Monday, October 5, 2009

One life or one hundred thousand?

I just finished watching House, and boy was that ending a doozy. I'll leave out any details/spoilers for those of you who haven't seen it yet, so don't worry. The entire episode was very morally gray, which is both thought provoking and discomforting. It makes you think, "What would I do?" and when you don't know, you get uneasy.

I'll present this dilemma since it's a common thought experiment, not exclusive to House.

As a doctor, you have the ability to end the life of one ill horrible man, an act which will most likely save the lives of a hundred thousand innocent people. If you let the man live, these people will probably die because of his actions. You will most likely not be caught for killing this man, but it's always a possibility. However, it is your duty as a doctor to save lives. What do you do?

Would your actions be different if you were 100% sure it would save lives, or 100% sure you wouldn't get caught?

I won't tell you what happened on House, but beware: read the comments at your own risks. Comments are allowed to contain spoilers about the episode. I'm also not sure what I would do. I may have to stew over it for a while, then I'll add my thoughts to the comments.


  1. *sobs*

    On-topic: I would. Absolutely. Murder is wrong, of course, but there are some cases in which one life must be ended so that countless others can be saved.

  2. I would never commit cold-blooded murder. You can alter the question all you want, but murder is wrong, especially if you are a doctor. There's always options - they probably aren't good ones, but they do exist.

    Murder is wrong. If it was self-defense, it's not murder, but it's not self-defense. It's murder to kill a helpless man in his sickbed. If Chase gets caught, he'll go to jail for the rest of his life. This I believe, because it's true.

    Probably, I'd apply Burn Notice morals to the situation and get the police to arrest the man for a serious crime he may or may not have committed.

    That's what James Kirk will believe, and that's what I believe - there's no such thing as a no-win scenario.

  3. As an aside, my journey towards the firmament of this particular stance parallels my loss of belief in the Judeo-Christian model. Originally I was very much in favour of capital punishment, and, indeed, ruthless behaviour when judging others, and wouldn't have hesitated to reduce this particular instance to math.

    But as the spiritual world's complexities are unwoven to reveal a heap of nothing, I've come to place greater belief in the rule of law, because there is no higher rule than that which we create. And the law allows for some grey areas, but *never* on the case of murder. There must be a clear and immediate danger to justify the taking of a life.

    That is to say, if I was treating a man who had the potential to murder hundreds of thousands, slaying him would be murder. If I stood by and watched as he pressed the button, or gave the order, or what-have-you and do nothing, then I am a party to murder. At that point, the only moral action is to convince the person to stop, or kill them, if there is no other way.

    Even at the cost of your own life.

    I'm sorry. Murder is wrong, be it to save lives, for punishment, for greed or revenge, it's wrong.

  4. There was no murder involved in the show. Did Jen mention murder? There was letting an evil man die.

    I hope I would make the same choice as Chase did in the show. I could die knowings that I saved thousands of lives, genocide, and let one man die to do so.

  5. But Chase didn't just let him die. Chase purposefully faked test results in order to change the man's treatment so he would die. I would consider that killing the man, not just passively letting him die.

    Even if Chase just passively let him die, would that be okay? Aren't doctors supposed to try their best to save lives? What's the moral difference between ending a life because you refuse to treat (passively), or ending a life by performing actions to do so (actively).

    I'm not saying I think one or the other is right, just presenting more moral questions to ponder.

  6. A doctor is sworn to do no harm. Faking a test result = harm. There's other methods. Granted, I haven't seen the show, but I don't understand why a mass murderer, by all accounts a tyrant, would be allowed in the USA in the first place, and secondly, why such a person would be allowed to return to their home.

    By the letter of the law, what Chase did is murder.

  7. Veritas, just go with the thought experiment. Pointing out all the illogical loopholes in House is another topic altogether ;P

  8. Okay.

    There's two courses of action I would consider appropriate. 1. Doing nothing. 2. Murdering the man...and immediately standing up and saying you did it, resigning your license to practice medicine, and calling the cops.

    Doing what Chase did is being a huge pussy.

  9. Yet another reason why I would never want to be a doctor. I'll leave it at that.

  10. I'd refuse to treat. You don't have to treat, you may loose your medical liscence, but you won't be doing any time, and you wouldn't be aiding and abetting the murderer or whatever it is.

  11. I do not know the people that say they would are doctors or not... But as a medical professional, you strive to save every life. You as a person cannot pass judgement, that is why we have a judicial system.

