Would You Kill the Fat Man (5 page)

Not One Effect, but Two

Philippa Foot was a careful intellectual mover. According to Tony Kenny, “She was like a climber who would make sure her footing was sound before taking the next step.”
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Foot was more self-deprecating. She once said, “I’m not clever at all. I’m a dreadfully slow thinker, really. But I do have a good nose for what is important. And even though the best philosophers combine cleverness and depth, I’d prefer a good nose over cleverness any day!”
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In 1967, in a seminal article, her philosophical nose led her to one of the most contentious areas in moral philosophy. The full title of the article was “The Problem of Abortion and the Doctrine of Double Effect.” In it, Foot rejects the use of the DDE as a weapon to criticize abortion.

She explains the DDE, first identified by Thomas Aquinas, as “based on a distinction between what a man foresees as a result of his voluntary action and what, in the strict sense, he intends.”
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Later she adds, “By ‘the doctrine of double effect’ I mean the thesis that it is sometimes permissible to bring about by oblique intention what one may not directly intend.” It is called the doctrine of
double
effect because of the twin effects of some actions: the one aimed at, the other foreseen but not intended.

A literary example comes from Nicholas Monsarrat’s
The Cruel Sea
.
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The book is set in World War II and the battle of
the Atlantic. A British merchant convoy has been struck by German torpedoes. Ships have been sunk and there are many survivors in the sea, waiting to be rescued. The commander of a British corvette is faced with the decision whether to drop a depth charge, to destroy a German U-boat knowing that the massive explosion will kill the survivors. He knows too that if he doesn’t take this action, the U-boat will continue to wreak havoc, sinking ship after ship. He drops the depth charge. In making his decision to sink the U-boat, the commander foresaw, but did not intend, the deaths of the survivors.

This distinction between intending and foreseeing is at the core of the DDE. In Catholic theology, the DDE has been pivotal to the church’s explanation of why, in its view, there are only rare cases in which abortion is acceptable. Most cases of abortion involve the intentional killing of the fetus. But if a pregnant woman has a tumor in her uterus, and a hysterectomy is required to save her life, the fact that there is also a fetus in the womb is, as it were, incidental. The aim of the hysterectomy is not to kill the fetus (or indeed to have any effect on the fetus) but to deal with the tumor.

The DDE is not just fundamental to Catholicism: it’s cited far beyond the pulpit. Some nonbelievers are minded to reject any tenet originating in theology—a puerile stance since so many philosophers have made their contributions from within a religious framework. But the centrality of the DDE in commonsense morality should give theists and nontheists alike at least pause. The DDE is built into law, into medical practice, and into the rules of war. The law draws a distinction between “direct” or “purposeful” intention on the one hand and “oblique” intention on the other. In medicine, it is permitted under certain circumstances to administer a dying person a pill, to reduce her pain, foreseeing but not intending that this will hasten her death. But it is not permitted to administer a pill intending to bring about her death. It is permitted in certain circumstances to target a military installation in war, foreseeing that it will bring about some civilian casualties (that dreadful euphemism, “collateral damage”); it is not permitted to deliberately target civilians.

The DDE

The DDE can be given a more precise formulation. It’s usually seen as consisting of four components, though this formulation is not universally accepted. The DDE comes into play when:

• the act considered independently of its harmful effects is not in itself wrong;

• the agent intends the good and does not intend the harm either as means or end, though the individual may foresee the harm;

• there is no way to achieve the good without causing the harmful effects; and

• the harmful effects are not disproportionately large relative to the good being sought.

The justifiability of targeting a particular military installation illustrates how the DDE can be applied. If it is legitimate to hit an installation with foreseen collateral damage then, according to the DDE, the following conditions must be met: (1) Hitting this installation must not in itself be wrong. (2) Hitting the installation must be the intended act, and the collateral damage must not be intended. (3) It must be impossible to hit the military installation without causing the collateral damage. (4) The badness of the collateral damage must not be disproportionate to the good that will result from hitting the installation.

Whether or not we’re aware of it, the DDE appears to play a role in our daily judgments of approbation and disapproval, from deadly serious instances to more trivial ones. As philosopher Sir Anthony Kenny puts it, “There’s surely a difference between appointing A over B for a professorship because A is the best candidate and knowing B will be annoyed, and appointing A over B just to annoy B—I’ve known both cases.”
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Studies suggest that most people do find the DDE intuitively appealing (see
chapter 9
).

Not everyone is persuaded. The American philosopher Thomas Scanlon argues that the onus should be on proponents of the DDE to show why we should take it seriously. “[N]o one has … come up with a satisfying theoretical explanation of why … the difference between consequences that are intended and those that are merely foreseen … should make a moral difference.”
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And there’s a practical worry that the DDE could be used as an excuse to skip over or shimmy around the taking of responsibility—especially when actions are taken on behalf of a state. Should we be satisfied with the defense minister who orders a highly effective raid against a wicked enemy, but who says, “I realized that villagers would be killed in the bombing: that side-effect of our operation is regrettable”?

Murder at the Hospital

The method of trolleyology involves conjuring up various trolleyesque scenarios and taking note of the (preferably) strong moral intuitions that they elicit. Then he or she tries to formulate a plausible principle (or principles) that unites and makes
sense of these intuitions. The principle should itself have some intuitive plausibility: it should not feel arbitrary. Once located, this principle can be transplanted into real life to help resolve real dilemmas.

