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Friday, April 26, 2013

Replies to the Organ Conscription Trolley Problem

Yesterday, I argued for more aggressive efforts to boost the supply of cadaveric organs available for transplant: If an out-of-control trolley were heading toward a living person strapped to the tracks, we surely ought to divert it to another track, even if doing so will crush a corpse along the alternate path. If we are permitted to crush a corpse when it's the only way to save a life, even if the family of the deceased doesn't want us to, then we can recover organs from the deceased when the invasion is fairly minimal (it won't interfere with burial) and the gains are not one life but several. I emphasized an important qualification, however: we are not permitted to just take organs when we can obtain consent with less invasive approaches, like offering financial or priority incentives.

Commenter SG raised questions about whether trolley problems do a good job of testing our intuitions. There is certainly a lively debate about the reliability of trolley problem intuitions and the reliability of moral intuitions more generally. Despite pitfalls, I believe trolley problems can help us abstract away  morally irrelevant considerations. A family considering donation, for example, doesn't know whose lives are in the balance. But we know that as a matter of policy, many lives end prematurely because lifesaving organs are wasted. Therefore, the trolley problem I posed helps us removes distractions and confront the loss of life more directly.

Commenter Mitch proposed a variation: Suppose the deceased on the alternate track is your recently-deceased loved one.  I have two replies: First, we need not frame the problem that way in order to draw conclusions about organ donation policy. The destruction of the corpse will be very upsetting to the family, but when we decide public policy, we typically abstract away from who our particular loved ones are. It would bias my hypothetical to stipulate that the living person is your relative, and it would bias the opposite way to assume the deceased was.

Second, even if the trolley problem were posed in this  fashion, you should still flip the switch if it's the only way to save a living human. (Perhaps families should be excused from blame given that they must  decide under pressure while grieving, but that's another matter). Interestingly, medical examiners frequently conduct autopsies in which consent is irrelevant. Some of these investigations may save lives by preventing murders. But organ donation is plausibly much more lifesaving than medical investigation.  

One last point: It's easy to think that our choices are to give up our organs or have them stay intact forever. Perhaps mandatory autopsies are viewed as different than conscripted donation because autopsies do not involve a prolonged "using" of someone's organs. But the "using" happens either way. Your organs can be taken over by bacteria and insects or they can go to save living people. If we were better able to come to terms with such unpleasant facts, we'd more effectively save and heal the living.

Posted by Adam Kolber on April 26, 2013 at 04:22 PM | Permalink


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"But it also allows us to focus on certain value trade-offs without getting distracted by the uncertainty factor." But that's just it, I'm not convinced that people responding are in fact not getting distracted by the uncertainty factor, even if you tell them to assume something is true. Judges do that sort of thing, and philosophers, but ordinary people don't have much experience thinking like that.

Posted by: Bruce Boyden | Apr 27, 2013 3:38:19 PM

Thanks, DrGrishka! I'm afraid I don't see the problem. I'm fine to stipulate the following: The family of the deceased recently found out that their relative died. They are now transporting the body from the hospital to a funeral home and in getting to the funeral home, the body gets stuck momentarily over some trolley tracks. I think you're still obligated to flip the switch.

(We could further add that the dead body is, for some reason, connected to portable machines to maintain blood flow and the like until it gets to the funeral home, but I think that adds more distraction, at least for people who accept the criteria for brain death. And for those who don't accept the criteria for brain death, I think they should still agree with my version of the trolley problem to the extent I stipulate that the body really is dead.)

Posted by: Adam Kolber | Apr 27, 2013 2:54:23 AM

Thanks, Bruce! They don't require complete omniscience, but they do require you to have the knowledge stipulated by any particular trolley problem. That does make them a bit less like real life. But it also allows us to focus on certain value trade-offs without getting distracted by the uncertainty factor. But:
(1) Don't courts do something similar in motions to dismiss when they accept as true the assertions of the non-moving party?
(2) If we changed the trolley problem I gave by saying that there's an 85-95% chance the trolley will kill the living person if you don't flip and a 99% chance that if you do flip, it will crush the deceased problem, I don't think it changes the result. It just introduces a distraction.

You're certainly right, though, about organ transplants. Sometimes they don't work. When they do work, they may lengthen a person's life without restoring full life expectancy, and so on. It raises the interesting question: for every additional body with organs available for transplant, on average, how many lives to do we save. I don't know the answer to that, but I expect it's at least more than one (which was what I assumed in the main version of the problem).

Posted by: Adam Kolber | Apr 27, 2013 2:43:14 AM

I am not quite sure the analogy works. In the initial hypothetical the corpse is essentially abandoned on the tracks. In real life, however, the corpse is being taken and cared for by the family. The family is not interfering with the diversion of the trolley, but neither are they helping. I think that that is where the analogy breaks down.

Posted by: DrGrishka | Apr 26, 2013 8:05:40 PM

I hate the trolley problem because it presumes omniscience, which no one has in real life. How is it that you know that throwing a person in the way of a train will save five lives? It sounds really implausible, unless that person weighs 10 tons, which is also implausible. And it's not just that the particular scenario is implausible; it is a very rare case in which you are going to know with certainty that taking someone's life would actually save others. Organ transplants fail; there are problems with transportation of the organs; etc. I think the trolley problems illustrate that people justifiably require more certainty before intentionally doing harm to someone than they do in taking action to switch between two equally probable results (the 5 vs. 1 scenario of the original problem); I am not convinced that they illustrate any particular difference in analyzing the morality of action vs. inaction.

Posted by: Bruce Boyden | Apr 26, 2013 5:02:53 PM

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