Windfall

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

http://triablogue.blogspot.com/2015/12/saving-little-himmler.html

I'll begin with a general observation. Lydia has recast my original position. I didn't suggest that the duty of a doctor is to sort out good guys from bad guys and then impose rough justice. Rather, I've discussed what's morally permissible for a doctor to do, using some hypothetical limiting-cases. 

I'm not saying in an extremely broad sense that no doctor should "discriminate" in which patients he takes or that ERs should be used as doctor's offices.
I am, however, saying that when a patient is taken into an ER, a doctor has a professional responsibility to set aside whatever else the doctor knows about the patient and think of him *as a patient* rather than as a person who has done this or that evil thing, or has these or those evil plans. Qua patient, it might be that he could and should be told that he cannot be treated for his non-life-threatening condition because his very act of coming to the ER is an abuse of the system. That's an entirely different matter, however, from saying that he's so-and-so (the evil head of a genocidal campaign) and that _for that reason_ we're going to let him die. The latter is a refusal to think of him qua patient and to think of oneself in one's professional capacity qua doctor. Rather, it is mingling one's role as doctor with some other role--purifying society of evil people, or something of that kind. It's wrong, yes, I would say _intrinsically_ wrong, for a doctor to interpret his role in such a way that people who are evil "richly deserve to feel fearful" when they are in his hands. That's just not what and who a doctor is.

i) Well, that's basically a paraphrase of what Lydia said before, so it does nothing to advance the argument. Again, what I find ironic is her morally compartmentalized view of moral obligations. That a physician has a moral obligation to be morally blind in the treatment of his patients. That strikes me as incoherent. 

ii) Problem is, "the patient" isn't just a patient, and the doctor isn't just a doctor. The doctor is a moral agent, and in this case, the patient is a mass murderer who will kill again if healed. I don't see that doctors have a duty to put moral blinders on when treating patients. Again, I'm not discussing garden-variety patients. 

iii) One of my basic principles is that we should treat like alike and unlike unalike. I don't begin to see how we're intrinsically obliged to treat morally unlike situations as if they're alike. Does Lydia have the same principle for international bankers who financed the Wehrmacht or an arms dealer who supplies a drug cartel? The arms dealer knows the drug cartel will kill many innocent people with the armaments that he retails. Does he get off the hook by saying "That's not my department"? 

iv) Likewise, I consider it an elementary principle in moral decision-making that we take the predictable consequences of our actions into account. Results are not all that matters, but we often have a responsibility to consider the impact of our actions on others. 

(Compare the situation where Ronald Reagan joked, "I hope you're all Republicans" before going into surgery after being shot. The liberal Democrat surgeon joked back, "Mr. President, today we are all Republicans." That's professionalism in medicine.)

i) Which doesn't work as well if we swap out Reagan and swap in Pablo Escobar. Ordinarily, physicians should focus on the well-being of the patient, but a patient like Himmler or Escobar is not entitled to well being. Not to mention the threat that his life poses to the innocent. 

One of the moral deficiencies of Lydia's analysis is her myopic focus on the well-being of "the patient," regardless of who the patient is. But that disregards the well-being of other affected parties. What is good for Escobar is bad for his prospective victims. 

ii) Furthermore, isn't just a quantitative comparison, where the good of the many outweighs the good of the few. Rather, this is a qualitative comparison, where what's good for the innocent takes precedence over what's good for mass murderers. So it's not utilitarian. In fact, if push comes to shove, what's good for a few innocents outweighs what's good for many mass murderers. 

On "discrimination" in organ transplants. There are a lot of other issues there, such as whether vital organ donation can ever be carried out morally. I tend to question whether it can. Let's set that aside and assume that it can. There is a triage system for organ transplant, and a person's past history would affect that triage system, but not for the reason you give. It is not that the person is "morally not entitled" to a liver donation because he ruined his previous liver but that he is not a good candidate because of a) probable later behavior that would render the transplant unsuccessful and b) other harm to his body that has the potential to render the transplant unsuccessful. So a person in Mantle's situation probably wouldn't be considered a good candidate, indirectly because of his past behavior, but not because he is morally undeserving.
Again, this should be a medical decision. I categorically reject the idea that people making triage decisions in transplant situations should be evaluating the moral worth of the prospective recipients, because that is contrary to their role as medical decision-makers. It is, rather, an attempt to involve them in deciding who _deserves_ to live or die, which is, frankly, a wicked corruption of the medical profession. There really is such a thing as professional essentialism.

