likelihood, other versions of utilitarianism could make equivalent arguments. With regard to the healthy passenger and doctor we ask what would a good person do, that is what would a person with good desires do? For the healthy passenger knowing that they would die either way, there is no real sacrifice in giving up their life, so it is not really a case of altruism - that is not a relevant issue. Still they might know what the right thing to do is - offer their life to save the others - but who is to say how one would react in that situation. On the doctors part - if they are a good person - they would be extremely reluctant to kill the healthy passenger and so both would be incentivised to see if there is a feasible alternative - an increase likelihood of rescue or increased ability to survive until found. Failing this, on the one hand a superogatory action - above and beyond the expectation of normal good persons - of the healthy passenger, would be to commit suicide to lessen the burden on the doctor. On the other hand, if the passenger did not do this and the doctor was unable to kill the passenger, being unable to overcome his typically good desire to do no harm, then they all would die.
Then again if doctor too easily killed (with or without the reluctant cooperation of) the healthy passenger, and without remorse or regret that is not the behaviour of a good person, even if the outcome is that 6 survive rather than 7 die. Or one could add that if there is some good chance of rescue and survival and that the doctor, maybe with the backing of the injured others, kills the the healthy passenger anyway - which serves to increase the chance of survival from high to almost definite - this is clearly a bad action, the desires of the passenger are being thwarted beyond what the situation reasonably dictates.
Of course, one could go on and on but it is quite clear that this is a highly unusual and extreme situation and cannot appeal to common sense morality. A riposte, from a critic would be that this has altered the original scenario so much as to render it useless as a critique of utilitarianism. Well yes it has, but the burden is on the critic to find an example that does find a clear clash between utilitarianism and common sense morality, and, in my view, this example plainly and simply fails, for the reasons presented here.
All in all, there is very little difference between the thrust of my point here and the intent of Hare's article. His strategy is to make sure that critics do not confuse the critical and intuitive levels of analysis. There is a broad correspondence between these and what is stated - in less user-friendly terms - in the literature, as the 'criterion of rightness (or goodness)' - the critical level - and 'decision making procedures' - the intuitive level. An appeal to common sense morality - 'intuition' - can only be made at the decision making procedure level, but pretty much all utilitarians - classical or modern - accept that no-one performs the utilitarian calculus or equivalent at this level, no-one has the time to think this through on a moment to moment, day to day basis, we all use rules, guidelines, principles, heuristics - that is types of "common sense morality". It is only at the critical level - applying the criterion of rightness or goodness - that such a calculus or equivalent is applicable and, at this level, appeals to common sense or intuition do not apply.
Indeed some such 'common sense morality' can be held under scrutiny itself - and this an important point I wish to explore in upcoming posts. Singer is perhaps most notorious - and misunderstood - for doing this but, whether one agrees or disagrees with his conclusions, if anyone wishes to secure their moral understanding on firm foundations, it would be dishonest and, indeed, surely, immoral not to explore this.