Dentistry, deontology, Double Effect and hypnosis

You are a dentist and a teenage Hitler comes to you to have a bad tooth removed. You only have available an anaesthetic with this feature: Within eight hours of the start of anaesthesia, a neutralizer must be given, otherwise the patient dies. This is not a problem: the extraction will only taken an hour.

You remove the tooth, and are about to administer the neutralizer when you learn that if Hitler survives, he will kill tens of millions of people. And now it seems you have a question whether to save the life of a person who will kill millions if saved. You apply the Principle of Double Effect and check whether the conditions are satisfied:

• Your end is good: Yup, saving the life of an innocent teenager.

• The action is good or neutral in itself: Yes, administering a neutralizer.

• The foreseen evils are not intended by you either as a means or as an end: Yes, you do not intend the deaths either as an end or as a means.

• The foreseen evil is not disproportionate to the intended good: Ah, here is the rub. How can the deaths of tens of millions not be disproportionate to the saving of the life of one?

So it seems that the Principle of Double Effect forbids you to administer the neutralizer, and you must allow Hitler to die. In so doing, you will be violating your professional code of ethics, and you will no doubt have to resign from the dental profession. But at least you won’t have done something that would cover the world with blood.

This is still counterintuitive to me. It feels wrong for a medical professional to deliberately stop mid-procedure in this way.

One can try soften the worry by thinking of other cases. Suppose that the neutralizer bottle has been linked by a terrorist to a bomb a mile away, so that picking up the bottle will result in the death of dozens of people. In that case it is clearly wrong for the dentist to complete the operation. But the Hitler case still feels different, because it is the very survival of Hitler that one doesn’t want to happen. It is a bit more like a case where the terrorist informs you that if the patient survives the procedure, the terrorist will kill many innocents. I still think that in that case you shouldn’t finish the procedure. But it’s a tough case.

Suppose you are with me so far. Now, here is a twist. You learn of Hitler’s future murders prior to the start of the procedure. You are the only dentist around. Should you perform the procedure?

Here are four possible courses of action:

1. You do nothing. The teenage Hitler suffers toothache for many a day, and then later on kills tens of millions.

2. You perform the extraction without anaesthesia. The teenage Hitler suffers excruciating pain, and then later on kills tens of millions.

3. You perform the procedure, including both anaesthesia and neutralizer. The teenage Hitler’s pain is relieved, but then later on he kills tens of millions.

4. You administer the anaesthesia, remove the bad tooth, and stop there. The teenage Hitler dies, but the world is a far better place.

Assume for simplicity that it is the same tens of millions who die in cases 1, 2 and 3.

So, now, which course of action should you intend to embark on? Option 4, while consequentialistically best, is not acceptable given correct deontology (if you are a consequentialist, the rest won’t be very interesting to you). For if you intend to go for Option 4, you will do so in order to kill Hitler by administering the anaesthesia while planning not to administer the neutralizer. And that’s wrong, because he is a juridically innocent teenager.

Option 3 seems clearly morally superior to Options 1 and 2. After all, one innocent person—the teenage Hitler—is better off in Option 3, and nobody is worse off there.

But you cannot morally go through with Option 3. For as soon as you’ve applied the anaesthesia, the Double Effect reasoning we went through above would prohibit you from applying the neutralizer. So Option 3 is not available to you if you expect to continue to act morally, because if you continue to act morally, you will be unable to administer the neutralizer.

What should you do? If you had a time-delay neutralizer, that would be the morally upright solution. You give the time-delay neutralizer, administer anaesthesia, remove the bad tooth, and you’re done. Tens of millions still die, but at least this innocent teenager won’t be suffering. It seems a little paradoxical that Option 3 is morally impossible, but if you tweak the order of the procedures by using a time-delay, you get things right. But there really is a difference between the time-delay case and Option 3. In Option 3, your administering the neutralizer kills tens of millions. But administering the time-delay neutralizer prior to the procedure doesn’t counterfactual results in the deaths of tens of millions, because had you not administered the time-delay neutralizer, you wouldn’t then administer the anaesthesia (Option 2) or you wouldn’t then perform the procedure at all (Option 1), and so tens of millions would still die.

Here is another interesting option. Suppose you could get yourself hypnotized so that as soon as the tooth is removed, you just find yourself administering the neutralizer with no choice on your part. That, I think, would be just like the time-delay neutralizer, and thus it seems permissible. But on the other hand, it seems that it is wrong to get yourself hypnotized to involuntarily do something that it would be wrong to do voluntarily, and to administer to Hitler the neutralizer after the anaesthesia is something that it would be wrong to do voluntarily. Perhaps, though, it is always wrong to get yourself hypnotized with the intention of taking away your of choice (maybe that’s a failure of respect for oneself)? Or maybe it is sometimes permissible to hypnotize yourself to involuntarily do something that it would be wrong to voluntarily do. (Here is a case that seems acceptable. You hypnotize yourself to involuntarily say: “I am now speaking involuntarily.” It would be a lie to say that voluntarily!)