John Harris on "the survival lottery" (in James E. White text)

The Conventional Doctrine  

The basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference. On this basis, we have a STRICT obligation not to kill.

Harris wants to challenge this assumption.

The Lottery 

Traditionally, utilitarians have faced the challenge that maximizing good consequences seems to imply that, if 2 people are facing death and could be saved by killing one other person, we should go ahead and kill the person. But this is contrary to our moral intuitions (our deepest moral beliefs). So there's something wrong with utilitarianism unless we modify it further.

The typical modification is rule utilitarianism, which asks us to follow the rules, which, if generally followed, would maximize utility. And this would lead us to adopt a rule that says we don't kill innocent people to save other people. This duty not to kill can be understood, even on utilitarian grounds, as a right to life.

Harris is proposing that if the rule is properly formulated, we could endorse killing one person to save two, and we could do so on a regular basis. This new rule would be an exception to the otherwise strict obligation not to kill innocent persons.

The main example: Y and Z are dying. One needs a heart transplant. One needs a lung transplant. If a recently deceased person were a donor, Y and Z can be saved. Why, ask Y and Z, don't we just kill a suitable donor? The medical procedures to save Y and Z are available, and in OTHER medical treatments, a doctor's failure to provide the service would be regarded as equivalent to killing the two patients. So, by not killing an innocent "donor" for the necessary heart and lungs, the doctor chooses to kill Y and Z.

Harris' proposal: 

There are two fundamental objections to killing one to save two.

1.  A doctor's choice of whom to kill will be arbitrary (within a range of suitable donors). It is simply not fair to the innocent person who is killed.
2. It will create "terror and distress to the victims, the witnesses, and society generally."

But we can set up a rule (a social policy) that removes these problems, and then the benefits will outweigh the "costs."

THE SURVIVAL LOTTERY

1. Put everyone at equal risk of being sacrificed (e.g., use a computer to select someone at random from the population of compatible organ donors).
2. Make sure that everyone becomes aware that their own chances of living are increased by this plan. Organ donation will no longer depend on the few people who become organ donors, and the many people who now die (due to scarcity of organs) can live. Those who object to being chosen in the lottery would be classified as murderers.

Inter-planetary travel example 

If we were able to observe this process in practice (on another planet), how could we object to it?

Our current procedure would seem crueler to THEM than theirs does to us.

Six Objections to the Lottery (and responses)

1. It reduces our security. Response: Except that it doesn't, and people need better education in what does and doesn't make them secure.
2. We should not "play God." Response: The same objection would make us stop doing transplants altogether.
3. Killing is worse than letting die, so it's better to let Y and Z die. Response: But other cases of inaction are a type of killing, so why isn't a refusal to use the lottery a sort of killing?
4. It makes too high a demand on us. We don't have to be "saints" and give up our lives when we want to live. For example, we have the right to self-defense. Response: Yes, and by saying that Y and Z have a right to kill in self-defense, we can agree to the lottery, provided anyone they would kill has a equal right to kill Y and Z in similar circumstances.
5. The lottery will create too much terror and distress. Response: Yes, in the short run, but time (and education) will get people used to it.
6. Third parties cannot decide who to save and who to kill, so only those who "are going to die" soon should be put into the lottery. Response: This objection already assumes that people who are very ill have lives that are of less value than everyone else's. Besides, if there IS a lottery, they are not really "going to die," at least not any more than any other living person.

Is Harris Serious? 

Perhaps he is not serious about the lottery. Look at his closing paragraph. His real point appears to be to force us to think about our current distribution of medical resources, which already IS a kind of lottery. We ALREADY sacrifice the lives of many people, and fail to think about the price we already pay in unfairly giving people a better chance at living longer lives.