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> Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be corre

> Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct. To be fair, while that is generally considered the "right thing", it is reasonable to debate it. The question of "at what point does the welfare of the many outweigh the welfare of the few" is a rather complex one. One question that I think highlights this well is... > There's a train headed for a group of 5 people that it will kill. You can flick a switch and make it take another track. However, doing so will make it run over 1 (different) person. Do you flick the switch? Edit: To be clear, I'm not saying I believe that the needs of the many always outweigh the needs of the few. I'm only saying it's not as cut and dry as some people seem to say it is. It's something that should sometimes be discussed based on the situation.

ams6110 11y ago
I don't like the train analogy in this case. You are faced with two choices: Kill five people or kill one. Medicine is never that cut and dried. "First, do no harm" is a sound moral position in the later case.
- Symmetry 11y ago
  If we really followed the prescription to "First, do no harm" then really we would have to stop doing surgery completely. If giving someone a drug which hasn't conclusively been proven to be safe is harm then cutting someone open certainly is. Someone may die from an unproven drug. Someone may also die from complications from surgery or anesthesia. But surgery will certainly leave a hole in their body.
- TeMPOraL 11y ago
  It is when you look at it in aggregate. It's an insight that I think most of the general population misses - that when you start to deal with interests of thousands or millions of people, things start to get much more mathematical. Consider the more zoomed-out equivalent of the train analogy: your hospital has 6 dying patients; one of them requires a serious procedure, the others need less complicated care. You don't have enough resources to help all of them - you can either spend everything on the single complicated procedure and save one patient, or distribute it to save the other 5. Which do you chose? Now scale that up to the country-level.
- richmarr 11y ago
  > Medicine is never that cut and dried. This feels like an incomplete argument to me. > "First, do no harm" is a sound moral position in the later case. But it's a black and white moral position that doctors in the real world can't cling to on anything more than a casual basis. All treatment comes with risks, from mild side-effects all the way to death. Surgery is inherently risky, and people die all the time. Cosmetic surgeons perform surgery all the time without being struck off. Then there's abortion, euthanasia, and refusal to treat people without medical insurance.
- Confusion 11y ago
  "first do no harm" is closing your eyes and acting as if you don't know those 5 people are going to die, because you don't want to face the risk you'll kill 1. And in terms of life-years saved, the expectation is much better than that for medicine.

ams6110 11y ago

I don't like the train analogy in this case. You are faced with two choices: Kill five people or kill one. Medicine is never that cut and dried. "First, do no harm" is a sound moral position in the later case.

Symmetry 11y ago
If we really followed the prescription to "First, do no harm" then really we would have to stop doing surgery completely. If giving someone a drug which hasn't conclusively been proven to be safe is harm then cutting someone open certainly is. Someone may die from an unproven drug. Someone may also die from complications from surgery or anesthesia. But surgery will certainly leave a hole in their body.
TeMPOraL 11y ago
It is when you look at it in aggregate. It's an insight that I think most of the general population misses - that when you start to deal with interests of thousands or millions of people, things start to get much more mathematical. Consider the more zoomed-out equivalent of the train analogy: your hospital has 6 dying patients; one of them requires a serious procedure, the others need less complicated care. You don't have enough resources to help all of them - you can either spend everything on the single complicated procedure and save one patient, or distribute it to save the other 5. Which do you chose? Now scale that up to the country-level.
richmarr 11y ago
> Medicine is never that cut and dried. This feels like an incomplete argument to me. > "First, do no harm" is a sound moral position in the later case. But it's a black and white moral position that doctors in the real world can't cling to on anything more than a casual basis. All treatment comes with risks, from mild side-effects all the way to death. Surgery is inherently risky, and people die all the time. Cosmetic surgeons perform surgery all the time without being struck off. Then there's abortion, euthanasia, and refusal to treat people without medical insurance.
Confusion 11y ago
"first do no harm" is closing your eyes and acting as if you don't know those 5 people are going to die, because you don't want to face the risk you'll kill 1. And in terms of life-years saved, the expectation is much better than that for medicine.