i) To begin with, Lydia fails to distinguish between medical protocols and normative ethics. The question at issue isn't what criteria happen to used for organ recipients, but what ought to be the case. The status quo isn't a moral arbiter. After all, there are European countries with protocols in place for euthanizing the elderly or developmentally disabled. But Lydia wouldn't appeal to the system to justify the system. So that's beside the point.

ii) Likewise, I didn't say Mantle was morally undeserving of a transplant. Rather, I said a patient who never indulged in high-risk behavior is more deserving. Take two patients: one with congenital liver disease and one with cirrhosis of the liver from alcoholism. Why is Mantle entitled to two chances when another patient never got one chance? Even if that's not one of the criteria, or even if there's additional criteria, it ought to figure in the decision. 

iii) Lydia says "deciding who _deserves_ to live or die, which is, frankly, a wicked corruption of the medical profession." But if there are not enough donated organs to go around, then that's inevitable. You will have winners and losers, and someone must decide. 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?

You expressly carried your position to the point of saying that the doctors should _kill_ the jihadists actively. You used the term "euthanized," by which you presumably meant "killed humanely."
You say this isn't execution. Well, in that case, you have just removed the only opportunity you might have had to fit your recommendation that doctors bump of their wicked patients into existing categories of justified killing. Presumably you don't want to call this murder. But you don't want to call it execution, either. You can't call it self-defense, as the jihadists aren't attacking the doctors. There are a fairly limited number of categories for justifiedly killing people. I guess you're trying to invent a new one. Perhaps we should call it "medical assassination of bad guys" or something.

Honestly, is Lydia even trying? What about the category of saving other lives? And, yes, that's a category of justified killing. Take a police sharpshooter who caps the sniper in the clocktower to prevent him from killing pedestrians who are pinned down. The sniper isn't attacking the sharpshooter. And it's not an execution. 

If anything, your rejection of the execution label only makes your recommendation that doctors actively kill their patients more obviously morally dubious. 

No, it means I reject deceptive terminology. 

But in any event, all the same objections apply. What you are talking about here is an *even worse* corruption of the medical profession than simply not treating the patient. You're talking about telling doctors to become killers of those brought to them *as patients*, on the grounds that the patients deserve to die, and using those patients as objects (via taking their organs) for the sake of others. This involves extra-judicial killing of a helpless person coupled with the pre-meditated intent to cannibalize the person's body for spare parts (the killing is even carried out for that purpose). Worse, it's being done to patients by doctors. There is so much wrong with that recommendation that, if you can't see it from what I've said already, I'm at a loss to do much more. I say as much as I have said because it's a heinous recommendation at a Christian blog and because I think I need to speak up.

i) Once again, it's ironic that Lydia uses morally neutral language like "a helpless person" in discussing ethical situations. Problem is, the moral status of the respective patients isn't neutral. On the one hand you have jihadists who shoot up the synagogue with the intention of taking as many innocent lives as they can. On the other hand, you have the security guards who return fire with the intention of protecting innocent lives. But Lydia feeds both kinds of patients through her morally equalizer. 

Sorry, but to simply describe the wounded jihadist as "a helpless person" is a morally deranged characterization, as if how he acquired that condition is ethically irrelevant. Wounded terrorists can't make the same moral claims on us. 

Same thing with the morally neutral language of cannibalizing "the person's" body for spare parts. Well, no doubt the jihadist is a person. But because he's a personal agent, persons can do things that affect how they ought to be treated. The jihadist who was wounded in an attempt to murder Jewish worshippers is not in the same moral category as the security guard who was wounded by the jihadist in the guard's attempt to protect Jewish worshipers from wrongful aggression. 

It's interesting that Lydia feels her position is self-evidently right despite glaring differences in the moral actions and moral status of the respective parties. I don't share her sympathy for the sacrosanctity of the perpetrator's bodies. 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? 

ii) BTW, it would still be a case of "cannibalizing the person's body for spare parts" even if this was a voluntary organ donor who died of natural causes. So it's unclear what the odium attaches to. 

