Monday, September 19, 2022

More on proportionality in Double Effect and prevention

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.

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