Michael Sandel, Trolleys, and Organ donors

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I spent some time today listening to Michael Sandel's popular Justice course on iTunes U. The first two episodes are kind of a "greatest hits" of ethics hypos: he starts with the trolley problem (switching and fat man variants) and then moves onto the transplant problem. As usual, a lot of people are willing to switch the track, a lot fewer are willing to push the fat man, and practically nobody is willing to kill a healthy person to harvest his organs. There's all the usual flailing around as the students try to differentiate cases which are similar in body count but provoke radically different moral intuitions.

The organ transplant case is supposed to be a sort of reductio ad absurdum for consequentialists. Like the basic trolley case, it involves trading the death of one person to save five, but unlike the basic trolley cases, you're actually murdering the guy. Unsurprisingly, practically nobody is willing to sign on to that being morally acceptable, but since the math is the same, this suggests that there's something morally icky about consequentialism. Obviously, you can just embrace the cold (but allegedly logical) result, but in this particular case there's an alternative response within the framework of consequentialism: argue that sacrificing one unwilling donor to save five people isn't actually the right consequentialist choice. Obviously, if we're talking about this one case, then the cost/benefit analysis works out, but you need to think about the general equilibrium scenario. If innocent people regularly walk into the ER and coming out in pieces, then everyone is going to be a lot less likely to visit the doctor, which is not only bad for them, but also means that there won't be anyone to use as organ donors, in which case there won't be any recipients to trade off against donors anyway. (Note that the hypo here is that the doctor doesn't get caught, but if the base rate of going in healthy and coming out dead goes up a lot, this deters people from visiting doctors even if they think the causes of death are innocent).

Obviously, you can try to sharpen the case to remove this problem (it's a one-time thing for some reason, for instance). This is the philosopher's natural response, as evidenced when one student suggests waiting for one of the sick people to die and harvesting his organs instead; Sandel's response is that he's ruined the philosophical point; more on this in a second. But now you run into the objection that the scenario is basically so artificial that it doesn't tell you anything useful about day-to-day moral reasoning, which is of cours the generic objection to most of the philosophical ethics hypos. The nice thing about the organ donar hypo is that it does seem plausible at some level, the more you adjust it to sharpen it the less it works as an intuition pump.

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