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> The key principle in medicine is to treat anyone who is sick, regardless of who they are. The victims family is saying “Our principle is that people who stab

> The key principle in medicine is to treat anyone who is sick, regardless of who they are. The victims family is saying “Our principle is that people who stab Ed should not get a heart, therefore David should not get a heart.” The doctor is saying “Our principle is that we don’t use the patient’s past violence or convictions to determine whether they should get a heart or not, so the stabbing doesn’t disqualify David.” Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative.

CamperBob2 5y ago
People who commit crimes should not get a heart can be transformed to Only people who have not committed crimes should get replacement hearts. The problem is, who hasn't committed crimes? Which crimes count? Who decides? That question makes the more-topical issue When the ER fills up, should unvaccinated people be treated by administering carbon monoxide in the hospital parking garage? look trivial to resolve, in comparison.
- stult 5y ago
  Seems pretty damn simple to me. If you wouldn’t put someone to death for a crime, you shouldn’t deny them medical care in a manner that will kill them for the same crime. It’s functionally and legally the same as putting them to death. Withholding necessary medical care is the same as withholding food, water, air, or shelter.
  - creato 5y ago
    We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around. In the case that people are already having life saving organs withheld from them, it makes sense to prioritize. I think people have the ethical issue in this case backwards: the reason this guy got this transplant is because it was an experiment. We effectively used an ex-con as a guinea pig. (Personally, I'm fine with that, he was fully aware and consented, it was his only chance.) If this guy had died due to the experimental heart failing, we'd probably be seeing a bunch of op-eds about our moral failure to prevent exploitation of a vulnerable (ex-)prison population.
    - stult 5y ago
      > We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around. Yeah. There is no shortage of pig organs which is kinda the whole point. Rationing limited care is different than denying perfectly available care simply out of retribution. I thought the context made that distinction rather self-evident.
      - BurningFrog 5y ago
        There is definitely a shortage of transplantable pig hearts. This is the first such heart ever.
        krisoft 5y ago
        There is shortage yes in the sense that the heart didn’t come from just any pig. It is a specific, modified breed which made the procedure more likely to succeed. The donor pig was also probably raised in more sanitary conditions than most other pig would be. There is not a huge supply of these transplantable pig hearts at the moment. But if the procedure proves to be viable and the long term consequences make it favourable we can scale up transplantable pig heart production. The reason we are not transplanting pig hearts to thousands of patients right now is not because of any such supposed shortage though, but because the procedure is not proven yet. The experiment in question is set out to provide data to help answer that question.
        BurningFrog 5y ago
        Yeah, I don't think we disagree about anything real.
    - joshuamorton 5y ago
      > We deny people waiting for organ transplants medical treatment regularly. Yes, but not for their moral failings. We deny care for health reasons, as generally speaking the goal is to optimize for additional healthy years of life.
    - 5y ago
- dghlsakjg 5y ago
  In the vaccination example: it is based on triage. Which is based on predicted outcome and resources available. If you have one hospital bed and two COVID patients that are looking like they will die if they don’t get admitted you treat the one with the greater chance of survival. Being vaccinated is predictive of a higher survival rate…
woodruffw 5y ago
> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. The majority of ethicists agree that normative statements can express true statements. But the positive/normative distinction is also not important here: medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine. It's not interested in what any individual does thinks should or shouldn't be the case: you do no harm and you always render treatment in accordance with your means.
- burrows 5y ago
  > The majority of ethicists agree that normative statements can express true statements. What do you think is a good candidate for such a statement? My impression is that arguments must proceed from axioms, positive axioms aren’t helpful because the statement is normative and normative axioms just reproduce the issue. > medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine. What is the meaning of “lexical ethics”? Google didn’t return anything helpful. I believe the essence of the claim you are making is that, “There is a powerful enforcement body that will only permit doctors to practice medicine if they do no harm and render treatment in accordance with their means.” I think this a positive claim about human behavior, a proposition potentially belonging to the set of sociological or historical facts. I suspect the family is talking about the way things ought to be, “Heart transplants should go to good people”. And you are pointing out that the doctors are responding with a positive claim, “That’s not what we do here.”?
  - woodruffw 5y ago
    > What do you think is a good candidate for such a statement? Here's an intuitive one: "you shouldn't kick puppies." Most people think that expresses a true statement (not that "most people" is itself indicative of truth value). In terms of my own ethics: "act only in a way that you can will be universal law." Of course, not everybody agrees with that one, but I think it's an awfully good candidate. We can talk about if and how those proceed from axioms, but I suspect that'll be a long thread :-) > What is the meaning of “lexical ethics”? Sorry: lex is in lex, legis, "law." Medical ethics don't concern themselves with normal moral objects or even moral laws in the deontological sense; they are literally a book of rules that doctors (broadly) are not allowed to disagree with. So yes, I think it's correct to read the doctors' responses as a positive claim: they're pointing out that it's a category error to appeal to their (potentially true!) moral beliefs.
polishdude20 5y ago
The first argument is a slippery slope. What crimes disqualify you from getting a heart? How much repentance do you have to go through the get qualified back? Who judges that?
- fennecfoxen 5y ago
  You’d can’t just have a list of disqualifying crimes. You’d need to balance things out a proper social credit score. With an indirect death penalty attached, yes. Can’t think of how this could go wrong at alllllllllllll
  - MisterMower 5y ago
    The guy should have got the death penalty for attempted and arguably successful murder (the victim later died of a stroke directly attributable to the wounds he received from the stabbing). 10 years for stabbing a guy multiple times to the point of putting him in a wheel chair is a slap on the wrist. Funny how a lot of problems work themselves out when swift justice is delivered. This whole thread doesn’t exist in that alternative, more just world.
    - femiagbabiaka 5y ago
      In the article I see a few pictures of the guy with his large, seemingly happy family. Getting rid of the opportunity for that to happen would be like creating another tragedy from the ashes of the first. I don’t know where you’re from, but in America a lot of folks share your view. But our use of the death penalty hasn’t eradicated crime. So then one has to wonder if the possible benefits are worth the price.