    Yes, it has flaws, but if people take the law into their own hands we end up in chaos. You see an ailing life, you save it, criminal or not. He will serve justice afterwards.

    You could make a judgement call if a criminal and cop, both badly wounded arrive at the same time... but when dealing directly with only that person, saving a life is all that matters.

    (Im a dentist, not a physician but have rotated in ER, Surgery rotations and seen patients in brink of death, and I have seen my share of oral cancer - which is very deadly... and I would notify anyone of the lesion if I see one.)

  12. Veritas, not turning yourself in to the police isn't being a "huge pussy". It's called acting in your own self interests, which is normal, completely natural, and logical. Particularly when you feel you've done nothing wrong, but zealots who adhere to moral absolutes would throw the book at you.

  13. Nice dig, Julie.

    I don't think that committing a murder and covering it up is rather acting in your own self interests. Murderers aren't particularly good at getting away with crimes, and malpractice is very closely investigated. My point was if you wanted to be moral, you would be rather proud of saving hundreds of thousands, wouldn't you?

    Why wouldn't you admit it?

  14. Veritas,

    The explanation given in the episode is if they found out the leader was murdered, the country would see him as a martyr and even more people would die.

    But as a general explanation, you wouldn't admit it because you don't want to go to jail or get punished for something you don't see as morally wrong.

  15. I'm staying in the parameters of the thought experiment, Jen. =P

    I suppose if you don't mind breaking the law, you might think that you deserve to get away with it too. However, if you were really a law-abiding citizen forced into a point of distasteful choices, would you not also realize that the aftermath of the distasteful choice would be less if you admitted to it?

    Given the additional parameters, it becomes even more hazy, of course. I still wouldn't kill the man.

  16. To stay vague enough that others can join in (don't want this conversation to just be between you and me), I don't really believe in moral absolutes. I don't think anything is ever 100% right or 100% - morality is a gray and complex. I suggest reading Marc Hauser's Moral Minds.

    Also, I don't consider the law to be the highest form of moral reasoning, nor do most psychologists. You can sometimes make the most moral choices and be breaking the law.

  17. I think it is immoral to murder a man in the hypothetical situation that murder would guarantee 100% saving hundreds of innocents. Given my position as a doctor, I think that killing a man in this situation would be murder. I have four caveats for killing formulated off of Kantian ethics. One of them might apply here: Killing to save innocents. However, the situation isn't direct enough, as in I could probably find another way to save innocents, and I would be violating my duty for reasons of emotional ferocity -- a clear violation of Kant. So, basically, I'm defining murder as unjustified killing, which I think this would be.

    I take it as a given that Murder is wrong. So, as long as there is no justification for killing him, this would be murder. Because I could look for other ways to possibly alleviate the murder of hundreds of thousands of innocents, despite the fact that even in this hypothetical killing him would 100% guarantee the lives of innocents (which is a hypothetical I generally have a problem with, but am taking it up for the sake of argument), killing the man would be unjustified, and therefore would be classified as murder, and would therefore be wrong.

    But, I generally don't go in for Utilitarian ethics, and I often go in for Kantian ethics. Especially when dealing with the more clear actions such as murder and rape.

  18. Kill him. Why is it even a question? 100,000 lives are more valuable than 1 life.

  19. @Veritas. Of course not admitting it and trying to get away with it, even for a few years, is acting in one's own self-interests. You kill a man. You believe that it was morally right, but know that legally it will be viewed as wrong. You know that there is a very good possibility that you will be found out, but know that there's also a chance you won't. Even with a reduced sentence if they admire your honesty or bravery or somesuch, you'll still have lost your license to practice medicine when you get out. The logical thing to do is to keep your mouth shut.

    Also, first time offenders, especially ones in a gray area such as this, are often offered plea bargains no matter what. Ten minutes, ten years, he'll likely be offered a deal if he pleads guilty.

    I'm a vet student. I kill patients all the time. Sometimes even dangerous or aggressive ones that pose a possible threat to other people. I see nothing wrong with the given scenario, and would have killed the man myself if I knew I could get away with it. Then again, I'm not a particularly nice person, and would do a lot of things if I knew I could get away with it.

  20. Did Chase change test results or did he just omit something? I need to go back and watch it again. I was trying to make dinner and watch at the same time.

  21. @ @}-,'---

    Under the auspices of ethics, it does.

    If we're talking some sort of universal apathy for human affairs in which we gaze into the Pit of Existential Despair, then probably not. But... ya'know... nothing really matters when you're being a philosophical party-pooper :).

