I heard this argument a couple of years ago via Youtube video and I liked its novelty (instead of having sides talk past each other it's gladdening to see some thought put into things).
That being said, for me, it fails on the responsibility front. The healthy person did not cause the sickness, is not the sick one's parent and did not in any way "give" life, so to speak. If we reimagine the sick neighbour's predicament so that her husband and child both need a new kidney and the healthy neighbour convinces her to give them up because the he has a special room in his house where she can convalesce and regrow her kidneys. Should the healthy neighbour now be allowed to withdraw the offer after the sick neighbour had donated both kidneys?
That kind of situation seems to align with some of the factors at play a bit better.
Yeah ... I'm fortunate that neither I nor my immediate family are immediately affected by this decision, which affords me the luxury of thinking about the ethics in the abstract.
> If we reimagine the sick neighbour's predicament so that her husband and child both need a new kidney and the healthy neighbour convinces her to give them up because the he has a special room in his house where she can convalesce and regrow her kidneys. Should the healthy neighbour now be allowed to withdraw the offer after the sick neighbour had donated both kidneys?
While I'm totally willing to engage in this kind of Talmudic thought experiment, is there a way you could recast your question to be more biologically plausible?
For example, suppose you offer to donate a kidney to your child, who is suffering from a fatal, heritable condition for which you carry a recessive gene. You thought that you were incurring a 0.007% risk of mortality (the average). During the surgery, the surgeon performing the extraction discovers that you have unexpected extra risk factors and their process will not work; they stop. They tell you that they can try again, but the new procedure they need to use will incur a 10% chance of your death. There is no other donor, and your child will die.
1 - Should you be allowed to withdraw your consent for the surgery?
2 - Should your child's wealthy spouse be allowed to pay you money to continue with the surgery?
> is there a way you could recast your question to be more biologically plausible?
It's a thought experiment, isn't the point that it is unencumbered by what is plausible? The reason for setting it up that way is to put responsibility for the sick person's life onto the healthy person through an action they took. I have no current alternative.
> 1 - Should you be allowed to withdraw your consent for the surgery?
Yes, the circumstances have changed.
> 2 - Should your child's wealthy spouse be allowed to pay you money to continue with the surgery?
I'm not against it but I can see why there could be rules against it.
> It's a thought experiment, isn't the point that it is unencumbered by what is plausible? The reason for setting it up that way is to put responsibility for the sick person's life onto the healthy person through an action they took. I have no current alternative.
> …
> If we reimagine the sick neighbour's predicament so that her husband and child both need a new kidney and the healthy neighbour convinces her to give them up because the he has a special room in his house where she can convalesce and regrow her kidneys. Should the healthy neighbour now be allowed to withdraw the offer after the sick neighbour had donated both kidneys?
> That kind of situation seems to align with some of the factors at play a bit better.
I'll admit that my preference for ethical questions to be realistic is an irrational preference. I don't know why I feel this way but I think we get answers which are more likely to be meaningful if we start with scenarios that could plausibly happen.
Let me try revisiting the one you propose:
Suppose there is a healthy person whose husband and child both need kidneys. Donating her kidneys to them both would ordinarily kill her -- people need at least one kidney to live, and she only has two. But her neighbor says "if you donate your kidneys to your family, I'll let you live in a special room in my house where you can regrow your kidneys".
Let's say this process takes 40 weeks, and at about week 10 the neighbor says "I don't want you in my house any more -- please leave". Should the neighbor be allowed to say this, even if this means the formerly healthy person will require daily dialysis, and may indeed die?
I wonder whether the answer changes on why the neighbor is saying "get out":
* What if the neighbor themself has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room?
* Does the answer to the above change if the room's special-ness is tied to the neighbor being alive (if they die, no one else can ever use it to regrow organs)?
* What if the neighbor's own infant child has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room; should they be allowed to evict the recovering kidney donor? Does the answer change if the kidney donor has a 1% chance of surviving on dialysis until the room is available again? 10%? 99%?
* If the neighbor is just being selfish and wants their room to be empty because they've decided think it looks better when it's tidy, should that be forbidden?
* One way or another, if the room is empty at the end of the 40 weeks, should the state use eminent domain to seize the room and force the neighbor to take in gravely ill people from local hospitals, housing them until they are well, for as long as the room is working?
