Archive | December 2, 2018

The Good Place, the Boy George principle, and the fallacy of the Doctor Problem

So I’m rewatching The Good Place s2 with my aunt. Simultaneously enjoying The Good Place: The Podcast (which is great but spoileriffic, so don’t pair it with your first watch).

I’ve watched s1 about four times by now, because it’s the kind of show where it’s really good to vicariously enjoy someone else’s first watch. This is my first revisit of s2, though.

And I’ve gotta vent about the Trolley Problem.

Quick summary for anyone who’s missed it: the Trolley Problem is a classic thought experiment. You’re driving a trolley, and the brakes fail. As it’s speeding down the track, you see five people on the track ahead of you. (They’re stuck. Maybe they’re tied down, Snidely Whiplash style?) There’s a switch coming up, so if you act quick, you can steer the trolley onto an alternate track — but there’s one person stuck on that track.

Is it morally better to let five people die through inaction, or to save the five by actively killing one person?

There’s a great episode of Mind Field on YouTube that makes people think they’re really in this situation (using an “experimental remote train-driving system” and non-live footage of people on tracks) and tests their results. With bonus meta-layer of how the experimenters avoided inflicting unethical levels of trauma on their unwitting subjects.

Everything is fine / Everyone is safe


So in the show, moral philosophy professor Chidi explains all of this. His students and fellow-torturees conclude that you gotta hit the switch. Chidi says, good, but there are other versions of this — like “Let’s say you’re a doctor, and you can save five patients. But you have to kill one healthy person and use his organs to do it.”

It’s not the same thing, and the others say so, but when Chidi asks why, they can’t articulate a reason. Later, when Chidi himself gets confronted with the Doctor Problem, he says “I won’t do it, because of the Hippocratic Oath.” But he, too, can’t articulate the moral foundation for why that works out.

Which is very in-character for Chidi. Any time something is declared an unshakeable moral absolute, he gets stuck on it. And none of the others have thought about the topic enough to go there.

So I’m gonna.

What makes the Trolley Problem work is, it’s so stripped-down. Short timeframe, very few variables, no room for complicating factors or alternate options.

There’s another alternate version which goes “you’re standing on the sidelines watching, and you can stop the train from running over 5 people down the line by pushing 1 person in front of it now.” Small change, but it still destroys the setup. Even if we accept the dicey premise (“this will definitely stop the train, it won’t just result in the train running over 6 people”), why can’t you push literally anything else in front of the train? “But the only thing in reach is this other person–” –yeah, and you.

There’s no third option in Trolley Problem Original Flavor. Much less a self-sacrifice option — which introduces a level of self-interest that unbalances the whole thing.

So when you get to the Doctor Problem, there’s not just a third option, there are billions of options. There’s none of the immediacy of “people who are stuck on the tracks in front of you right now.” Lots of people need organs. Even more people have organs. (Including you, the person considering the problem.) How do you fill the slots of the 5 and the 1?

There’s a few immutable conditions that narrow it down a little. Blood types have to be compatible, for instance. But that just means you’re down to 3 billion instead of 7 billion. Not real helpful.

About the 5 recipients: “Hit by a train in the next 30 seconds” versus “not hit by a train in the next 30 seconds” is extremely binary. Surgery…is not. Say you have a bad heart. Maybe you don’t get a new one, but you live another 30 years with medication and a strict diet and a careful lifestyle. Maybe you do get a new one, but the transplant itself is what kills you, through a bad rejection or an opportunistic infection or the basic risk of anesthesia.

…can you tell I’ve been watching a lot of medical dramas recently?

So you’d have to do a ton of evaluation, aimed at coming up with 5 people who have the best chance of getting the most substantial benefit out of this surgery.

About the 1 unwilling donor: you have to do a ton of evaluation there, too. Gotta be someone whose organs are all in good condition. Gotta be someone who’s healthy in other ways, so the recipients don’t just die of pneumonia the week after. And there are other practical concerns. What if the best candidate is someone who has to be flown in from another continent? Is it even worth testing people on other continents? If you test just your local city and find someone workable, is there a substantial benefit to testing for someone slightly-better in the next city over?

I could go on. There’s a lot.

But the real point here isn’t to actually consider these questions.

The real point is: if you give people the power to make this choice, they won’t bother answering all the questions.

What they will do is: designate people from “undesirable” groups as the donors, designate people from socially-powerful groups as the recipients, and, if asked to justify it, bring up only the details that happen to align with that particular choice.

History is littered with examples of — not organ-donation specifically, but this general flavor of human failing, being put into action. Infecting prisoners with malaria at Stateville Penitentiary, infecting disabled children of financially-stressed parents with hepatitis at Willowbrook State School, withholding treatment from poor black men with syphilis in the Tuskegee Institute study, verbally abusing orphan children in the Monster Study, exposing poor prisoners to massive radiation in the Washington and Oregon Reproductive Radiation Tests, deliberately infecting Guatemalan citizens including poor women and mental patients in the Guatemala syphilis experiment, giving poor pregnant women radioactive drinks at Vanderbilt University…to say nothing of the whole horror-shows of experiments done on prisoners — mostly political opponents and/or demonized minority ethnic groups — by the Nazis, Unit 731 in Japan, the Soviet Union, North Korea….

There would’ve been no shortage of “the people behind this are definitely in the Bad Place” references on this topic, is what I’m saying.

So this whole thing is a situation where “is this concept, considered on a pure objective level, ethical?” has a prerequisite, which is “can humans, in the real world, handle this objectively?”

And the answer is, good lord no.

Which is why nobody gets to designate who’ll be an organ donor except the donor. Full stop. (With recipients, there has to be some designating — so we have transplant lists and review boards and a whole bunch of safeguards, trying to keep things as objective as possible.)

The general principle of “seriously, on a practical level, can you trust real people to handle this?” has other applications, too.

Take the death penalty. Are there people that I think the world would be objectively better without — so much that it would be ethical to kill them? Honestly, yes. Do I think human society can be trusted to accurately identify those people? Good lord no.

(The Innocence Project has exonerated at least 20 people who were on death row, dozens more have been found innocent for other reasons, sometimes it’s only come to light after the person was killed — and, listen, I don’t have to tell you that in the US the death penalty is disproportionately applied to people who are black, poor, and/or mentally disabled, right? Right.)

…if I was the first person to articulate all this, I’d call it the Boy George principle, in honor of his immortal lyric “people are stupid.”

But it’s gotta have a proper term in Moral Philosophy Academia already, right? Comment and tell me if you know one.

Anyway, [the Boy George principle] is why the Doctor Problem has a different answer than the Trolley Problem.

Vent over. As they say on TGPTP: go do something good.

(December talking meme.)