Typhoid Mary

I'm going to respond to some comments that Lydia McGrew left on this post:

http://triablogue.blogspot.com/2015/12/windfall.html

Problem is, Lydia starts with a principle that's reasonable in ordinary cases, but stretches it to cover cases where that becomes fanatically unreasonable. Extending plausible cases to lend bogus plausibility to implausible cases. 

For instance, if your patient is Typhoid Mary, then it would be wildly irresponsible to just consider what's best for her. For she needs to be quarantined. To act in her best interests, to the exclusion of everyone else, is far too one-sided.

No, I don't, because there is no special, ethically enormously important, relationship between bankers and people who borrow money or between arms dealers and people who buy their stuff. My position isn't just in general to say, "That's not my department." My position is that there is something enormously special about certain life-saving or life-giving occupations that puts them in a special relationship (I keep looking for a word similar to "fiduciary trust" or something, mutatis mutandis, for doctor-patient, fireman-trapped-person, but nothing is coming immediately to mind) to those they help. This is not a _general_ statement that everybody who sells a product or a service just should "do their thing" and not worry about anything else.

Fine. And I say folks like Himmler and Pablo Escobar are not entitled to benefit from that live-saving or life-giving relationship when they themselves are in the business of wrongful life-taking.

"What is Lydia's preferred alternative? If everyone who needs it can't have it, is it better that everyone die rather than saving some?" My preferred alternative is the use of _medical_ criteria for triaging, criteria that assume that the goal is to help as many patients as possible, not criteria concerning "just desserts." There are plenty of the former to permit make the relevant decisions.

Again, as I already explained, in my hypothetical, the organ harvesting isn't punitive. The evil actions of the jihadists make them morally liable to harm–a susceptibility to which they'd ordinarily be immune. But they aren't used as involuntary organ donors as punishment. It isn't to give them their just deserts, but to restore the gunshot victims whom they wrongfully wounded. It creates that possibility because, by their actions, they lose certain prima facie protections. That's a necessary, but insufficient condition, in my hypothetical.

You are here including "defense of the innocent" as a category. It's true that I didn't happen to include that in my list of possible categories. 

Actually, I believe I used "saving other [innocent] lives," which is broader than defense of the innocent. 

But "defense of the innocent," like "self-defense," is always (and should always be) applied to _immediate threat_, not to assassination of a person already neutralized as a threat. 

i) One reason we normally stress "immediacy" is that we normally don't know the future, and the future becomes less predictable the further out we go. But in a foreknowledge or counterfactual knowledge scenario, that would be different.

ii) In addition, I don't grant your stipulative restriction.

There are categories for killing people who are not an immediate threat: One such category is execution. Another is attacking a military target in war. Some would also say that assassination is sometimes justified. That was why I used "medical assassination" as a possibility. Because it gets at the fact that the person is not presently a threat, whereas "defense of the innocent" blurs that and, in fact, accesses intuitions concerning neutralizing an immediate threat.
I take it that your position _is_ that assassination is not always morally wrong, which is why it is a little surprising that you are annoyed by my use of "medical assassination."

True, I think targeted assassination can be morally preferable. Take a decapitation strike. It saves more lives all around if you eliminate one person giving orders rather many persons taking orders. Moreover, some of the people taking orders may be forced conscripts. So it's preferable, when possible, to spare their lives–not to mention collateral damage, or the lives of your own soldiers.

However, that's a different scenario than my hypothetical. So the category is inaccurate.

However, let's remember that Steve's position is much stronger than, "Some given doctor could be justified in not operating on Himmler." His position is that it would be justified for all doctors to enter into an agreement deliberately to let Himmler die by jointly boycotting operating on him. Moreover, his position is that doctors are morally justified in _actively killing_ certain evil people such as jihadists (and presumably, Himmler) and even doing so in order to take their organs for their victims. 

Correct.

So what he's talking about is not some kind of case-by-case doctor decision but rather generalized medical intent either to let die or even actively to kill.

False dichotomy. My examples (Himmler, Escobar, jihadists) do involve case-by-case assessment. 

If we were talking about a) self-defense, b) defense of the innocent, or c) execution, I would agree with you. I am often pointing out that guilt vs. innocence makes a difference.
But when it comes to enlisting doctors to kill their patients (which is what you are doing), then a serious line has been crossed, and that is an _abuse_ of the guilt vs. innocence distinction. It is not that I do not make that distinction. It's that I think you are using it in the wrong context.

