What about this? You are the aforementioned perfect surgeon with five dying patients. The universal donor comes in with a lethal gunshot wound that left all the transplantable organs intact. I you act as quickly as possible and exert yourself completely, it is very likely that you will save the gunshot victim. If you relax even slightly (or simply choose not to operate), the patient will almost certainly die, and you will be able to harvest his organs, saving the five otherwise doomed patients.
This seems to remove almost all of the features of the scenario that make it different from the trolley one, but I still react differently.
I think the issue may be that the first scenario is extraordinary–we don’t expect to find ourselves in any of the roles, and can picture ourselves in any of the roles equally well. In the doctor scenario, we recognize that life-and-death decisions are made daily in hospitals. We expect a doctor to be in a similar situation, and the doctor has not simply found himself there, but actively worked hard to be put in the role of deciding who lives and who dies. Because the doctor is special, we see ourselves more readily in the role of healthy patient (we don’t generally expect ourselves to suffer a fatal illness, either). Part of the social contract we make with doctors is that we allow them to possess extraordinary power over life and death only if they wield it in certain very limited ways. We want to know that if we walk into a doctor’s office we will be cared for, not harmed.
Ultimately, a world in which all trolley operators are expected to flip the switch to kill the single person is a world in which we feel (and are) safer than we would be in a world in which trolley operators always let fate take its course.
A world in which doctors always seek the greatest good feels (and perhaps is) more dangerous than a world in which doctors follow expected rules, even it means people die. Even if we knew that our individual expected lifespan was greater in Murdering-Doctor World, we would feel less safe because we wouldn’t be able to trust people to whom we grant great power not to deliberately harm us. It would be less predictable and scarier, even if objectively “safer.”
If I’m right that all this factors into our gut decision, then must say–our guts do some pretty sophisticated moral calculus!
PS–I think those who argue that the innocent person walking on the spur should not be sacrificed for the wanton fools lounging on the track are missing the point. For the dilemma to work, I think you have to assume that both the main track and the spur are (as far as any pedestrian can tell) equally used, and no person was behaving more recklessly than another. Would that change anybody’s answer?
Well, as long as the train is derailing, you can probably assume that the people riding it are at least going to be severely injured.
And I too would switch tracks towards the one and pray, while not killing the superdonor.
I know you’re being tongue-in-cheek, but would Spock’s philosophy (the needs of the many outweigh the needs of the few) apply in both scenarios? I could see applying Vulcan logic to the first example and choosing the track with the one person on it instead of the track with five people. But would Spock advocate putting a healthy person to death in the second example in order to harvest his organs for the five terminal patients? Having had first-hand experience with death, Spock would likely say it is a natural part of life and not to be feared. However, he would also argue for the right of the one healthy individual to choose to keep his life. (Of course, in the 24th century, it would also likely be possible to clone healthy organs from one’s own cells and the whole argument would be moot.)
A few points:
(1) We’re all more used to driving cars than driving trolleys, so that’s the perspective we’re thinking from. And when you’re driving a car, you’ve got your hands on the wheels at all times and are always choosing which direction the car is facing. Thus, at least if we treat the trolley as a car, the first question does not boil down to “do nothing, let nature take its course, 5 die” vs “take an action, 1 dies”. Rather, it’s “come to a fork in the road… choose one fork, 5 die, choose the other, 1 die”. Turning the steering wheel isn’t some extraordinary action that overrides the non-intervened state of not turning the steering wheel. Turning the wheel or not are both choices. That, to me, is the biggest difference.
So if the doctor is faced with 6 critical patients, and the only two reasonable treatment plans he can think of are kill 1 to save 5 or kill 5 and say 1, both of those are choices, both are forks in the road, and most would agree that saving 5 is better… and either is better than his third choice, going home and doing nothing.
(2) The issue is also confused by the fact that we all know that someone whose organs are failing is generally unhealthy. So we naturally assume that in this question, the one guy is young and healthy whereas the 5 are not. We can eliminate that variable by specifying that the 5 are equally young and healthy and innocent, but all 5 were hit and run over by a runaway trolley, causing each to suffer acute damage in one but only one organ
(3) It would be interesting to see how morality had evolved if we had the ability to perform ad hoc organ transplants by hand (can you cut bits off flatworm’s tails and reassemble them on other flatworms?).