The DDE is one possible candidate for a principle that explains our intuitions. In exploring the validity of the DDE in her article, Philippa Foot describes several imaginary thought experiments. At the time, the hoariest involved a fat man—but not the fat man who stars as the main protagonist of this book. This earlier fat man is stuck in a hole in a cave. His head is out of the cave, so he can breathe, but a party of potholers is behind him, and unable to escape. “Obviously,” wrote Foot, “the right thing to do is to sit down and wait until the fat man grows thin; but philosophers have arranged that flood waters should be rising within the cave.”
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You have a stick of dynamite. The question is; can you use it to blow up the fat man?

It is only on page twenty-three that the trolley is introduced. In fact, in its original form, it differs from the usual description in a few details. Foot asks us to imagine not that the person facing the dilemma is a bystander near the track, but that he is actually driving the train. More trivially, and peculiarly, the vehicle is not a train, but the unthreatening, slow-trundling tram. Trams had largely disappeared from the developing world by the time Foot wrote her article. Among the safest forms of transport ever invented, they were not in the habit of careening out of control, though one of the most celebrated architects of the last two centuries, the Catalan modernist Antoni Gaudi, was knocked down by a tram in Barcelona in 1926 on his way to confession and died a few days later. (In the subsequent inquiry the driver said that he saw a man, who looked like a tramp, cross his path—there had been no time to slow down.) But “tram,” not “train,” was how Foot conceived her
problem, and when it crossed the Atlantic it was Americanized and became a trolley—hence trolleyology. (A rather unfortunate label for British readers, for whom the image is conjured up of marauding supermarket carts full of baked beans and washing powder.)

Foot compares her scenario, which we’re calling Spur—where it seems right to turn the trolley (or tram) to save the five even though one will thereby die—with a twin set of cases. These cases run roughly as follows. Imagine we could either save a patient with a massive dose of a drug, or save five patients who only need a fifth each of this drug: what should we do? Once again it would be permissible, thinks Foot, to save the five though one will die. Now take the Transplant Case. Suppose that there are five seriously ill patients, all in urgent need of organ transplants. Two require kidneys, two need lungs, one needs a heart. They will die today unless the organs are forthcoming. As luck would have it, an innocent, healthy, young man who has just the right blood type walks in for his annual checkup: should the surgeon bump him off so that his organs can be farmed out to the five at risk? We are expected to find this proposal abominable.
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The fat man, a character we’re about to meet, dramatizes much the same conundrum. The question is why our moral reactions differ in these two kinds of cases—cases such as Spur, where it seems morally acceptable to take a life to save five lives, and cases such as Transplant, where it doesn’t. One disquieting aspect of these examples is that although most people have instant, powerful, and unyielding reactions to them, they can’t usually articulate why they feel so strongly, nor can they easily identify a compelling rationale for the distinction they want to draw.
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Yet the DDE appears to provide just such a rationale. After
all, we do not intend to kill the single man in Spur, but we do intend to kill the healthy patient whose organs will save five lives. In Spur, if, after you’ve switched the train’s direction, the man on the track were somehow to untie himself and escape in the nick of time, you would be delighted. Not only would you have avoided crashing into the five, but no one else would have gotten hurt. But with the healthy patient, you require his death—if the visitor’s suspicions were aroused when he saw an orderly approach with a bludgeon, any successful escape by him would mean the five would die. His death is a means to save the five.

More about this distinction later. But Foot believed that we do not need to resort to the DDE to explain our intuitions in these scenarios. She proffered an alternative explanation. We have, she says, both negative and positive duties. Negative duties are the duties not to interfere in other people’s lives (say by killing them!). Positive duties are duties to help others. In Spur, her dilemma is faced by the driver (not a bystander), and since the driver presumably started the train, his terrible choice is between killing one and killing five, with the former being obviously preferable to the latter. But in the hospital scenario, although the surgeon has a positive duty to save the lives of the five sick patients, this is in conflict and outweighed by the negative duty not to harm a healthy patient.

In a subsequent article Foot went on to highlight what to her was a crucial point. In Spur one is merely redirecting an already existing threat. The runaway train is a moving threat and all we are doing is nudging it, as it were, elsewhere. But in the hospital case, in taking the life of the healthy man, we have introduced a whole new threat.

It’s a nice try, but can it be right? Has Philippa Foot solved her own conundrum?

CHAPTER 5

Fat Man, Loop, and Lazy Susan

Always recognize that human individuals are ends, and do not use them as means to your end.

—Immanuel Kant

I am the man, the very fat man, that watered the workers’ beer …

—music hall song

Don’t want to be a fat man, People would think that I was Just good fun.
Would rather be a thin man, I am so glad to go on being one.

—Ian Anderson, “Fat Man”

(performed by Jethro Tull)

PHILIPPA FOOT SET TROLLEYOLOGY rolling, but it was Judith Jarvis Thomson, a philosopher at the Massachusetts Institute of Technology, who delivered its most high-voltage jolt. Struck by Foot’s thought experiment she responded with not one but two influential articles on what she labeled “The Trolley Problem.”
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The first article included many thought experiments of her own, involving, in order, the imaginary Alfred, Bert, Charles, David, Frank, George, Harry, and Irving, all faced with life-and-death decisions Thus Alfred, who hates his wife, puts cleaning fluid in her coffee, killing her, while Burt, who also hates his wife, sees her putting cleaning fluid in her coffee by mistake (believing it to be cream). Although Burt has the antidote to the cleaning fluid, he does not give it to his wife—he lets her die.