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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.

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"The issue with this argument is that it presupposes a very specific consequentialist framework"

This is false. No part of the argument, nor any of the premises assume this. Rather, it is an argument for the symmetry, rather than assuming it.

In the disease case, it seems like the reason that that's worse is it violates the workers consent in an objectionable way and is, from the perspective of the worker, worse for them. We're terrified (Righly) by the idea of other people violating our bodily autonomy merely based on the fact that it seems better.

Yeah, I guess we have different intuitions in the last scenario. What do you make of the combined bridge and switch case?

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But the argument is immediately defused if your opponent just says, "Okay, but they can't be symmetrical, because one contains [impermissible feature] while the other doesn't." That's my point - virtue ethics and deontology both have room for "deal breakers" that consequentialism doesn't, so while a consequentialist might be compelled by the comparison between relative amounts of suffering, there's no reason to think that would be persuasive (absent other salient questions) to anyone else.

I agree that the secret vaccination is worse because it violates consent. But that's also obviously true when it comes to forced organ harvesting or pushing the fat man. I mean, presumably most people don't consent to being killed by their doctors! Meanwhile, I don't think killing either of them with the trolley can be conceptualized the same way - you don't need their consent to merely bring about their death as an foreseen consequence of an otherwise justified action. I don't think it's possible to fully appreciate consent as a morally relevant concept without also acknowledging something like the doctrine of double effect.

As for the bridge and switch case, I guess I would want to go to the fat man and say, "Hey, there's a trolley coming this way and I'm very sorry but I have to pull the lever and reroute it this way - it's going to crush and kill you slowly, so let me know if you'd rather I just push you over the edge right now so you don't suffer." And if he agreed, I would probably still pull the lever and *then* push him before it could hit him. But, if he really did refuse to let me push him, then I would definitely *not* altruistically do it against his will. I would honor his wish and let the trolley crush him. Same goes for the guy on the track with the organs - if he expressed that he didn't *want* to be murdered and have his organs harvested, then I just wouldn't do that.

Of course, it might be that I'm not able to ask him all that before having to make my decision - in that case, I think I would either 1) let the train run him down, or 2) maybe pull the lever and *then* push him over so he avoided being hit. But I definitely would not proactively decide to use his body without permission as a means to an end.

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As for your first paragraph, I'm not just comparing the relative amounts of suffering. I am relying on the relatively common intuition that giving a person a painless death by pushing her off a bridge is less bad than painlessly killing her y flipping a switch.

Both pulling the switch and pushing the man violate consent in the same way.

In the switch case, we should stipulate that you cannot talk to the man (he has earphones in). We can imagine that you can only do one or the other but not both--perhaps there are 30 people standing behind him, so that if you flip the switch and push him, things will go worse. I also think Loop disproves the mere means account.

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I guess I just don't see much value in that intuition - there are obviously a million different contexts you could provide to that comparison that would lead normal people to believe one or the other was better or worse. That's sorta my point - considered apart from the sort of morally relevant features that most people value, the comparison doesn't have much to say.

Otherwise, I think I just strongly disagree with you that pulling the switch and pushing the man violate consent in the same way. Subjecting someone to a particular harm as a foreseen but unintended consequence of a justified act can't be compared to directly acting with intention to harm them. If pulling the switch violates consent, then what about something like taking a job that would otherwise go to someone else, or not giving up my spot in a line when the person behind me is running late? In both those situations, someone is made worse off by my action, and I would certainly need consent to harm them in an equivalent way directly - I couldn't just steal the amount of money I ended up costing my competitor, or forcibly restrain the person I was delaying. But I don't think anyone believes I would require their consent in any meaningful sense to cause those sorts of harms derivatively in pursuit of a justified end.

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