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@fozz appeals to sustainability in iterative games (an argument that's vulnerable to simple rug pulls)

One of the most common objections to consequentialism is based on a hypothetical situation in which a surgeon has to do a delicate brain operation on a patient who happens to be the ideal organ donor for four other patients in the hospital, each of whom will die shortly unless they receive, respectively, a heart, a liver, and – for two of them – a kidney. The doctor is highly skilled, and is confident of her ability to carry out the brain surgery successfully. If she does, her patient will lead a more or less normal life.

We agree that the consequentialist must accept that, in these circumstances, the right thing for the surgeon to do would be to kill the one to save the four, but we do not agree that this means that consequentialism should be rejected. We think, on the contrary, that the appearance of unacceptability here comes from the fact that this is one of those rare cases in which the action is right only if perfect secrecy can be expected. Moreover, it is not an action that should be recommended to others.

It's more than sustainability, as I said, though I think sustainability is at the heart of the issue and will be fine for this discussion.

I'm advocating for a sort of hybrid of utilitarianism & deontology. Ultimately, the ends are what matter. But it turns out the best way of ensuring sustainably good ends involves honoring certain non-strictly-utilitarian principles in certain circumstances.

In your thought experiment, I'd say a correct moral decision would be for the patient to choose to die in order to save the four people who would benefit from his organs. The logic is related non-directed organ donations, where the donor lives.

Deontologically, we'd need to normalize rational, voluntary personal sacrifice such that surgeons would never need to accidently kill patients on purpose to maximize life-saving organ availability. People ought to recognize suffering (regardless of proximity) & feel a very natural obligation to help—as in the child drowning in a shallow pond.

Yes, I am saying people should be willing to sacrifice their own lives to save the lives of others. If by your death you can save 10 other people, while I'm sure we can imagine lots of creative exceptions (e.g. they were 10 Hitlers), but it's generally, and obviously, the right thing to do.

EA recognizes this foundational principle of self-sacrifice.

Giving away all your wealth above subsistence is whack-a-doodle & flies in the face of all of economics. But people are doing it. They're also donating organs to strangers. This will grow to greater and greater levels of sacrifice. Because the logic is airtight. It feels super hard, but there is no escaping the logic.

The characteristic that makes this non-political is that the government (roughly in the same position as the surgeon) has no say in any of this. Your choice to sacrifice self for the sake of others is free and personal.