Reflection on Trolley vs Hospital

Last Friday, I presented the two following scenarios from David Schmidtz's Elements of Justice.

Two Scenarios

Trolley

A trolley is rolling down the track on its way to killing five people. If you switch the trolley to another track on which there is only one person, you will say five and kill one.

Hospital

Five patients are dying due to lack of suitable organ donors. A UPS driver person walks into the hospital. You know she is a suitable donor for all five patients. If you kidnap her and harvest her organs, you save five and kill one.

Then I asked, "What would you do in each scenario and why?" Thanks to those of you who chimed in. I think you were in the same ballpark as Schmidtz.

Schmidtz says there are several views in the literature on the distinction between the two scenarios. Most people quickly detect that both scenarios seem to be a numbers game. "Unconstrained maximizers," who focus solely on the optimal outcome (most lives saved), might be inclined to view it just this way. But Schmidtz writes:

Hospital tells us that sometimes what matters is being able to trust others to respect us as separate persons. Hospitals cannot exist, and more generally we cannot live well together, unless we can trust each other to acknowledge that we will all have lives of our own. Hospital shows that sometimes we get the best result – a community of people living well together – not by aiming at a result so much as by being trustworthy, so that people can plan to deal with us in mutually beneficial ways.

To a cartoon utilitarian thinking about Trolley, all that matters is numbers. But in a more realistic institutional context like Hospital, we intuitively grasp a more fundamental point. Namely, if we don’t take seriously rights and separate personhood, we won’t get justice; in fact, we won’t even get good numbers. (171)

More generally, we are dealing with a matter of "the ends justifies the means." Schmidtz notes that while most philosophical thought experiments are more like Trolley, real life is more like Hospital. Some utilitarians may be mystified as to why moral constraints should be allowed to interfere with optimal outcomes, but they fail to see that it is precisely by observing moral constraints that optimal outcomes may be achieved. "If people can count on us not to murder them, new possibilities open up – opportunities people would not otherwise have." (172)

Schmidtz goes on to say:

…moral institutions get the best result not so much by aiming at the best result as by imposing constraints on individual pursuits so as to bring individual pursuits into better harmony with each other. Institutions (hospitals, for example) serve the common good by leaving well enough alone – creating opportunities for mutual benefit, then trusting individuals to take advantage of them. That is how (even from a utilitarian perspective) institutions have a moral mandate for moral agents to maximize utility. In effect, there are two sides to the sense in which institutional utility is based on trust. First, people have to able to trust their society to treat them as rights-bearers. Second, society must in turn trust people to use the opportunities they have as rights-bearers within society. (174)

…and…

[People] do not need to be surrounded by unconstrained maximizers. They do not need perfect justice either. They do need to be able to get on with their lives in peace. They need to know what to expect from each other. (175)

I particularly liked the last two paragraphs of this essay:

Wherever I go, whether my audience consists of local students, congressional staffers, or post-Soviet professors, when I present the Trolley case and ask them whether they would switch tracks, most will say, “There has to be another way!” A philosophy professor’s first reaction to this is to say, “Please, stay on topic. I’m trying to illustrate a point here! To see the point, you need to decide what to do when there is no other way.” When I said this to my class of post-Soviet professors, though, they spoke briefly among themselves, then two of them quietly said (as others nodded in agreement), “Yes, we understand. We have heard this before. All our lives we were told the few must be sacrificed for the sake of the many. We were told there is no other way. But what we were told was a lie. There was always another way.”

The more I ponder this reaction, the more I realize how right it is. The real world does not stipulate that there is no other way. (Have you, or anyone you know, ever been in a situation as tragic as Trolley? Why not? Have you been unusually lucky?) In any case, I now see more wisdom in the untutored insight that there has to be another way than in what Trolley originally was meant to illustrate. As Rawls and Nozick (in different ways) say, justice is about respecting the separateness of persons. If we find ourselves seemingly called upon to sacrifice the few for the sake of the many, justice is about finding another way. (175-176)

Going back to the days of my youth, I've had an ongoing interest in justice issues. Eliminating poverty has been one of them. My interaction with Scripture eventually brought me to a hermeneutic of "rebellion and atonement "(at-one-ment); atonement means the reconciliation of human beings to God, each other, and the created order, and restored wholeness within one's self. Initially, I was drawn to a somewhat politically leftward bent on addressing justice issues, but as the years rolled by, there was an emerging discomfort with the agenda. It took some time, but I eventually narrowed my uneasiness to what I saw as a hermeneutic of "oppression and liberation" combined with utilitarian optimization thinking. Optimizing liberation (however that might be defined) trumped all other considerations, including (especially so) the rights of anyone deemed an oppressor.

I think the biblical narrative is one of God granting rebellious humanity considerable freedom, respecting us as free moral agents with the right to choose or reject God. God does not use his power to optimize his outcomes regarding our choices. God providentially sets boundaries that make our life possible, but God seeks our transformation through unmerited suffering and grace so that we will choose God and atonement.

I think this also applies to how the Church should see its mission in the world and the social environments it seeks to create. When I write about economic issues, I frequently write about the importance of economic freedom infused with virtue. The separateness of individuals, and therefore their freedom and rights, are to be respected, but Godly virtue is nurtured and instilled to the point that people choose the good as they live out their freedom. (see the last three sentences for page 174 above.)

True justice always exists as a constellation of rights and obligations. No freedom is absolute and economic freedom is no exception. However, what troubles me is the willingness of many Christians who genuinely care about the poor or the environment to default to a utilitarian optimizing mode. "The rights of a few rich people are outweighed by the needs of the many" or "the needs of the environment outweigh the need to respect human freedom." "There is no other way!" Rather than doing the difficult work of nurturing transformation in the lives of individuals and communities so they will act with greater virtue, they ironically make allegiance with the utilitarian optimization inclination of "the Empire" to overcome what they perceive to be the injustices wrought by "the Empire." From the standpoint of the biblical narrative, I think freedom infused with virtue, and all the hard work that entails, is a more optimal approach.


Comments

7 responses to “Reflection on Trolley vs Hospital”

  1. Great Post.

  2. I think it is that rigidity of thinking that locks people into simplistic options. Both on an intellectual level and on a moral level, it seems that looking for other options and avoiding the end justifies bad means are necessary disciplines. I find this need especially pronounced when people speak as if they have moral authority (such as those who invoke church or religious support).

  3. Thanks Ron.
    Thanks Will. I think there is a never ending temptation to do what seems expidient rather than thinking in holistic terms. Its the unintended and unexamined consequences that reach up and bite us every time.

  4. “Its the unintended and unexamined consequences that reach up and bite us every time.”
    That’s very true. I think most people recognize the need for change – but it is deliberate, well-considered change coupled with a willingness to abandon what clearly doesn’t work that can have a positive impact.

  5. Patrick Hare Avatar
    Patrick Hare

    I’m wondering how people who believe in Just War (where civilians will be among the victims) distinguish their stance from Hospital?

  6. Great question, Patrick!
    Both Trolley and Hospital have rectification of unintentional deaths to address. I think the Just War question introduces the element of an intentional belligerent. True Just War theory also requires the pursuit of other options before prosecuting a war. It is something to think about.

  7. Well said, Michael and all. It is so grand to see/hear some true thinking rather that the simplistic slop served up all too often.
    …there is always another way! It is the truly liminal experience that always comes up with the brilliant solution, if one is patient and willing to not sacrifice one good for another.

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