Saving Humans by Numbers: Part 5 – Attractions

Dr Jussi Suikkanen

So far, in this series, I have considered cases in which you have to decide whether to save one individual person from death or a larger group of people from the same faith. Through critically thinking about John Taurek’s work, we have reached an appealing way of thinking about these situations. I should say that this way of moral thinking is also very much inspired by an ethical theory called contractualism which was recently made popular by T.M. Scanlon in his book What We Owe to Each Other.

If you are in a tricky situation like the case where you have to save either one person or five people, you first consider what kind of general policies could be adopted for that situation. We could adopt a principle that requires to save the greater number, or to flip a coin, or to always save the single person, or to always save whoever you fancy, or … We then think what consequences these principles would have for individuals. If a principle would cause serious and unnecessary burdens to some individuals, then the use of that principle can’t be justified to those people. If it doesn’t, then it’s fine to act on the principle in the situation you are in.

If we think of the principles for the life-saving case in this way, in the basic case the saving the greater number principle seems to be the only justifiable principle. All other principles would cause each one of us a higher risk of death in the live-saving incidents we might have to face during our lives. For that reason, you are not allowed to do anything else except to save the greater number, other things being equal.

This way of comparing the moral principles has attractive consequences also in other kind of cases that are problematic for utilitarian thinking. Consider a case in which you can either save one person from getting a broken bone or million people from a mild headache. When utilitarians think about this type of cases, they’ll have to sum up all the headaches and thus for them it seems like saving a lot people from mild headaches is the better outcome which you should bring about. This to me seems like the wrong to say.

But let’s consider this case with the previous method of moral reasoning. We could all either adopt a principle that requires us to save an individual from breaking a bone in this type of cases or a principle that requires saving the million people from mild headaches instead. When you compare these principles, you don’t know how you will end up being affected by them. You might be end up being the one person whose bone can get broken or you might end up being one of the million people who’ll get a mild headache. Thus, one of the principles will generally protect you from mild headaches in these cases whereas the other principle protects you from breaking a bone in similar situations. It seems to me that it is far more important to be protected from broken arms than mild headaches even if it is likelier that you will occasionally be in the group of million who’ll get a mild headache.

The previous case shows why adopting a principle that requires us to save a huge number of people from trivial harms instead of fewer people from significantly more serious harms can’t be justified to us as individuals. This case too has important implications for distributing healthcare resources. It offers us a way of thinking about the seriousness of harms when we make policy.

Of course this way of thinking about saving lives also has its problems. For example, it will be difficult to deal with cases in which the sizes of the groups and the seriousness of harms are very close. Given a choice between saving one person from death or three people from complete paralysis, what should you do? Adopting the save the one person policy would give us all slightly lower chance of death but a somewhat higher chance of paralysis. Adopting the save the group policy for this type of cases would give us a somewhat lower chance of paralysis but a slightly higher chance of death. Which one of these patterns of risk is a more serious burden to bear that couldn’t be justified to us? This question then seems here just as difficult as the question of what you should do in the original situation.

Image source: http://commons.wikimedia.org/wiki/File:Vintgar-Gorge_people-on-bridge_(8139628676).jpg

Saving Humans by Numbers: Part 4 – The Veil of Ignorance

Dr Jussi Suikkanen

This series of blog-posts is investigating who we should save in a simple case in which we can either save one person or five people from drowning, other things being equal. Intuitively, in this case you should save the group of five in the same way as you should always save as many people you can. In the previous two posts, I have gone through John Taurek’s argument to the conclusion that this isn’t right.

According to Taurek, we can’t justify our choice of saving the greater number to the single person who is about to die. The individuals in the group can offer the best justification for why the group should be saved: each one of them will die unless the group gets saved. The crux of the argument is that the single person who is about to drown can say exactly the same thing. Unless he gets saved, he dies too. This means that the demands of the single person and each one of the people in the group for being saved are equally strong and no individual has a strong claim for being saved. There is no group entity how has to suffer from death five times as much as the single person. For this reason, both the single person and the individuals in the group have an equal claim for being saved. As a result, it is permissible to save either the single person or the group, but you are not required to save the greater number. According to Taurek, this leads to the conclusion that we should flip a coin.

Note how radical consequences this argument has. Imagine that you have a set amount of drugs to administer. Imagine that there are two groups with two different medical conditions. One of these conditions is such that you need to give much more of the drug for people who suffer from it. If you give the drugs to group A, you’ll give 100 people 10 more quality-adjusted life years each. If you give the drug to group B, you’ll give only 20 people 10 more quality-adjusted life years each. Intuitively, you would want to give the drug to the larger group where it ends up giving people more quality life, but if Taurek is right you should flip a coin between these groups too. You could not justify favouring the bigger group to the members of the smaller group. If this were right, a maximally efficient health-care system would not be just.

Today I want to argue that Taurek reasoned in the right way but he drew the wrong conclusions from his argument. When you think about whom you should save in the basic case, it is exactly right to think about what you can justify to the individuals in question.  And, I think it is also right that when we think what can be justified to individuals in this kind of cases we need to compare what kind of burdens individuals come to bear as a result of our choices. The justifiable way of acting is the one that doesn’t unnecessarily burden any single individual.

