Killing the Healthy in the Name of Utilitarianism

John Harris proposed that in the (largely hypothetical) situation of two people needing transplant organs or they will die, it would be acceptable by the principles of utilitarianism to select one healthy person by lottery to be sacrificed in order to save the lives of the two. This, on its surface at least, conforms to Mill’s stated goal for society of creating the greatest good (happiness) for the greatest number, which in this instance can be construed as causing the least harm to the fewest number. However, Harris’s proposal can only be seen as valid in the light of a number of points of view that are not held by the majority of human societies, nor were they held by Mill, so Mill would reject the sacrifice-by-lottery plan.

John Stuart Mill’s principle of utilitarianism, as first stated by Bentham, was that human institutions should have as their goal the maximization of utility, or happiness, for society as a whole. In this regard, decisions should be made with the goal of increasing the collective good. The term “collective good” means that the utility of the individual should be subordinated to that of the group. Two happy people and one miserable person is a superior outcome to one happy and two miserable persons.

Of course, there is the problem of quantifying utility and happiness. It would surely be wrong to kill someone and divide up the ten dollars in his pocket, even though that would make ten people somewhat happier and only one person very unhappy. The matter of degree is crucial. Mill’s definition of “greatest happiness” is “…an existence exempt as far as possible from pain, and as rich as possible in enjoyments, both in point of quality and quantity” (Mills 12). Therefore, pleasure and pain are mathematical opposites—pain is the negative of pleasure—and since both can presumably be quantified, it is the net sum of pain and pleasure that matters. Action should only be taken if the net sum is positive.

Of course, there are several objections that come immediately to mind. The most compelling one is that we are not all perfect altruists (nor should we be). In point of fact, my pleasure and pain matter more to me than yours do, even though they may be equal from an objective standpoint. I am not willing to forfeit my entire income, even if doing so could keep ten people from starving to death, or fifty people from being hungry. Nor should I be expected to precisely equate the pain and pleasure of others with my own, let alone give it more weight. Altruism only goes so far and attempts to construct a perfectly collectivist society must fail (as such attempts always have in the past) as long as such a society is comprised of human beings.

Mill attempted to address the subjective nature of measuring utility by stating that certainly, some people found the same pleasures more pleasurable than others did, and therefore, there is no such thing as an absolute value of a given pleasure or pain. This is quite similar to the economic definition of utility, in that the utility of a good is defined by the amount a given person is willing to pay for it. One criticism that has been leveled at the concept of variable utility is that it amounts to a tautology: this is desirable because someone desires it, and someone desires it because it is desirable. Furthermore, utility is highly situational, and just like economic utility, there is diminishing marginal utility in pleasure: the fifth ice cream bar on a hot day isn’t nearly as pleasurable as the first one (and on the other side of the coin, the fifth lash of the whip doesn’t hurt as much as the first, though this author has no desire to empirically test that). Mill did mention that an act of evil that is done to produce a greater good does not actually have a net benefit, because the expedient choice weakens and degrades society and thus reduces the utility of all in the long run.

This last point may be the strongest argument against Harris’s hypothetical plan, an argument he himself addresses. It could very well be argued that the lottery system is objectively fair and would increase human utility/happiness because, statistically, it would increase everyone’s life expectancy. This, however, would be cold comfort to the healthy person actually selected, no matter how noble that person’s sentiments or how thoroughly he had been inculcated in the value of increasing the collective good. Again, our personal experiences matter more to us than those of others, with the possible exception of those who are very close to us. Very few of us would greet with joy the news that 99% of the passengers were going to survive a plane crash if we were told that we were the one person who wasn’t going to make it. Therefore, the calculus of saving two lives being exactly twice as good as taking one life is bad is flawed. This is partly because the hypothetical transplant patients are already in trouble, and already contemplating death. The person awakened in the middle of the night: “We would never know when we would hear them knocking at the door” (Harris 84) would be traumatized to a much greater extent than the transplant recipients would be relieved. Even more importantly, society itself would be traumatized by the fact that any person, anytime, could “win” the lottery and be snatched up and taken to the harvesting facility. Under the Harris plan, this trauma would ostensibly be balanced by the greater security people would have with the realization that transplant organs would always be available.

