Killing People for their Organs
by Benjamin Studebaker
Many people believe they have a knockdown objection to utilitarian moral theory. They argue that utilitarianism implies that it is morally permissible to kill people for their organs in order to save other people. They argue this conclusion is repugnant and obviously wrong, and that therefore utilitarianism must also be a repugnant, obviously wrong moral theory. Sophisticated critics attempt to explain why killing people for their organs is obviously wrong–they claim it uses people as a means to someone else’s ends. In this case, the people killed for their organs are said to be used as a means to the ends of those in need of transplants. As someone with strongly utilitarian leanings, it is important that I have a response to this case, so here goes.
First off, the way the case is presented is morally misleading. Typically, the case is presented in something like this way:
You are a doctor. You have five patients in need of transplants. If they don’t get these transplants, they will die. No compatible existent organs are available. You encounter an additional sixth patient, whom you run tests on. It is revealed that this patient has organs are compatible with all five of the others. If you kill this patient and harvest his organs, you will be able to save five lives that otherwise would have been lost. There is no chance that you will be caught, arrested, or punished in any way. What do you do?
The trouble with this presentation is not that you’re treating the sixth patient as means, it’s that you, the doctor, are not qualified to determine who lives and who dies. Doctors exist to help people, not to make moral determinations. The doctor is not a suitable judge–if he decides to kill the sixth patient, he does so through a decision model that is both unfair and arbitrary. Why should the sixth patient suffer just because he happened to choose to see a doctor?
In a society in which doctors regularly killed some patients to save others, people would avoid doctors out of fear. Many more people would die as a result of untreated conditions. It would be ridiculous, even from a utilitarian standpoint, to permit doctors to decide who lives and who dies on the basis of whom they happened to run into or perform tests on that day.
This does not strike the case down–it merely shows the popular formulation of the case to be deeply flawed. There is a better formulation, and it goes something like this:
You are a statesman. Your state has a total population of 300 million. Every year, 6570 of your people die due to an insufficiently large number of organ transplants. An organ donor can save the lives of up to 8 people. Assume the average number saved is 4. This means that if you kill 1643 of your people and harvest their organs, you can save the 6570, for a net difference of 4927 lives saved. Do you design and create a fair and impartial selection method (i.e. not racist/sexist/otherwise bigoted) for this purpose?
The statistics I use in the above case are based on real statistics available online, with some necessary extrapolations where I was unable to find data. In any case, a small shift up or down in the figures would not likely be decisive–the reader is probably inclined to accept or reject state organ harvesting regardless.
The primary feature of this case is that it looks precisely like the sort of case in which it is almost universally considered reasonable to impose a military draft, the case in which we are fighting an unavoidable defensive war. In a military draft, we coerce some number of citizens into participating in a dangerous activity (war) in order to reduce the total negative effects across society. This is collectively rational, because it improves the outcome for the average citizen–the average citizen is more likely to survive if a sufficiently large number of people are forced to be in the military than he is if the state makes no provision for this. A rational citizen, unaware of whether or not he himself would be forced to join the military through the draft, would support the draft because it makes his odds of surviving and living well higher in a way that is fair and impartial. It is not biased against anyone, and therefore treats the interests of all citizens as being of equal value.
Returning to the organ case, let’s imagine we were behind a veil of ignorance. We do not know whether or not we are going to end up requiring an organ transplant to survive. We also do not know if we would ourselves be chosen in the lottery to die for the good of others. The total number of people who die either due to disease or due to lottery selection is lowest when we have a lottery, and therefore the odds of any one individual behind the veil of ignorance dying are best when we have the lottery. It is collectively rational to have the lottery; it makes the average citizen better off.
The organ harvesting lottery is quite justifiable to a person behind a veil of ignorance whose chances of developing an illness that requires an organ transplant and whose chances of being chosen in the lottery are average. Of course, in nature, people are not awarded failing organs through a random system. Some people who engage in certain behaviors are more likely to need organs than others. Obese people are more likely to needs new hearts, smokers are more likely to need lungs, alcoholics are more likely to need livers, and so on. If we were to adopt a personal responsibility model, as theorists on the right routinely do, many of those in need of organs would be blameworthy for that need in the first place. In that case, it might be unreasonable to kill other citizens through a random system to save the lives of citizens who, had they altered their behavior, might never have needed organs in the first place.
Of course, this response presumes a defensible model of personal responsibility, which requires a defensible conception of free will. I would maintain that it is impossible to offer such a conception, because free will requires that we be the authors of the mechanisms we use to make decisions. This is logically impossible, because we cannot decide without decision-making mechanisms, so free will is false, and personal responsibility models unjustifiable. The obese, the smokers, and the alcoholics inevitably became what they are because of the societies they grew up in and the genetic predispositions they were born with. Their problems are socially constructed and therefore society has a moral obligation to resolve them as best it can.
Without lengthening this post much further, I would like to throw out the idea that it might be better to choose a system of selecting people for organ harvesting that minimizes the damage said harvesting does. For instance, there are several criteria that make a person more or less suitable for harvesting:
- The number of other people who are invested in or dependent upon that person’s continued existence (children, parents, friends, other family)
- The productive efficiency of the individual (much worse to harvest Einstein’s organs than those of a chronically lazy person)
- Suitability of the organs (can use fewer people for harvesting if the average number of lives saved per person harvested is maximized)
With these things in mind, some kind of meritocratic, efficiency-based system might be preferable to a lottery, if such a system could be devised that would be fair and uphold the state’s obligation to treat the interests of all citizens as being of equal value.