When I have interrogated these views personally I have found that some things may be wrong to do, but society should still be structured in such a way that people may sometimes do wrong things.
And, btw, in this thought experiment my gut feeling is:
> What if the neighbor themself has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room?
The neighbor should be allowed to evict the donor, even if this causes terrible outcomes for the donor.
> Does the answer to the above change if the room's special-ness is tied to the neighbor being alive (if they die, no one else can ever use it to regrow organs)?
My answer doesn't change.
> What if the neighbor's own infant child has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room; should they be allowed to evict the recovering kidney donor? Does the answer change if the kidney donor has a 1% chance of surviving on dialysis until the room is available again? 10%? 99%?
My answer doesn't change; the neighbor should be allowed to evict the donor.
> If the neighbor is just being selfish and wants their room to be empty because they've decided think it looks better when it's tidy, should that be forbidden?
The donor should be allowed to stay under EMTALA.
> One way or another, if the room is empty at the end of the 40 weeks, should the state use eminent domain to seize the room and force the neighbor to take in gravely ill people from local hospitals, housing them until they are well, for as long as the room is working?
Yes. If there exists a special room which can heal people and if it is idle, the government should seize control of it and distribute its healing ability to help as many people as possible. Ideally we should raise taxes to investigate how this healing room works and replicate it until we can end all death in the world and heal all disease. But in the short term we should immediately maximize its use, and compensate its owner accordingly.
You gave me a lot to think about. Tackling the main one that I think maps best to the situation at hand:
> Let's say this process takes 40 weeks, and at about week 10 the neighbor says "I don't want you in my house any more -- please leave". Should the neighbor be allowed to say this, even if this means the formerly healthy person will require daily dialysis, and may indeed die?
I would say no, there is at least an implied contract with such severe consequences for backing out that it cannot be backed out of without it becoming murder (it would meet mens rea).
> What if the neighbor themself has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room?
This one maps to the mother's health, which will almost always be prioritised (though I'm sure there are exceptions/considerations depending on circumstances). I reckon this is done for two reasons, that an adult is a known quantity whereas the child may be born and still not make it, but also because the mother can probably try again. In the case of the room, if the room would continue to work its magic even though the owner died then I'm not sure society/law would prioritise them.
It might also map to a doctor treating someone in hospital then falling ill themselves.
> What if the neighbor's own infant child has suddenly developed kidney failure, no transplants are available, and the only thing that will save them is an immediate 30-week stay in the special room; should they be allowed to evict the recovering kidney donor?
This one was difficult but I'd have to say no, based on the same reason as above, that the treatment had started and there was (at least) an implied contract to finish it and knowledge to not to would be reckless and akin to murder.
In the UK the House of Lords ruled[1]:
> that it was lawful to withdraw life-sustaining medical treatment from [a] man who had fallen into the condition known as permanent vegetative state. Their Lordships agreed that although, in withdrawing the life-sustaining treatment, death would be intended, his death would not be regarded at law as caused by the withdrawal of the treatment, but rather by his underlying condition.
(I've edited that for consideration to the family and length)
That decision was considered controversial among the medical community (apparently[2]). However, I doubt one could justify withdrawing treatment to someone who would probably go on to live a full life.
> If the neighbor is just being selfish
No.
> One way or another, if the room is empty at the end of the 40 weeks, should the state use eminent domain to seize the room
No. Property rights mean something (to me, anyway), and in our analogy that would be like the state making someone forcibly pregnant or available for rape. That's not the same as telling someone who became pregnant through actions of their own free will to bear the ultimate responsibility for those actions, nor forcing someone to keep to a contract they made freely.
> I have found that some things may be wrong to do, but society should still be structured in such a way that people may sometimes do wrong things.
I agree, which is one reason why I'm against abortion but pro-choice (because it would go against bodily autonomy, so I choose the lesser of two evils). I'm not against quite short term limits.
That being said, for me, it fails on the responsibility front. The healthy person did not cause the sickness, is not the sick one's parent and did not in any way "give" life, so to speak. If we reimagine the sick neighbour's predicament so that her husband and child both need a new kidney and the healthy neighbour convinces her to give them up because the he has a special room in his house where she can convalesce and regrow her kidneys. Should the healthy neighbour now be allowed to withdraw the offer after the sick neighbour had donated both kidneys?
That kind of situation seems to align with some of the factors at play a bit better.