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alex_zag_al comments on The Least Convenient Possible World - Less Wrong
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I like the phrase "precedent utilitarianism". It sounds to utilitarians like you're joining their camp, while actually pointing out that you're taking a long-term view of utility, which they usually refuse to do. The important ingredient is paying attention to incentives, which is really the rational response to most questions about morality. Many choices which seem "fairer", "more just", or whose alternatives provoke a disgust response don't take the long-term view into account. If we go around sacrificing every lonely stranger to the highest benefit of others nearby, no one is safe. It's a tragedy that all those people are sick and will die if they don't get help, but we don't make the world less tragic by sacrificing one to save ten every chance we get.
Actually, we would all be more safe, because we'd be in less danger from organ failure. We are each more likely to be one of the "others nearby" than the "lonely stranger".
That would be true if they were hunting people down. As stated, people would become more resistant to going to hospitals, which would cause problems that way.
This is an exact instance of the point of the post. It is important to assume they are hunting people down, because that's the LCPW and the fact that this trolley problem incorporates using someone who shows up at the hospital is entirely an unnecessary contingent fact.