On little Himmler: "Because at that stage in his career, Himmler is known to be a leading agent of the Holocaust (at least in my hypothetical). His mother lacks that foresight." I should have been clearer. Suppose that the mother is given information (several of your recent examples have turned around such foresight) of his later career. Is she then "insuring genocide" (the phrase you used of the doctors) by caring for him? The point I was making is that _neither_ of them is "insuring genocide." Himmler goes on to carry out his own acts afterwards. Whatever people know or don't know about him when they do a good action to care for him, feed him, patch up his medical wounds, etc., that doesn't make them responsible for his later actions. It doesn't even guarantee his later actions.

i) Actually, I believe I used the phrase "ensuring genocide," not "insuring genocide."

ii) I don't know what you mean by saying it "doesn't even guarantee his later actions." I'm considering one point in a timeline. An earlier link in a chain of events. That's how it plays out. 

iii) Are you operating with a view of libertarian freedom in which, every time we rewind the tape, the outcome might be different? Even if that follows from a libertarian theory of the will, the supposition of my hypothetical is different. You may think that in reality, patching him up doesn't ensure that outcome, but thought-experiments needn't be realistic to establish a point of principle. 

iv) There's such a thing as moral complicity in the actions of others. I can share responsibility for what another agent does even if I'm not solely responsible or the one who carried it out. Do I really need to give examples? 

Whoa. This _sounds_ like it's saying that _if_ a mother knew that her child were going to grow up to do monstrous wrong, it might be okay for her to kill him as a baby, but she just lacks the emotional detachment to do so.

i) There can be some things that are right to do, but it's wrong for certain people to do them, or be made to do them. It is right to execute a convicted serial killer. It would be cruel to make his teenage son flip the switch. 

ii) There are situations when it might be right for a parent to kill a child. Suppose my son is a violent juvenile delinquent. Suppose he pulls a knife on his mother. I respond my drawing a gun. I don't want to shoot my son. But if need be, I will shoot him to protect my wife. I won't shoot to kill, but when you shoot someone, there's a significant risk of killing them, even if that's not your intention. 

You _might_ be saying that the mother actually _shouldn't_ kill him as a baby because she has natural duties to him. Very well, then, suppose that we are talking about a person who happens to pass through a daycare where the child is being cared for. This visitor has prophetic powers and suddenly realizes that the baby in front of him is going to grow up to commit some terrible evil if he is allowed to live. The visitor has no natural attachment to the baby. Is it morally okay to strangle him? I've gotta say, this is morally pretty crazy talk.

i) But I didn't advocate that example. That's your example (or counterexample), not mine. In your original example, the fireman doesn't kill Himmler. There's a difference between taking his life and letting him die. The fireman didn't put him in mortal danger. 

ii) Furthermore, by saving this child's life, he's taking the lives of other children (hundreds of thousands) in the future. 

iii) That's different than killing the child in the daycare. There are many evils we have no moral opportunity to prevent. In that case, we must let them happen. If they are to be prevented, God must prevent them, because he hasn't given us a morally licit opportunity to do so. 

You seem to have a host of conflicting intuitions about the fireman, but as near as I can figure, you think it might be just fine for the fireman to let three-year-old Himmler die in the flames if the fireman actually knows what he will grow up and do. I consider that an ethical reductio of your approach.

i) Well, there's an ethical reductio to your alternative. You're myopically focussed on the well-being of that one child to the detriment of hundreds of thousands of other children who will die if he survives. The well-being of more than one child is at stake here. Sure, it's appalling to let him die, but it's appalling to let the other kids die instead. 

We can't always avoid appalling outcomes. Sometimes it comes down to a choice between lesser and greater appalling outcomes. 

ii) 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. 

(As David Lewis defines it, “We think of a cause as something that makes a difference, and the difference it makes must be a difference from what would have happened without it. Had it been absent, its effects — some of them, at least, and usually all — would have been absent as well.”)

iii) To say it might be "just fine" is inappropriately sarcastic in a context where whatever he does will have tragic consequences. Do you think it might be "just fine" when Himmler grows up to be a genocidal maniac? 

iv) I didn't state that he had a duty to let the child die. Rather, I suggested that he doesn't have a clear-cut choice. And I mentioned complications which you ignore. 

You ask if I think a fireman should let the adult Himmler die in a fire. Qua fireman, no. Again, we have to distinguish roles. If you're talking about a soldier, bomber pilot, etc., then of course one could blow up a military target where Himmler is located and not try to rescue anybody. By definition it's a military target, and Himmler is a justified part of that military target. But if you're a civilian fireman whose job is to put out fires, and you would normally go in and get person X who happens to be sleeping in a bedroom, and you are told that person X is a murderer who is planning to commit later murders or even will go on to commit later murders, that's not supposed to be relevant to your decision as a fireman. Your decision should be based on the normal considerations--probable success of rescuing the person without harming anyone else, etc. Firemen are not executioners anymore than doctors are.

i) Your decision should be based on normal considerations when normal considerations apply. All things being equal, a fireman should rescue people from burning buildings. But treating morally unequal situations equally is illogical and unethical.

ii) Keep in mind, too, that this isn't even a case of killing Himmler. The question, rather, is whether to intervene in an ongoing situation. 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?