Category: ethics
Associated thinker(s): Philippa Foot, Judith Jarvis Thomson
Original publication or approximate period: Twentieth-century trolley and transplant debates; Foot (1967), Thomson’s later discussions
Difficulty: Beginner
Themes: rights, killing, medical ethics
Related experiments: trolley, organ-lottery
Kind: thought experiment
Research checked: 2026-10-30
Five patients will die without different organs. One healthy person has the organs needed to save all five. Assume compatibility, successful surgery, and no other available treatment. A surgeon could kill the healthy person and distribute the organs. Even readers who permit diverting a trolley commonly reject this operation. The deliberately artificial certainty makes the disagreement harder to explain merely through medical risk.
Why might killing one to save five be forbidden even when five lives would certainly be saved?
Transplant cases challenge the inference from a better outcome to a permissible action. They help distinguish outcomes from the way outcomes are produced, and invite examination of consent, professional duties, and the moral standing of a threatened individual.
Compare the causal structures. In the transplant version, the unwilling victim’s organs are necessary means to the rescue. In a simple switch case, the lone person’s presence is not what saves the five: an empty side track would work better. This distinction is worth testing, but it should not be assumed to solve every trolley variant. Write down the role played by the person, the threat, and the rescuing act in each case. Doing so makes it easier to evaluate whether “using a person” identifies a defensible moral boundary.
Rights-based approaches stress that an unwilling person cannot simply be treated as a supply of parts. Some consequentialist accounts appeal to the consequences of social rules protecting patients; act-consequentialists must address the stipulated case even when secrecy removes reputational effects. Other approaches distinguish directing an existing threat from creating a new attack.
This is not ordinary organ allocation among consenting donors and recipients. It is also not evidence that doctors actually make such choices. Adding discovery, panic, or surgical failure may explain practical prohibitions without answering the idealized question originally posed.
Harris’s Survival Lottery replaces an isolated surgeon’s decision with an impartial social scheme. That changes the argument about fairness without removing the question of what each person may be forced to surrender.
Historical association: Twentieth-century trolley and transplant debates; Foot (1967), Thomson’s later discussions. The sources above support the scenario and its intellectual context. Where an original work was not retrieved in full, its account is mediated by the named academic reference; no claim of full primary-source verification is made. The explanation and reflection questions here are original editorial prose.