Organ Harvesting Isn't Different From Switch Flipping
Modified versions of the cases show this
Most people think that you should flip the switch in the illuminatingly titled switch version of the trolley problem. The basic scenario is this. A train is on a track that is going to hit five people. SAD! However, you can flip a switch to redirect it so that it will hit one other person on the track. Most people think that you should do so; we know this from poll results.
There’s a very natural explanation of why this is the case. The explanation is roughly the following: it’s good to bring about some number of deaths to prevent some greater number of deaths. One death is less bad than five deaths, so you should bring about a state of affairs that ends up with one death rather than five. It’s good to make things better, so you should flip the switch.
I like this account, and think it is true. However, this account does not fit all of our initial intuitions—consider the following two sets of intuitions.
Transplant: a doctor can harvest a healthy person’s organs to redistribute them and save five people.
Push: A big man is on a track. A train will hit five people unless you push the man off the track. He’ll be killed by the train, but he’ll stop the train from hitting the five.
Now, elsewhere I’ve argued that utilitarianism does, in fact, get the correct answer in Transplant and bridge. But here, I’ll argue for something more modest—the wrongness of flipping the switch is roughly the same as the wrongness of pushing the person and harvesting the person’s organs.
Suppose that flipping the switch was less wrong than pushing the guy off the bridge. In this case, we should expect that, if one is given the choice between the two actions, they ought to flip the switch. After all, it’s better to do less wrong things rather than more wrong things.
Thus, the argument is as follows.
If flipping the switch is significantly less wrong than pushing the man, then if given the choice between the two options, even if flipping the switch is made less choiceworthy, one ought to flip the switch.
If given the choice between the two options, even if flipping the switch is made less choiceworthy, one ought not flip the switch.
Therefore, flipping the switch is not significantly less wrong than pushing the man.
1 is very obvious. If it’s not seriously wrong to flip the switch but it’s seriously wrong to push the man, then there won’t be scenarios where you should push the man, rather than flip the switch, even if we equalize things and make flipping the switch less choiceworthy. If you think that pushing small children is very wrong but eating cake is not very wrong, then if given the choice between the two, even if pushing small children is made slightly more choiceworthy, you should still eat cake instead.
I’ll clarify what I mean more in the defense of premise 2. Imagine the following scenario. There’s a train that will hit five people unless you do something. There’s a man standing above, on a bridge. There’s a track that you can, by flipping a switch, redirect the train onto, which leads up to the man on the bridge above the track. However, the train moves very slowly, so if you do that, the man will be very slowly and painfully crushed.
However, you have another option. You can, by pushing the man, cause him to die painlessly as he hits the tracks, and he’ll stop the five people. Which should you do?
Now, the deontologist is in a bit of a pickle. On the one hand, they think that you should flip the switch in general to bring about one death while saving five, but you shouldn’t push a man to save five. But in this case, it seems obvious that, given that the man would be far, far better off, it’s much better to push him than it is to flip the switch.
One might say that in this case, the man would consent. However, this doesn’t have to be so. We could imagine the man refusing to consent to anything, or just not having the opportunity to consent to anything for some reason, you can’t ask him; perhaps he’s asleep.
They could just bite the bullet and say you should flip the switch. But this is obviously wrong. It makes the victim much worse off than he’d otherwise be. Whatever morality is, it mustn’t be harming the victims of your actions.
Consider another case that should bare out the intuition. Suppose that it’s like the previous scenario, except you can either push the man or flip the switch. However, if you push the man, it will save five people, while it will only save three if you flip the switch. If you push the man, it will save all three of the people that will be saved by the switch flipping as well as two others. In this case, it seems obvious that you should push the man. But the deontologist has to deny this. They have to deny this precisely because they think that the morally salient difference between flipping the switch and pushing the man is greater than the lives of two people—after all, they think that you should flip the switch to save two but you shouldn’t push the man to save five.
If this convinces you that there’s no particularly salient difference between flipping the switch and pushing the man, then it should also convince you that there’s no particularly salient difference between flipping the switch and harvesting the organs. To see this, suppose that the following is the case.
There are five people on a track that a train will hit. These people are immobilized because they’re temporarily missing organs. However, later in the day, they will get organs and be able to move. You can flip the switch to redirect the train to hit the one person—however, this will kill him painfully. Alternatively, you can very quickly harvest his organs and put them in the five people. He will die, but the five people will be able to move to evade the train. It seems very obvious that you should harvest the organs—that’s what the “victim” would rationally prefer. Yet deontology struggles with such a trivial claim.
We can also make it analogous to the second scenario that I talked about by making the organ harvest able to save not merely the five people on the tracks, but there would be organs to spare which would save two others. Either way, it’s a big problem for the deontologist.
The issue with this argument is that it presupposes a very specific consequentialist framework, where different actions are ranked better or worse depending on one big "badness score" and you pick the one that comes out best. I don't think any virtue ethicist or deontologist would support that way of looking at things. For most non-consequentialists, there are certain features of an act that automatically render it impermissible - not just because that feature jacks up the act's "badness score" beyond anything else, but because it essentially takes the act out of the "badness score" running in the first place. It's just not something you're allowed to consider doing. So if you think using someone's body as a means to an end is one of those sorts of things, then the calculus you're trying to do here isn't even going to get off the ground.
Specifically with regards to the trolley, pulling the switch in the classic scenario isn't using someone's body as a means to an end - it's just acting to avoid harming others in a way that has a foreseeable but unintended harm to someone else. This is also true of pulling the lever in the scenario where the fat man gets crushed. Pushing the fat man, on the other hand, *does* use their body as a means to an end. That is obviously a morally relevant distinction. You're right that the additional suffering generated is important, but it's not immediately obvious to me that, if you're justified in causing someone a certain amount of pain in order to achieve a certain end, you're automatically justified in doing anything to achieve that end that causes a lesser amount of suffering to them.
Imagine a boss who has a legitimate need to make sure his employees are vaccinated from some serious disease. He might fine or otherwise punish a hesitant worker in order to achieve that goal, or he might just inject them with the vaccine while they're sleeping. The former strategy hurts the worker more than the latter strategy, but it seems obvious to me that the latter strategy is still impermissible while the former isn't. So it can't *automatically* be the case that, just because you're allowed to harm someone seriously in pursuit of some end, you're also allowed to harm them in any less serious way. You'd have to do more to actually justify that. "Whatever morality is, it mustn’t be harming the victims of your actions" is too simplistic.
Finally, I'd just say that my moral intuitions are immediately opposite yours in the last scenario. It *does* seem much worse to me to kill someone (against their will) and harvest their organs in order to aid the movement of some other endangered group, as opposed to pulling the switch and having the trolley hit them. Of course, if they were to volunteer their own life, then it would be better to painlessly kill them. But if they don't want to die, then it seems obviously worse to actively violate that wish by direct killing than it would be to cause their death as a mere foreseen consequence of a life-saving act. I think a lot of utilitarians need to remember that their moral intuitions around this stuff are actually somewhat uncommon, or at least not universal, and that merely referencing those intuitions as though they're obviously correct won't have a lot of traction with people.