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MBlume comments on The Least Convenient Possible World - Less Wrong
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I'm not sure if I'm evading the spirit of the post, but it seems to me that the answer to the opening problem is this:
If you were willing to kill this man to save these ten others, then you should long ago have simply had all ten patients agree to a 1/10 game of Russian Roulette, with the proviso that the nine winners get the organs of the one loser.
While emphasizing that I don't want this post to turn into a discussion of trolley problems, I endorse that solution.
In the least convenient possible world, only the random traveler has a blood type compatible with all ten patients.
This is fair, because you're using the technique to redirect us back to the original morality issue.
But i also don't think that MBlume was completely evading the question either. The question was about ethical principles, and his response does represent an exploration of ethical principles. MBlume suggests that it's more ethical to sacrifice one of the lives that was already in danger, than to sacrifice an uninvolved stranger. (remember, from a strict utilitarian view, both solutions leave one person dead, so this is definitely a different moral principle.)
This technique is good for stopping people from evading the question. But some evasions are more appropriate than others.
Agreed.
I'd go with that he's the only one who has organs healthy enough to ensure the recipients survive.
MBlume knows this, he's just telling us what he was thinking.
Throwing a die is a way of avoiding bias in choosing a person to kill. If you choose a person to kill personally, you run a risk of doing in in an unfair fashion, and thus being guilty in making an unfair choice. People value fairness. Using dice frees you of this responsibility, unless there is a predictably better option. You are alleviating additional technical moral issues involved in killing a person. This issue is separate from deciding whether to kill a person at all, although the reduction in moral cost of killing a person achieved by using the fair roulette technology may figure in the original decision.
But as a doctor, probably you will have to choose non-randomly, if you want to stand by your utilitarian viewpoint, since killing different people might have different probabilities of success. Assuming the lest convenient possible world hypothesis, you can't make your own life easier by assuming each one's sacrifice is as likely to go well. So in the end you will have to assume that one patients sacrifice will be the "best", and will have to decide if you kill them, thus reverting to the original problem.
What if one or more of the patients don't agree to do this?
Then you let him die, and repeat the question with a 1/9 chance of death.