Many people still die of organ failure whose lives could be saved if there were only enough organs available for transplantation. Unfortunately, there aren’t. Various solutions to the problem have been proposed, but those that promise to be most effective also tend to be rather unpalatable. Thus Dominic Wilkinson and Julian Savulescu have recently suggested that we suspend the dead donor rule (i.e. the rule that we should not remove organs from patients prior to death), and instead of merely withdrawing life support from critically ill patients in intensive care whose lives are deemed to be no longer worth living, we should just kill them and harvest their organs as long as they are still fresh and in good working order. Alternatively, we could establish a system of organ conscription, where you can no longer even opt out: never mind what you or your family want, once you’re dead your body belongs to the state (“Should We Allow Organ Donation Euthanasia? Alternatives for Maximizing the Number of Organs for Transplantation”, Bioethics 26/1 (2012): 32-48).
The typical bioethicist is rather fond of radical solutions. He dislikes waste, has no patience with what he sees as people’s squeamishness, and believes that we should be rational about things, which mostly means that we should rethink our morality, our established views of right and wrong, if there is no other or better way to solve a problem quickly and efficiently. Do you believe that people should have a say in what happens to their bodies when they are dead? - But then they may not allow us to use their organs, which we urgently need. To save lives! To help people! So we really cannot afford letting those organs go to waste, and that means we cannot afford allowing people to decide for themselves whether they want to “donate” their organs or not. Do you believe that organs should only be taken from dead people who no longer need them? - But some who are still alive are in fact as good as dead, so that they would not really miss those organs. And besides, we urgently need them now. We really cannot afford to wait until people are completely dead. After all, there are people’s lives at stake here. Actually, come to think about it, we cannot even afford to wait until people are almost dead. It would be so much more efficient if we could just take the organs we need from the living, if we could kill a few to save many others. It’s all for the greater good. Yes, of course, killing people for their organs is currently frowned upon, but hey, it doesn’t have to stay this way. Sometimes sacrifices have to be made for the common good, and anyway, we may quickly get used to it and see the error of our previous ways.
This is what the Manchester-based philosopher John Harris suggested in a paper published almost 40 years ago (“The Survival Lottery”, Philosophy 50/ 191 (1975): 81-87), in which he proposed that we solve the problem of not being able to procure enough spare organs to save the growing number of people who need new organs to survive by establishing a lottery. Each of us is assigned a number, and whenever there is a shortfall of organs, a number is drawn and the lucky bastard whose number it is gets killed (or rather called upon to “give his life”). All his organs can then be used to preserve the lives of those who need them. This way a lot less people would have to die.
To me this is the stuff that dystopian nightmares are made of. Yet when I put the question to my students, asking them in an exam whether they thought that Harris’s survival lottery was “a morally acceptable way to tackle organ shortage”, I once again found that a majority of them did not only think that it was morally acceptable, but in fact that it was clearly what was morally required. They showed themselves quite convinced by Harris’s utilitarian reasoning and the crucial assumption that there is no morally relevant difference between killing and letting die, so that if we have to kill one to prevent two or more people from dying, then that is exactly what we should do. The numbers speak for themselves. They appear to have an enormous persuasive power. As one student put it: “Such massive consequential benefits to society as a whole seem to me to rather morally outshine the far rarer occasional acts of killing.” As if the legalisation of “occasional acts of killing” by an agency of the state could ever be justified. That is the kind of argument that Hitler and Stalin must have used when they justified their policies before themselves and others. It blindly follows the imperative of maximisation. And I think I get its allure. It makes things so much easier. Who needs a conscience when we’ve got numbers, right? But I’m still surprised, and also dismayed, by how easily people can be persuaded to endorse inhuman practices and how willing they are to believe that everybody is expendable and that to be treated solely as a means to an end is perfectly all right, so that the state should have the power to take our lives whenever it is deemed expedient. As another student put it: “As utility is the maximisation of pleasure, then people can rightly be viewed as interchangeable parts in a mechanism, designed to promote as much happiness as possible.” Rightly! How can people be so willing to give up their most basic rights, to see themselves as an interchangeable part in a mechanism? We are all oil on the wheels of the great utilitarian happiness machine. Is that really what we are or how we want to see ourselves? And for whose sake really? Other people’s lives? But those other people are just as expendable as we are. Surely there is a contradiction at the heart of this terrifying proposal: human life is proclaimed to be so important that anything is acceptable to save it, including the killing of a healthy, innocent and perfectly alive human being. But by finding this acceptable we implicitly declare the life of that human (and with it the life of any human) for disposable. If the individual human life doesn’t count, then we don’t seem to have a good reason to want to save it at all costs. Then we can just as well let people die. The truth is that the reason why we think that we should save people’s lives if we can is in fact the same reason that makes us (or, if we were thinking straight, should make us) reject Harris’s proposal.
Sometimes I think that, on the whole, applied ethics might be doing more harm than good, that more often than not it doesn’t aid our moral thinking, but corrupts it. It makes the unthinkable thinkable. I used to believe that this was an advantage. I’m not so sure anymore.