      - Chris2048 5y ago
        > with his large, seemingly happy family If we take that into account, then do loners without friends/children/family not deserve the same consideration?
graderjs 5y ago
The weird thing about saying "Do not save those who took another's life" is that you are saying, "The person took a life. That's bad. We should punish them for the bad thing." Then saying, "Let's take their life to punish them." (not saving a life you could being essentially the same as life taking, to me, here). To me, you are undermining your view that life-taking is bad, by engaging in it yourselves. To me, this is a paradox. You seem to be standing up for your belief in the badness of life-taking, by doing something against those who do it, then you do something which goes against the very thing that you are trying to protect--which, to me, makes it seems like you are merely pretending to protect. So, to me, their moral claim (?) that they are somehow "better" than this life-taker, and therefore have a right to say/do this life-save withholding, is completely undermined by their action of said withholding (or proposal to do it). On the other hand, my ape-brain very much endorses the logic of revenge and sees no problem with an eye for a eye. It will teach people a lesson, let them know they can't mess with us, and let them know there are consequences if they try. Hopefully, my ape brain says, that will make us safer and rest easier, in future. But the logical/rational part of me trying (but maybe failing) to consider this from an ethical or moral point of view, says, "Nah, that doesn't work."
- nautilius 5y ago
  So, thieves cannot be fined for their crimes (take their money after they took someone else's), kidnappers cannot go to jail (take their freedom after they took someone else's) - because it would undermine, what exactly? That makes no sense.
  - graderjs 5y ago
    Well it makes sense to me. Your reading is a little bit uncharitable. Seems almost like you didn't make any effort to understand it, and just rather pretend that it's stupid...Sigh. But I suppose I could have helped you by saying the other part which I think about this: That's why the legal system is so important. We need a way to do these things, that's not about individuals getting revenge. So...you kill Alice, then society takes it up with you, through their legal/punitive officers--rather than Alice's family. But even so...that doesn't fully resolve it for me, the paradox I see there. But at the same time, I get your point of view. I mean, what that means we can't punish anyone? Because we don't want to seem bad, by pushing back against the bad people? Are you saying we just turn the other cheek? That's crazy. Yeah, I get that...But I think it's important...You do some crime, and I say, "I have to get back at you". But no, I'm the one that has to be moral. Individuals have to be moral. The state doesn't have to be moral in the same way. But we can't let that spill over to individuals otherwise everything collapses. I mean, I'm not saying I can resolve this right here--and your strong reaction to what I said, indicates that I have raised a complex, subtle point that's not easy to resolve. People face stuff like that, it's difficult, so they react strongly, or emphatically, like you did. So I think we need the state, the organs of the state, to be able to enact this violence on our part (take their money, their freedom, their life--maybe? I'm not sure about the last one). Then we can afford to be moral and live up to that, and that's good overall. It's not perfect but then what other options do we have?
skissane 5y ago
> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. Can you offer a valid argument for the truth of your own principle, that it is impossible to offer a valid argument for the truth of any normative principle? I think your own position is a normative principle, and hence your position is self-refuting. To call an argument "valid" is to make a normative claim; it is to claim that a rational agent ought to accept it. To call an argument invalid is to claim that a rational agent ought not accept it. Rationality has as much oughtness as morality does, and hence is a normative discipline just as morality is.
- burrows 5y ago
  Thank you for prompting me to reevaluate my position. Initially I claimed, “There are no valid arguments for normative claims.”, I would like to amend my claim. Def: An inferential system is a tuple of axioms and inferential rules. Def: An argument is a non-empty ordered sequence of statements. The last statement is called its conclusion. Claim: If an inferential system produces an argument for a normative claim, the system is either inconsistent or permits inference from positive statements to normative statements or the argument proceeds from normative axioms. Proof. Suppose S is a consistent inferential system and that A is an argument in S from S’s axioms to a normative conclusion. If S has only positive axioms then A makes inference from positive to normative statements. QED Corollary: There are no arguments for normative claims that don’t proceed from normative axioms in consistent systems that don’t permit inference from normative to positive statements.
  - skissane 5y ago
    You are saying that, a valid deductive argument with a normative conclusion must either have a normative premise, or else rely on a logic whose inference rules permit normative statements to be inferred from non-normative ones. I agree with you there. But you haven't explained how this (obviously true) statement is relevant to the original discussion, about the morality of providing life-saving medical treatment to perpetrators of serious crimes.
    - 5y ago
geoduck14 5y ago
>The doctor is saying “Our principle is that we don’t use the patient’s past violence or convictions to determine whether they should get a heart or not, so the stabbing doesn’t disqualify David.” >Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. I'm pretty sure someone mentioned that the Dr's pov is that the doctors don't punish crime. Someone else does that. If they have a crime worthy of death, someone else determines that and administers that punishment. The Dr's stay out of that conversation.
- vidarh 5y ago
  Exactly. If the law was changed to allow judges to impose "denial of transplants" as a punishment, then one might consider that a good or bad thing, but in that case it would be the courts not the doctors who makes the determination, and the legislative who'd be ultimately responsible for the rule existing. As long as there is no such law, it's not for doctors to impose such restrictions.
bawolff 5y ago
I mean one of those principles generalize, the other does not. I would argue making medical decisions based on ad-hoc principles is unjust.
sersi 5y ago
When evaluating principles, the trick is to extrapolate from each principles what society would be like if they were followed. The first one “Our principle is that people who stab Ed should not get a heart, therefore David should not get a heart.” means that there is no rehabilitation for ex-cons, that doctors have the power to condemn people to death based on their past by refusing a life saving procedure and that in the case of new research like this one, doctors cannot have access to the best candidate. Extrapolating the second principle means living in a society where the judicial system decides the punishment and people pay their due afterward, potentially reducing recividism. It means that when doing an experimental procedure that requires very specific candidates, the doctors have to pass on an ideal candidate delaying discovery.