The problem is that Taurek is wrong to focus just on the individual case. Instead, we should think about what kind of consequences general policies have for different individuals and whether these policies can be justified for everyone personally. This means that we must compare two different life-saving policies: the saving greater number policy and the coin flip policy. In the long term of course if the coin is fair, adopting the coin flip policy will kill three times more people than the saving the greater number policy (in the basic 1 vs. 5 situations we been considering).

The utilitarians will at this point automatically think that this just shows that the saving the greater number, but I think Taurek is right in insisting that utilitarianism overlooks what happens to individuals. Instead, when we think about which one of these principles we should adopt together, at that point we don’t know which ones of us the possible adoption of these principles will come to affect and how. We don’t know who will be saved because of them and who won’t. So, when we decide which one of these principles we should accept, we are all behind what John Rawls called the ‘veil of ignorance’. We know the consequences of the alternative policies in general, but not the impact on us as particular individuals.

If we think of the two possible principles in this way, both the saving the greater number principle and the coin flip principle will end up causing burdens to as individuals. The acceptance of the saving the greater principle gives us all a 17% chance of dying in a future life-saving incident where we turn out to be in one of the boats. The coin flip principle in contrast gives us only a 50% chance of dying in such incidents when we don’t know which boat we will be in. In this way, Taurek’s coin flip principle causes us all an unnecessary burden – a higher risk of death – if we don’t just think of what happens in one individual case. For this reason, the adoption of that principle can’t be justified to us. As a consequence, the saving the greater number principle is the only principle that we can be expected to accept, which is really why you should save the greater number in the life-saving cases. Principles that permit acting in any other way can’t be justified to us as individuals because they all make us more likely to die which is a burden in itself.

Image Source: http://commons.wikimedia.org/wiki/File:Ripple_effect_on_water.jpg

Saving Humans by Numbers: Part 3 – Lotteries

Dr Jussi Suikkanen

This series of blog posts considers how we should take numbers into account in saving lives. So far three things have happened. We are considering a simple case in which we can either save one person or five people from death in a case in which no special considerations are present. Intuitively, and according to utilitarianism, in this case we should save the five people.

Yesterday, we considered John Taurek’s objection to this conclusion. According to him, we must be able to justify our plan to save the bigger group to the single person who drowns if we do so. This justification must address the single person’s personal perspective – some real person must be able to put forward the justification to the single person in the form “Unless you bear the regrettable burden of dying, something even worse will happen to me and for that reason unfortunately you can’t be saved”. Taurek’s insight was that no person can give justification of this concrete and personal kind to the single person who is about to drown. The people in the group can only put forward the same personal burden of dying as the single individual to justify the choice to save them, and there is no higher entity who has to bear the burden of dying five times.

From this failure to justify the plan to save the greater number to the single person, Taurek draws the conclusion that both options must be permissible for us: in the simple case, you are allowed to save the single person and similarly you are also allowed to save the group of five. Whichever way you go, you do no wrong. The crucial point is that you are not required to save the group and you are not required to save the single person as these straightforward requirements could not be justified to the people in question for the reasons explained yesterday. We need to keep in mind though that not saving anyone is not an option for you either. This is something you could not justify to anyone.

If you are allowed to save either the single person or the group, what should you then do? For example, can you just do what you want? If you happen to like the shoes a person in the group is wearing, can you thereby save the group? Or if you just feel like saving the single person, can you go for that option?

Taurek claims that making the choice in these ways would not be right even if it is permissible for you to save either the single person or the group. Consider the following example. Imagine that you have two children and you have only one cookie left. Neither one of your children has a special claim for getting the cookie. In principle, it is permissible for you to give the cookie to either one of them. Despite this, you can’t give the cookie to the child you just happen to like more. This would be an unfair way to make the choice.

Intuitively, in this case you should flip a coin. This would be a fair procedure to solve the problem you are facing. It gives both children the same chance. Taurek claims that the right solution to the basic life-saving case is the same. We must use a fair procedure that gives each person an equal chance of being saved. Taurek’s own suggestion is that we should flip a coin here too. If it lands heads, save the single person; if it lands tails, save the group. In this case, each person gets the same 50% chance of surviving, and thereby our procedure for using a lottery can be justified to the people who end up drowning. We can tell them that they too had a fair chance of surviving: in fact, they had the same chance of surviving as the people who got saved. The only way in which we could have given them a better chance of surviving would have been to make the other people face certain death and this is something they wouldn’t have accepted. For this reason, by flipping a coin we do not ask the people who end up dying to bear a more serious burden than anyone else. Because of this, we can justify using the coin flip procedure to solve the problem to everyone.

To summarise, so far Taurek has given a strong argument against the intuitive view that in the simple life-saving case we should save the bigger group. The consequence of this argument is the somewhat surprising conclusion that instead of saving the group we should flip a coin about whom to save. 

Image Source:

http://commons.wikimedia.org/wiki/File:Boston_Swan_Boat_Lagoon_Bridge.jpg