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SilasBarta comments on The Preference Utilitarian’s Time Inconsistency Problem - Less Wrong
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You really don't even have to go that far in your justification, if you're clever. You could just note that the actual result of such a practice is to make people go to greater efforts to avoid being in a position whereby they'll be selected for murder/organ harvesting, resulting in an aggregate waste of resources on such risk avoidance that is bad even from a utilitarian standpoint.
It's much harder to find scenarios where such an action is justified on utilitarian grounds than you might think.
Not at all. If it were revealed that a doctor had deliberately killed a patient to harvest the organs, it's not like people will say, "Oh, well, I guess the law doesn't make all doctors do this, so I shouldn't change my behavior in response." Most likely, they would want to know how common this is, and if there are any tell-tale signs that a doctor will act this way, and avoid being in a situation where they'll be harvested.
You have to account for these behavioral adjustments in any honest utilitarian calculus.
Likewise, the Catholic Church worries about the consequence of one priest breaking confidence of a confessioner, even if they don't make it a policy to do so afterward.
Unless I were under duress, no, but I can't imagine a situation how I'd be in the position to make such a decision without being under duress!
And again, I have to factor in the above calculation: if it's not a one time thing, I have to account for the information that I'm doing this "leaking out", and the fact that my very perceptions will be biased to artificially make this more noble than it really is.
Btw, I was recently in an argument with Gene Callahan on his blog about how Peter Singer handles these issues (Singer targets the situation you've described), but I think he deleted those posts.