The X-mas quiz: are you a utilitarian? Part 1

The quiz has four questions. ‘Classical utilitarian’ answers are discussed below (answers for question 2, 3, and 4 are discussed tomorrow).

1. To which identifiable group should society allocate its scarce supply of life-saving donor organs? I am thinking here of gender, age, race, area, anything that is a potential basis for an administrative allocation.
2. There is a potential terrorist of whom there is a probability that he will cause a million deaths and he can only be stopped by being killed. How high should the probability of the threat materializing be for you to agree that your society should have institutions (such as drone programs) that kill him off pre-emptively? And how high should the probability be for you yourself to be willing to kill him off pre-emptively, presuming no other consequences for yourself of that act?
3. Suppose you are in the position whereby you alone can choose to make it statistically visible what socially-unwanted things are done to pets by people in their own homes, but no-one knows you have that ability. In this hypothetical, making the data available would in no way change outcomes. Would you make that information visible?
4. Suppose you are in the position to decide on whether to have an institution that saves the lives of an identified group of patients, say with a particular genetic or childhood disease. With the same money you could set up an institution that prevents 10% more deaths in the general population, for instance by innoculation or investments in road quality that reduce accident rates. Hence the second institution saves more lives, but the lives saved are not visible, either beforehand or afterwards: even afterwards, you do now know who was saved so the lives saved are ‘statistical’. Would you invest in the first or the second institution? More generally, what is the ratio of ‘statistical lives saved’ to ‘identified lives saved’ you implicitly choose via your policies?

Classical utilitarian answer for question 1

There are no ‘right’ answers, merely classic utilitarian ones and other ones.

The first question was to whom we should allocate a scarce supply of donor organs. Let us first briefly discuss the policy reality and then the classic utilitarian approach.

The policy reality is murky. Australia has guidelines on this that advocate taking various factors into account, including the expected benefit to the organ recipient (relevant to the utilitarian) but also the time spent on the waiting list (not so relevant). Because organs deteriorate quickly once removed, there are furthermore a lot of incidental factors important, such as which potential recipient is answering the phone (relevant to a utilitarian)? In terms of priorities though, the guidelines supposedly take no account of ‘race, religion, gender, social status, disability or age – unless age is relevant to the organ matching criteria.’ To the utilitarian this form of equity is in fact inequity: the utilitarian does not care who receives an extra year of happy life, but by caring about the total number of additional happy years, the utilitarian would use any information that predicts those additional happy years, including race and gender.

In other countries, the practices vary. In some countries the allocation is more or less on the basis of expected benefit and in the other is it all about ‘medical criteria’ which in reality include the possibility that donor organs go to people with a high probability of a successful transplant but a very low number of expected additional years. Some leave the decision entirely up to individual doctors and hospitals, putting huge discretion on the side of an individual doctor, which raises the fear that their allocation is not purely on the grounds of societal gain.

What would the classic utilitarian do? Allocate organs where there is the highest expected number of additional happy lives. This thus involves a judgement on who is going to live long and who is going to live happy. Such things are not knowable with certainty, so a utilitarian would turn to statistical predictors of both, using whatever indicator could be administrated.

As to length of life, we generally know that rich young women have the highest life expectancy. And amongst rich young women in the West, white/Asian rich young women live even longer. According to some studies in the US, the difference with other ethnic groups (Black) can be up to 10 years (see the research links in this Wikipedia page on the issue). As to whom is happy, again the general finding is that rich women are amongst the happiest groups. Hence the classic utilitarian would want to allocate the organs to rich white/Asian young women.I should note that the classic utilitarian would thus have no qualms about ending up with a policy that violates the anti-discrimination laws of many societies. Our societies shy away from using observable vague characteristics as information to base allocations on, which implicitly means that the years of life of some groups are weighed higher than the years of life of another. The example thus points to a real tension between on the one hand classic utilitarianism and its acceptance of statistical discrimination on the basis of gender and perceived ethnicity and on the other hand the dominant moral positions within our society. Again, I have no wish to say which one is ‘right’ but merely note the discrepancy. As to myself, I have no problem with the idea that priority in donor organs should be given to young women though I also see a utilitarian argument for a bit of positive discrimination in terms of a blind eye to ethnicity (ie, there is utilitarian value in maintaining the idea that allocations should not be on the basis of perceived ethnicity, even though in this case that comes at a clear loss of expected life years).

Answers and discussion for question 2, 3 and 4 will follow tomorrow.