HughRistik comments on Consequentialism Need Not Be Nearsighted - Less Wrong
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What if, instead of deciding whether the doctor murders the patient in secret when she comes to the hospital, we have to decide whether the government (perhaps armed with genetic screening results seized from a police databases and companies like 23andMe) passes a law allowing police to openly kill and confiscate organs from anyone whose organs could presumably save five or more transplant patients?
As far as I can tell, this would have no bad effects beyond the obvious one of killing the people involved - it wouldn't make people less likely to go to hospitals or anything - but it keeps most of the creepiness of the original. Which makes me think although everything you say in this post is both true and important (and I've upvoted it) it doesn't get to the heart of why most people are creeped out by the transplant example.
No, but it would make them afraid to go outside, or at least within the vicinity of police. This law might encourage people to walk around with weapons to deter police from nabbing them, and/or to fight back. People would be afraid to get genetic screening lest they make their organs a target. They would be afraid to go to police stations to report crimes lest they come out minus a kidney.
People with good organs would start bribing the police to defer their harvesting, and corruption would become rampant. Law and order would break down.
This sounds like an excellent plot for a science fiction movie about a dystopia, which indicates that it fails on consequentialist grounds unless our utility function is so warped that we are willing to create a police state to give organ transplants.
Not to mention an incentive to self mutilate. That is, to do damage to oneself such that the organs are no longer desirable but which leaves you better off than if you'd been harvested. Give yourself HIV for example.