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Thursday, April 25, 2013

The Organ Conscription Trolley Problem

Yesterday, Glenn discussed paying people to donate nonessential organs while they are alive. I will argue that we ought to more aggressively incentivize organ donations from the recently deceased.

Imagine that an out-of-control trolley is heading toward an innocent person who is for some reason strapped to the trolley tracks. You happen to be standing near a switch that can divert the trolley to a different track and represents the only available means of saving the person. Here's where this trolley problem gets much easier than others you've seen: If you divert the trolley, it will unavoidably crush the body of an already-deceased person who is strapped for some reason to the diversion track. Are you morally permitted to flip the switch to save a life when doing so will crush a deceased person? Clearly you are. Indeed, you are morally obligated to do so.

What if the family of the deceased is standing nearby and urges you not to, pleading that if their loved one's remains are crushed, it will interfere with his religious preferences about burial? No matter how much it upsets the family and would have upset the deceased, you are  permitted to divert. Now what if diverting  would save not one life but six or seven? And what if the trolley wouldn't crush the deceased beyond recognition but would merely cause some internal change that would be invisible at burial? Surely the answers only become easier.

If you've answered as I have, we should be permitted to take the organs from the recently deceased when doing so represents the only way of saving the six or more people who need those organs to survive. Does this mean we should implement a routine salvage program where people must donate if they die with organs available for transplantation? Not necessarily. There may be financial or priority incentives that will induce sufficent donation such that we don't have to go so far as to conscript lifesaving organs. But our current practices cause far too much unnecessary death and misery. See here and here for more.

Posted by Adam Kolber on April 25, 2013 at 06:44 AM | Permalink

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Comments

Clever intuition pump, Adam.

Posted by: Dan Markel | Apr 25, 2013 3:02:26 PM

The trolley is headed for an unknown stranger strapped to the tracks. You can divert the trolley. On the other track is DaVinci's Mona Lisa. Gonna pull the lever? (Be honest -- it took you a little longer to answer the question this time didn't it. Why? Because the Mona Lisa is unique?)

The trolley is headed for an unknown stranger. On the other track is your mother, who died yesterday. Gonna pull the lever? (how long did it take this time?)

Posted by: Mitch | Apr 25, 2013 3:34:49 PM

Adam Kolber, if your first trolly scenario is meant to elicit the response that of course one is obliged to save the living person and destroy the deceased body, but the whole point of the scenario is to explore compelling organ donation to save perhaps six people from every deceased body...assuming that the corpse was viable for donation in the first scenario, might the more appropriate moral response be to consider destroying the corpse equivalent to killing six people who simply are not present on the scene? Funnily even if you assume that this is the case, that destroying the corpse means that six people who would have benefited from its donations would lose their lives, I doubt many people would want to throw a switch to divert the trolley onto the living person.

Arranged this way, the donor-corpse trolley scenario might resemble that presented in Judith Jarvis Thomson's, The Trolley Problem, 94 Yale L. J. 1395 (1985) where a brilliant transplant surgeon considers killing a patient to harvest their organs to save five other patients. While most people agree to sacrifice the one in the classic trolley problem, virtually no one endorses killing someone to save others with their organs (similarly, comparatively few people endorse sacrificing the single person in Thompson's 'fat man' variant to the Trolley problem).

It might be that the varied intuitions we have about these different trolley problem cases just demonstrate that our intuitions about this class of problem are unreliable for moral guidance - that our intuitions about at least some class of trolley problem are faulty and we can therefore not use our intuitions on the trolley problems to extrapolate to general moral principles.

I think with regards to Mitch's scenarios, in the Mona Lisa case and the deceased mother's corpse case most people who seriously distinguish moral evaluation from emotional reaction (which is not to say that they make moral decisions dispassionately but that they do not believe morality is reducible to doing what feels most gratifying or anxiety-releiving), to the extent that someone anticipates that they'd hesitate in those cases, they should only illustrate to them a case where fulfilling their moral duties produces some sadness and conflict. Everyone should still come to the conclusion that specially valued paintings and corpses should be sacrificed for actual living people (except for the concerns for their organs as described above).

Posted by: SG | Apr 25, 2013 5:55:40 PM

The most moral solution that preserves personal autonomy is to allow folks to prospectively contract, at or after age 18, to allow harvesting of their cadaver's organs, for which they would pay the market rate. This would preserve individual autonomy and provide funds for college study. The grieving family would not be involved in any decision about organ donation.

Posted by: jimbino | Apr 26, 2013 12:00:31 PM

Thanks, everyone, for these very thoughtful comments. I've used some of them as jumping off points for my next post. (Apparently, if I link to it this comment is more likely to be eaten up as spam.)

Posted by: Adam Kolber | Apr 26, 2013 4:26:54 PM

Thanks, everyone, for these very thoughtful comments. I've used some of them as jumping off points for another organ donation post that just went up.

Posted by: Adam Kolber | Apr 26, 2013 4:29:12 PM

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