In my previous
post, I discuss cases where someone is doing an evil for the sake of
preventing significantly worse goods—say, murdering a patient to save
four others with the organs from the one—and note that a straightforward
reading of the Principle of Double Effect’s proportionality condition
seems to forbid one from stopping that evil. I offer the suggestion, due
to a graduate student, that failure to stop the evil in such cases
implies complicity with the evils.
I now think that complicity doesn’t solve the problem, because we can
imagine case where there is no relevant evildoer. Take a trolley problem
where the trolley is coming to a fork and about to turn onto the left
track and kill Alice. There is no one on the right track. So far this is
straightforward and doesn’t involve Double Effect at all—you should
obviously redirect the trolley. But now add that if Alice dies, four
people will be saved with her organs, and if Alice lives, they will
die.
Among the results of redirecting the trolley, now, are the deaths of
the four who won’t be saved, and hence Double Effect does apply. To save
one person at the expense of four is disproportionate, and so it seems
that one violates Double Effect in saving the one. And in this case, a
failure to save Alice would not involve any complicity in anyone else’s
evildoing.
It is tempting to say that the deaths of the four are due to their
medical condition and not the result of trolley redirection, and hence
do not count for Double Effect proportionality purposes. But now imagine
that the four people can be saved with synthetic organs, though only if
the surgery happens very quickly. However, the only four surgeons in the
region are all on an automated trolley, which is heading towards the
hospital along the left track, is expected to kill Alice along the way,
but will continue on until it stops at the hospital. If the trolley is
redirected on the right path, it will go far away and not reach the
hospital in time.
In this case, it does seem correct to say that Double Effect
forbids one from redirecting the trolley—you should not stop the
surgeons’ trolley even if a person is expected to die from a trolley
accident along the way. (Perhaps you are unconvinced if the number of
patients needing to be saved is only four. If so, increase the number.)
But for Double Effect to have this consequence, the deaths of the of the
patients in the hospital have to count as effects of your trolley
redirection.
And if the deaths count in this case, they should count in the
original case where Alice’s organs are needed. After all, in both cases
the patients die of their medical condition because the trolley
redirection has prevented the only possible way of saving them.
Here’s another tempting response. In the original version of the
story, if one refrains from redirecting the trolley in light of the
people needing Alice’s organs, one is intending that Alice die as a
means to saving the four, and hence one is violating Double Effect. But
this response would not save Double Effect: it would make Double Effect
be in conflict with itself. For if my earlier argument that Double
Effect prohibits redirecting the trolley stands, and this response does
nothing to counter it, then Double Effect both prohibits redirecting and
prohibits refraining from redirecting!
I think what we need is some careful way of computing proportionality
in Double Effect. Here is a thought. Start by saying in both
versions of the case that the deaths of the four patients are
not the effects of the trolley redirection. This was very
intuitive, but seemed to cause a problem in the delayed-surgeons
version. However, there is a fairly natural way to reconstrue things.
Take it that leaving the trolley to go along the left track results
in the good of saving the four patients. So far we’ve only
shifted whether we count the deaths of the four as an evil on the
redirection side of the ledger or the saving of the four as a good on
the non-redirection side. This makes no difference to the comparison.
But now add one more move: don’t count goods that result from evils in
the ledger at all. This second move doesn’t affect the delayed-surgeons
case. For the good of saving lives in that case is not a result of
Alice’s death, and the proportionality calculation is unaffected. In
particular, in that case we still get the correct result that you should
not redirect the trolley, since the events relevant to proportionality
are the evil of Alice’s death and the good of saving four lives, and so
preventing Alice’s death is disproportionate. But in the organ case, the
good of saving lives is a result of Alice’s death. So in that
case, Double Effect’s proportionality calculation does not include the
lives saved, and hence, quite correctly, we conclude that you
should redirect to save Alice’s life.
Maybe. But I am not sure. Maybe my initial intuition is wrong, and
one should not redirect the trolley in the organ case. What pulls me the
other way is the hungry bear case here.