Except that you erect a wall between guilt, innocence, and "the patient"–whom you treat as if he's innocent. You say I'm using that in the wrong context, but of course, that objection assumes the very issue in dispute.

"Why should they be nursed back to health while the innocent gunshot victims are allowed to die? In what moral universe is that a just outcome?"

Because organ transplant is _massively_ extraordinary treatment, hence, it is possible to refrain from carrying out that treatment while still treating the patient as an intrinsically valuable entity. 

Which patient? It isn't possible to refrain from carrying out that treatment and still save the life of the innocent gunshot victim. 

It is possible, and indeed mandatory, for doctors to treat both the victims and the perpetrators as intrinsically valuable beings, made in the image of God, and this is possible to do while not carrying out an organ transplant from one to the other. Indeed, it is _impossible_ to do while using the bodies of one group for the benefit of the other.

i) The physicians may "treating" both parties as intrinsically valuable beings, but absent organ transplantation, their medical treatment is futile. At best, palliative care. 

ii) Once again, we're back to Lydia's morally neutral language about "the bodies of one group." 

iii) There's the question of how much work you think the imago Dei is able to do in this argument. That's a category that offers precious little guidance regarding what's permissible or impermissible. Basically, you're using a Biblical category as a cipher, into which you plug the ethical strictures of Kantian deontology. 

The imago Dei is a category that's taken on a life of its own in historical theology and moral theology. That's often far removed from what it means in Scripture. The locus classicus would be Gen 9:5-6, which ratifies the lex talonis and poetic justice.

Christian ethicists routinely invest the imago Dei with moral and metaphysical specifications that can't be exegetically supported. Keep in mind, too, that this occurs in a book (the Pentateuch) which also contains the laws of holy war, involving mass execution of noncombatants. 

 

"So it's unclear what the odium attaches to." The special odium in this case attaches to the _absolutely unequivocal_ treatment of the "donors" as _mere_ objects, as _mere_ means to an end, as _mere_ sources of spare parts.

i) Except that I'm not discussing involuntary organ donors in general, but perpetrators in relation to their moribund victims. There's a vanishing window of opportunity to save the life of the victims by using the perpetrators to supply the organs. Poetic justice.

It's not about generic perpetrators and generic patients. Rather, it's the particular victims of those particular perps. 

ii) Lydia's objection hinges on her Kantian axiom that no human should be used as a mere means to an end. That absolutizes the agent without regard to their moral status. 

No, I'm working with a concept of free will according to which the free individual is an irreducible part of the causal chain. 

Which is also consistent with compatibilism. It's only at odds with que sera sera fatalism. 

As long as his actions are free (he's not just a zombie or a hypnotized robot or something), _no_ other cause or set of causes that precedes his choice _guarantees_ (that is, deterministically makes it the case) that he will make that choice. Otherwise his choice would not be free.

Except that in my hypothetical, we're looking back at the past with the benefit of hindsight. We know how one thing led to another.

Again, defense of the innocent from imminent threat from an active attacker. That isn't what we're talking about with baby Himmler, and it isn't what we're talking about with Himmler who is out cold and needs surgery. Or jihadists, either.

What you did was use a hypothetical that conflates several ethical issues. For instance, there's the distinction between doing harm and allowing harm. There's the distinction between guilt and innocence. I'm taking that apart and considering the elements separately. To give the entire package thumbs up or thumbs down is equivocal. 

"But I didn't advocate that example. That's your example (or counterexample), not mine." My active killing examples are meant to be relevant to your claim that it is morally justifiable for doctors (not state executioners) actively to kill a wicked person in order to prevent his future evil actions. Note that you _reject_ the characterization of this as an execution and also that you specifically argue for _doctors_ qua doctors to do it. I would agree with the death penalty for the jihadists, or for Himmler, but you are talking about having people in a doctor-patient relationship with him kill him when he does not constitute an imminent threat, and you justify this on the basis of preventing his later evil. I therefore think killing a young child based on special ESP that he will otherwise grow up to do evil constitutes a relevant counterexample to the principles you are invoking.

Again, though, that bundles more than one ethical issue. Whether it's morally licit to kill a wicked adult to prevent his future evil actions is a different proposition than whether it's morally licit to kill an innocent child to prevent his future evil actions. The second scenario adds a moral complication absent from the first scenario. 

It's not a relevant counterexample, because it introduces a morally significant differential factor. It's fine for you to probe how far I'm prepared to go, but I'm not inconsistent if I draw a line there.

