Utility and the survival lottery

We Should Not Use Randomization Procedures to Allocate Scarce Life-Saving Resources

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures (RAND) to allocate scarce life-saving resources (SLSR). In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims to these resources rather than use RAND to allocate such resources.

Nonconsequentialist decisions

According to a simple form of consequentialism, we should base decisions on our judgments about their consequences for achieving our goals. Our goals give us reason to endorse consequentialism as a standard of decision making. Alternative standards invariably lead to consequences that are less good in this sense. Yet some people knowingly follow decision rules that violate consequentialism. For example, they prefer harmful omissions to less harmful acts, they favor the status quo over alternatives they would otherwise judge to be belter, they provide third-party compensation on the basis of the cause of an injury rather than the benefit from the compensation, they ignore deterrent effects in decisions about punishment, and they resist coercive reforms they judge to be beneficial. I suggest that nonconsequentialist principles arise from overgeneralizing rules that are consistent with consequentialism in a limited set of cases. Commitment to such rules is detached from their original purposes. The existence of such nonconsequentialist decision biases has implications for philosophical and experimental methodology, the relation between psychology and public policy, and education.

Consequentialism, complacency, and slippery slope arguments

The standard problem with many slippery slope arguments is that they fail to provide us with the necessary evidence to warrant our believing that the significantly morally worse circumstances they predict will in fact come about. As such these arguments have widely been criticised as 'scare-mongering'. Consequentialists have traditionally been at the forefront of such criticisms, demanding that we get serious about guiding our prescriptions for right action by a comprehensive appreciation of the empirical facts. This is not surprising, since consequentialism has traditionally been committed to the idea that right action be driven by empirical realities, and this hard-headed approach has been an especially notable feature of Australian consequentialism. But this apparent empirical hard-headedness is very selective. While consequentialists have understood their moral outlook and commitments as guided by a partnership with empirical science - most explicitly in their replies to the arguments of their detractors - some consequentialists have been remarkably complacent about providing empirical support for their own prescriptions. Our key example here is the consequentialist claim that our current practises of partiality in fact maximise the good, impartially conceived. This claim has invariably been made without compelling support for the large empirical claims upon which it rests, and so, like the speculative empirical hand-waving of weak slippery slope arguments, it seems similarly to be undermined. While these arguments have presented us with 'wishful thinking' rather than 'scare-mongering', we argue in this paper that their complacency in meeting the relevant empirical justificatory burden remains much the same.

What is so wrong with killing people?

If killing another human being is morally wrong on at least some occasions (as it clearly is), what precisely makes it wrong on those occasions? I have framed the question thus to indicate that I shall not be considering the view that killing another human being is always and everywhere morally wrong. I take it as read that there are at least some morally justifiable killings (for instance, in self-defence where no other means of disarming one's attacker is available). Once it is clear what is wrong with killing on some occasions it should become possible to explain why it is not wrong on others. My immediate concern is with the killing of another human being, and with applying my answer to cases of voluntary and non-voluntary euthanasia, but light will be shed on whether and, if so, why it is wrong to kill oneself, to kill unborn human beings, and to kill non-human animals especially those whose life has most in common with the life of human beings.

Harris's modest proposal

In ‘The Survival Lottery’ John Harris raises the following issue. Suppose it is possible for physicians to save the lives of two patients, Y and Z, otherwise doomed to die through no fault of their own, by taking the life of a third person, P, and using various of his organs appropriately for transplants. To provide a fair and impartial way of selecting the organ donor, a survival lottery is proposed for the society. This lottery randomly selects an organ donor from the population at large. Harris, speaking from the point of view of Y and Z, defends the demand that such a lottery be established. What if anything is wrong with this scheme?