Utilitarianism and the organ lottery
Is it ever OK to kill one person to save five? What if it’s just a random person on the street? What if it’s a societal institution that we all sign on to in the same way that we agree to taxes or the draft? The proposal to create an organ lottery has been around for a long time now. That is, a random societal lottery like the draft lottery that would randomly select among people with healthy organs. If someone’s “organ card” were selected, then she would be killed and her organs given to someone who needed them to survive.
It seems like utilitarians like Peter Singer should be excited by the idea, but in fact Peter Singer makes a classical economic argument against this. Essentially he argues that creating this system of social insurance leads to moral hazard. In other words, if I know I’m likely to get a new kidney if I destroy my current one, I’m much less likely to take care of the one I’ve got now. Because I don’t take care of my kidney, more people die in a needless way.
While this argument might get Singer out of having a poorly instituted lottery, a well-designed lottery might work. Just as health insurance companies might require us to have a deductible or co-pay of sorts, we might be forced to accept a lot of risk if our kidneys fail. Alternatively, people could be monitored and their behavior regulated to ensure they aren’t negligent with their own organs. I’m not entirely sure what the right sort of incentive structures are for a game like this.