"Furthermore, by saving this child's life, he's taking the lives of other children (hundreds of thousands) in the future."
"If, moreover, the fireman rescues him, then the fireman is causing the death of hundreds of thousands of future children at Himmler's hands. So it wouldn't be morally outrageous if the fireman is hesitant to bring that about. His action won't be the only cause of that outcome, but it will be one link in a chain of events leading up to that catastrophe. A precipitating event."

Taking the lives? That's the kind of moral confusion that arises from treating a person who helps someone as morally responsible for the evil that person goes on and does. I'm afraid I regard it as simply crazy talk to say that a fireman who saves a child, even, yes, a fireman with ESP who knows that the child will grow up to kill other people, is "taking the lives" of those the child grows up and freely kills. Perhaps this shows what happens when one denies free will?

i) But presumably you believe that there are situations in which enablers are complicit in the evil done by the person they knowingly help. Surely you don't need me to give you examples. Not just hypothetical examples, but real-life examples. 

ii) Most freewill theists affirm the accidental necessity of the past. A few flirt with retrocausation, but that's bedeviled by familiar antinomies. 

And, given ESP, we're viewing the past from the vantage-point of the actual future. From that perspective, it's a fait accompli, even though it might be contingent if we looking ahead rather than behind.

ii) Moreover, your objection is incoherent. You yourself were the one who in your hypothetical counterexample conferred "prophetic powers" (or ESP) on the fireman. For him to know the future, the future must be a given. If he had advance knowledge of the outcome, then that's inevitable–unless he changes a key variable. 

You're trying to ride two different horses at one time. Pick one and stick with it. 

iii) But suppose, for the sake of argument, that it's not inevitable. As a rule, it's morally incumbent on us to consider the consequences of our actions even if we don't know for sure what the consequences will be. Indeed, it's the uncertainties that oblige us to provide a margin for error. So you're still expected to take elementary precautions to avoid putting others at unnecessary risk.  

Take OT regulations requiring a homeowner to put a parapet around the roof, or requiring a property owner to cover an open well. It's not inevitable or even likely that such an accident will happen. In fact, it's quite possible that a child will never fall into that particular well. Quite possible that no one will fall from the roof of any particular house. But if it did happen, the owner would be culpable for failing to take basic precautions.

"If Himmler is in danger of dying in a fire, why not regard his predicament as a providential windfall? A boom for his prospective victims?"

Because you're a fireman who took on the role of being a fireman and who has shown up at this fire.

i) How does that refute what I said? Seems like a non sequitur to me. 

ii) One of my fundamental problems with your position is that you drive a wedge between professional responsibilities and personal/social obligations, as if assuming the role of physician or fireman automatically suspends your personal and social obligations. It's hard to see, even in principle, how you can ethically justify the suspension of personal and social ethical duties. 

iii) In addition, what we call professional ethics isn't even conterminous with normative ethics. It's just a professional code of conduct–for better or worse. For instance, suppose it's a breach of professional ethics for a surgeon to access confidential test-results to ascertain the HIV status of his patients. Yet a surgeon has a moral right to know that inasmuch as invasive procedures expose the surgeon to risk of infection.  

This is a concept of a contributing cause. I have no problem with talking about contributing causes sometimes. It's a useful and an interesting concept. But it is an extremely broad concept and simply cannot sustain the moral weight being placed on it. E.g. "Taking the lives," etc.
In _this_ broad sense of "cause," Himmler's great-grandfather's act of conceiving his grandmother was also a link in the chain of events. Everyone who ever gave Himmler necessary care as a child was also a link in the chain of events. This sense of "cause," though relevant in some contexts, just cannot bear the weight of justifying deliberately letting someone die when you are in such a position that it is normally your responsibility to care for or help that person.

i) But that disregards additional potentially inculpatory considerations, like advance knowledge of the catastrophic denouement. 

ii) As far as that goes, if Himmer's father could foresee the dire outcome of impregnating his wife on that night, it's arguable that he has a duty to abstain for a few weeks, or contracept. 

iii) In addition, you're ignoring something I said before in response to the same basic objection: you have a lot more options when Himmler is four than when he is forty. As an adult, as head of the SS, with the Final Solution underway, saving his life guarantees the death of millions. But at the age of four, there are many potential opportunities to influence his development for the better and deflect him away from that horrendous career. 

iv) Finally, the further back in time we go, changing a particular variable wouldn't merely eliminate the future evil, but eliminate many intervening goods. So that interjects some countervailing considerations into the moral assessment.