  22. Rose ascii thingy:

    They needed to go do a blood test to see if evil president potentially had a different disease. Instead of getting the president's blood, Chase went to the morgue and got the blood of a deceased woman who was known to have recently died from the disease they were trying to test for. He knew the test would come back positive and they would then treat the president for it, effectively killing him.

    Love the term philosophical party-pooper!

  23. Unless you are a doctor, then forget the ethics. Does it matter that it's wrong? Thousands of lives will be saved, does it matter that it's wrong?

  24. I would say anyone that is "willing to do anything" (and mean it) for any cause is, by definition, insane. I understand how these individuals rise to power (they will do ANYTHING) and I understand how they justify their actions ("it was for the good of everyone"). This is a very dangerous mentality and they should be removed from political power. It is quite the interesting dilemma when you mix the "do no harm" with "healing this person harms millions" with no obvious answer. Perhaps, ultimately, there is no wrong or right decision but one based on the principle of "least harm" which so many physicians must rely upon to treat the complex myriad of illnesses we understand today.

    Ultimately, it is not a question of murder, however, but a question of how the ethics of a physician are defined. Is the scope of ethics limited to the specific patient, or to all of society? I would say that physicians are limited exclusively to the ethics concerning care of the patient(s) in his or her care and to provide medical attention for that individual.

  25. Oh, in addition, he thought he was doing the "greater good" by killing thousands of people. What do you think is the "greater good" and why?

  26. Not entirely sure what I think about this.

    Veritas, you said:

    "...If I stood by and watched as he pressed the button, or gave the order, or what-have-you and do nothing, then I am a party to murder. At that point, the only moral action is to convince the person to stop, or kill them, if there is no other way."

    When does killing become justified in this situation? That is, how imminent must the deaths of innocents be before you can justify interfering? Certainly, if he had his finger on the kill-thousands-of-people button, I would feel obligated to stop him. But what about before that instant? If his intent to kill was certain, like it is in this thought experiment, then what is the difference if I were to kill him 5 seconds, 5 minutes, or even 5 days before he pushed the button?

    In a practical situation, there might be other ways to stop the bad man from committing genocide without killing him, up to a certain point in time before he actually performs the act. In a very strict thought experiment where treating the man guarantees genocide, and killing him prevents it... I'm not sure.

    Being sure I wouldn't be caught would not change my decision. Getting away with something does not make that act moral, and the life or death of another human being is more significant to me than the punishment I might face.

  27. I don't know, and I certainly hope I never have to face that decision.

    I can rationalize a decision either way, but there's no way I could make that decision and feel good about what I did afterward, whatever it was I chose to do.

  28. I'm going to agree with Mike and some of the other more utilitarian arguements others have given-- the "when his finger is on the big red kill-people button" scenario draws a rather meaningless line. If we KNOW that he will kill 100's of thousands, and KNOW that we can stop him, wouldn't it be more correct to do it as early as possible, to prevent missing our chance?

    I'm sure many people here have heard the moral dilema posed before about the train rushing towards 5 innocent people. In one version of this scenario, you can flip a switch, and the train will run over 1 person instead of five. Many people say that is morally acceptable. However, if instead of flipping a switch, it's pushing a fat man in front of the train, most people say it is morally unacceptable, despite the fact that the results of the action are the same.

    These two scenarios are generally presented when discussing a utilitarian view of ethics: results focused, ends justify the means. Cut and dry.

    I wouldn't consider myself a strict utilitarian though, for two reasons. a) life is always messier than these neat little scenarios. you NEVER have 100% certainty that the fat man will stop the train. or that the 5 morons won't move off the track, making your efforts unnecessary. or that you are right about the political realities of a country halfway around the world and how your actions will affect them. or that someone you believe to be a murderer/criminal really is one. etc. all these uncertainties require a rule of law to try and set up a process around these kinds of decisions when possible, to create consequences for running around causing havoc as a misguided vigilante. doesn't mean what is legally correct is always morally correct, but I think the existence of legal/social consequencies for dramatic actions based on personal moral judgements is a net gain overall, if not for all cases. b) utilitarians would regard all lives as equal, regardless of the relationship between the persons we are considering and the person making the decisions. I know we'd all like to believe that we can think that way, at least in some cases, but it is human nature to value family/other small community group members as more important than 'outsiders'. And this can lead to incredibly immoral judgements, yes, and I don't want to suggest that we are entirely restrained by our biology--we absolutely can and should second guess our immediate moral intuitions, because natural is NOT equal to good--but I think to some limited degree, these instincts will always be a part of our morality, if only because they are such a deep part of what makes us who we are.