Mill might accept Harris’s argument on the simple cost/benefit principle if he accepted the premise that all lives in society are equal and that the subjective nature of utility for individuals is balanced by the absolute value of utility for society as a whole. It cannot be denied that Harris’s plan would increase overall life expectancy, and this alone might be a sufficiently compelling reason for Mill to accept Harris’s argument in principle. Mill would have no problem with the reduction in personal autonomy that would be endemic to such a plan, or in general with that same reduction that is a necessary part of all collectivist societies. Whatever works, Mill would say.

Mill might reject Harris’s plan on the basis of his opinion of “the necessary evil.” As noted above, Mill rejected the concept of doing harm in order to serve the greater good, because the harm such actions bring ripples through society as a whole and thus, considering only the immediate harm done by the necessary evil skews the utility/cost equation unfairly in that direction. Certainly, it would be necessary to view the harm caused by the lottery not just in terms of that done to the unfortunate individuals selected but also in terms of that done to society as a whole. While perhaps thinly spread, there would be real, palpable harm is done to each individual who could be selected. It is a dangerous trap to fall into to discount a small amount of harm done to a great number of people because of the relative innocuousness of that harm to any one individual. While as a practical matter, many if not most people are happy to make small sacrifices to benefit a relatively few people, such sacrifices are more often than not voluntary. The small sacrifice (in mathematical terms, at least) of being eligible for the lottery would be traumatic and its imposition immoral simply because it would not be voluntary.

It seems to this writer that Mill would not be in favor of the transplant lottery. If utility were measured by him as an absolute and objective quality, the lottery would for him to be a hands-down winner. However, he recognized that utility is subjective. He might consider the lottery officials pounding on the door of a new bride, the father of a newborn child, or a beloved parent and reflect that the harm caused would by no means be confined to that done to the lottery “winner.” While one could say that the pain and terror thus inflicted would be more than compensated for, society-wise, by the joy and relief felt by the transplant recipients’ loved ones, this would be another attempt to quantify that which cannot be quantified. Mills would reject the argument, as most philosophers and the common man have, that the pain and suffering of one person is exactly one-half of that of two people.

This feeling is expressed in reactions as measured by several psychological researchers as well as popular culture. People asked the hypothetical question: “If you were in control of a railway switch, and a runaway train was bearing down on you, and if you did nothing, the train would kill five people, but if you threw the switch, the train would be diverted onto a siding and only kill the one person standing there, would you throw the switch?” have answered “no” by a large margin. The pervasive sentiment is that it is wrong to kill the innocent to save others, even if the “utility equation” is strongly skewed in favor of doing so. Aside from the abhorrent nature of playing God, there is the concept as famously articulated in the movie, “Star Trek III”: “Sometimes the needs of the few—or the one—outweigh the needs of the many.” Mill’s concept of utilitarianism has been widely misinterpreted as a cold-blooded relational calculus, but even a cursory examination of his writings shows that his true philosophy was anything but that.

Harris might claim that the very unquantifiable nature of human utility is what makes the lottery fair, by assigning everyone an equal chance to be selected. However, treating everyone equally unfairly (by assuming that the pain caused to each person by the lottery is exactly equivalent) is, one might suppose, a kind of rough justice but not something that would satisfy Mills. Ironically, the only real way to make the lottery fair would be to make it unfair, i.e., by weighting some people’s chances more or less heavily than others (childless people get two picks, older people get three, people who are suicidal get thirty, etc. while new mothers, doctors, and public safety officials are exempt). In fact, this has been done, in a way, in America in the past with draft exemptions—of which Mills would probably approve.

Works Cited

Harris, John. “The Survival Lottery.” Oxford, U.K.: Balliol Colleges. 1975.

Mill, John Stuart. “Utilitarianism.” (2nd ed.) Indianapolis/Cambridge: Hackett. 1865.