Double effect and causal remoteness

I think some people feel that more immediate effects count for more than more remote ones in moral choices, including in the context of the Principle of Double Effect. I used to think this is wrong, as long as the probabilities of effects are the same (typically more remote effects are more uncertain, but we can easily imagine cases where this is not so). But then I thought of two strange trolley cases.

In both cases, the trolley is heading for a track with Fluffy the cat asleep on it. The trolley can be redirected to a second track on which an innocent human is sleeping. Moreover, in a nearby hospital there are five people who will die if they do not receive a simple medical treatment. There is only one surgeon available.

But now we have two cases:

1. All five people love Fluffy very much and have specified that they consent to life-saving treatment if and only if Fluffy is alive. The surgeon refuses to perform surgery that the patients have not consented to.

2. The surgeon loves Fluffy and after hearing of the situation has informed you that they will perform surgery if and only if Fluffy is alive.

In both cases, I am rather uncomfortable with the idea of redirecting the trolley. But if we don’t take immediacy into account, both cases seem straightforward applications of Double Effect. The intention in both cases is to save five human lives by saving Fluffy, with the death of the person on the second track being an unintended side-effect. Proportionality between the good and the bad effects seems indisputable.

However, in both cases, redirecting the trolley leads much more directly to the death of the one person than to the saving of the five. The causal chain from redirection to life-saving in both cases is mediated by the surgeon’s choice to perform surgery. (In Case 1, the surgeon is reasonable and in Case 2, the surgeon is unreasonable.) So perhaps in considerations of proportionality, the more immediate but smaller bad effect (the death of the person on the side-track) outweighs the more remote but larger good effect (the saving of the five).

I can feel the pull of this. Here is a test. Suppose we make the death of the sixth innocent person equally indirect, by supposing instead that Rover the dog is on the second track, and is connected to someone’s survival in the way that Fluffy is connected to the survival of the five. In that case, it seems pretty plausible that you should redirect. (Though I am not completely certain, because I worry that in redirecting the trolley even in this case you are unduly cooperating with immoral people—the five people who care more about a cat than about their own human dignity, or the crazy surgeon.)

If this is right, how do we measure the remoteness of causal chains? Is it the number of independent free choices that have to be made, perhaps? That doesn’t seem quite right. Suppose that we have a trolley heading towards Alice who is tied to the track, and we can redirect the trolley towards Bob. Alice is a surgeon needed to save ten people. Bob is a surgeon needed to save one. However, Alice works in a hospital that has vastly more red tape, and hence for her to save the ten people, thirty times as many people need to sign off on the paperwork. But in both cases the probabilities of success (including the signing off on the paperwork) are the same. In this case, maybe we should ignore the red tape, and redirect?

So the measure of the remoteness of causal chains is going to have to be quite complex.

All this confirms my conviction that the proportionality condition in Double Effect is much more complex than initially seems.