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Kingreaper 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.
But people still die.
I think a major part of how our instinctive morality works (and a reason humans, as a species, have been so successful) is that we don't go for cheap solutions. The most moral thing is to save everyone. The solution here is a stopgap that just diminishes the urgency of technology to grow organ replacements, and even if short-term consequentially it leaves more people alive, it in fact worsens out long-term life expectancy by not addressing the problem (which is that people's organs get damaged or wear out).
If a train is heading for 5 people, and you can press a switch to make it hit 1 person, the best moral decision is "I will find a way to save them all!" Even if you don't find that solution, at least you were looking!
[parody mode]
[/parody mode]
Have you ever heard the saying "the perfect is the enemy of the good"? By insisting that only perfect solutions are worthwhile, you are arguing against any measure that doesn't make humans immortal.
My point was meant in the sense that random culling for organs is not the best solution available to us. Organ growth is not that far in the future, and it's held back primarily because of moral concerns. This is not analagous to your parody, which more closely resembles something like: "any action that does not work towards achieving immortality is wrong".
The point is that people always try to find better solutions. If we lived in a world where, as a matter of fact, there is no way whatsoever to get organs for transplant victims except from living donors, then from a consequentialist standpoint some sort of random culling would in fact be the best solution. And I'm saying, that is not the world we live in.