    All that aside, I totally saw Chase's actions coming and I was rooting for him. I'd like to think I would do something similar if I were in his shoes, but knowing me I would just have a breakdown and avoid the whole issue. Which is just one of countless reasons why an M.D. is NOT in my future. Ever ever ever.

  29. For all those think they have a good handle on right and wrong should go and try: the Harvard moral sense test

  30. I'd kill the guy. He was basically a mini-Hitler. If you could go back in time to kill Hitler, would you?

  31. One of the late second season episodes of Trigun had a similar situation. Vash had to kill one of the bad guys to save his friends and an entire town. Vash always insisted on not killing anyone or anything, but I side with Vash if the only recourse to stop the murder of others is to kill someone, then it has to be done. I would be the guy in the last Batman Movie that actually did push the button to detonate the other boat. I believe the needs of the many outweigh the needs of the few or the one.

  32. One of the interesting things you learn from psychology is that framing matters a lot. If the dilemma is presented as killing v not killing a hundred thousand it is easier to kill the one than if it is presented as saving v not saving the hundred thousand.

    I could probably go on for a while about this and related dilemmas, since it's kinda close to my research, but since I don't have time for that I'll just give my own view: I would like to think that even if I knew with 100% certainty that I would get caught I would do it, kill the one to save the hundred thousand. Whether I could actually do it if I were in the situation, I don't know, but I think it would be the right thing to do. 2 lives for 100,000 is an easy choice. As Spock would say, the needs of the many outweigh the needs of the few.

    Once I've seen this house episode, I'll have to come back here and read the rest of these comments.

  33. This is probably why I usually end up as Chaotic Good or Neutral...

    I am also not saying that the decision wouldn't be hard, because it would. The episode of Trigun I am talking about is called "Sin". It is still a struggle but one has to do what one has to do for the greater good, damn the laws if they are in the way.

  34. Frank nice to see we came up with the same quote. :)

  35. @TraumaPony: No. But it depends on the theory of time travel you subscribe to.

  36. @Veritas - what you wouldn't want to live in a Command and Conquer Universe?

  37. @Beamer: I've fought those wars. All of them. All I have to say is...Defcon 5! Red Alert!

  38. if adolf hitler was the patient, would it still be a discussion whether chase should've saved his life? yes it is murder, but if he saved the life of the dictator, he contributed to the killing of the millions of people that this guy gonna do. I would call it justifiable.

  39. My feeling is a doctor should never have the decision to be judge jury and executioner. As a physician your primary job is to treat the patient even if they're a murderer and you know they will murder again. You're a doctor not the law. The reasons we have laws and practitioners and keepers of the law is because of situations like this. Also, I always felt the reason a doctor must treat anyone, even if their murderers, is they must be OBJECTIVE in their practice for if they're not they won't be able to save lives that the general public morally feels should be saved. Think, maybe the ailment the dictator had was a special case that could have been used for study to treat other patients with the same issue easier and in turn save their lives. Wow, would you look at that, the new discovery of treatment would save "thousands and millions of lives". Sorry for all the mispellings.:)

  40. that is always my problem with these kinds of discussions, it assumes a level of absolutes that simply doesn't exist in real life.

    Much like the torture debate, the famous "ticking bomb" example. I reject the entire argument because it is vacuously built on assumptions that I believe are impossible to ever exist in reality.

    It smells to me much like religious absolutism. Moral absolutes, as if any moral doctrine could exist without an exception. Its hogwash.

    It is quite possible the murder will be found out, and the genocide will be worse. It is just as possible the second in command is even more brutal and evil, and the genocide will be worse. It is just too simplistic to assume we know the outcome for either possible future.

  41. One other interesting element is Foreman's destruction of the evidence -- the paper trail -- of what Chase did. That's an intriguing, but separate, question altogether.

  42. All the people that agree with murdering to save the other lives must also agree with the PRO LIFE wackos that think murdering the doctors to save the future abortion fetuses is ok too. you can't have it both ways.

  43. anonymous? what the heck, you're only logically constrained to agree with that IF you also grant that abortion is genocide. Which is an idiotic second assumption that's unsupported by the evidence. The fact you totally didn't see that assumption plus are posting as annonymous kinda indicates to me you probably ARE one of those "pro life wackos".