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NihilCredo comments on Metacontrarian Metaethics - Less Wrong
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Have you come up with a better scenario for the trolley problem?
The one I currently like the best is:
Trolley: You're a surgeon, you have a dying patient in your care, he needs five full litres of healthy blood to survive the operation; fortunately, you have exactly five liters available. You've just opened him up when five more emergency patients arrive, each of whom could survive with just one litre.
Fat man: There is no dying surgery patient, but the same five new emergencies have just arrived and you have no blood reserves at all. What you do have is a healthy but unconscious patient, with five litres of good blood in his veins.
It's still not perfect though, because the role of doctors has deep cultural roots (Hyppocratic oath and so on), so the idea of a doctor doing harm to a patient feels repugnant and blasphemous, and since a patient feels like he is "entrusting" himself to a surgeon there's also an overtone of betrayal. Modern hospitals, huge and anonymous, have only partially deleted such feelings (and they try their best not to).
Having played a healer in many online games, I've discovered that triage (what you've described above) quickly becomes second nature, to the point where if someone performs the wrong response to a threat, I will literally say aloud, "go die then" because I have more important people to take care of. I consider it a signature of the best healers that they will abort a spell on someone who needs it to instead cast it on someone who is more important.
A true trolley problem would have to be contrived by a murderous, insane villain ala Saw; the uncertainty remains in any real world scenario that I've come across
Though perhaps organ transplants can serve as a stand-in. Tons of otherwise healthy people just need one organ to live out a good life, and tons of people who are somewhat negative utility have nice, juicy organs. We'll know we're on our way to fixing the trolley problem when organ donation is mandatory, and can be a punishment handed down similar to the death penalty for those who harm society.