CamperBob2 5y ago

People who commit crimes should not get a heart can be transformed to Only people who have not committed crimes should get replacement hearts. The problem is, who hasn't committed crimes? Which crimes count? Who decides? That question makes the more-topical issue When the ER fills up, should unvaccinated people be treated by administering carbon monoxide in the hospital parking garage? look trivial to resolve, in comparison.

stult 5y ago
Seems pretty damn simple to me. If you wouldn’t put someone to death for a crime, you shouldn’t deny them medical care in a manner that will kill them for the same crime. It’s functionally and legally the same as putting them to death. Withholding necessary medical care is the same as withholding food, water, air, or shelter.
- creato 5y ago
  We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around. In the case that people are already having life saving organs withheld from them, it makes sense to prioritize. I think people have the ethical issue in this case backwards: the reason this guy got this transplant is because it was an experiment. We effectively used an ex-con as a guinea pig. (Personally, I'm fine with that, he was fully aware and consented, it was his only chance.) If this guy had died due to the experimental heart failing, we'd probably be seeing a bunch of op-eds about our moral failure to prevent exploitation of a vulnerable (ex-)prison population.
  - stult 5y ago
    > We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around. Yeah. There is no shortage of pig organs which is kinda the whole point. Rationing limited care is different than denying perfectly available care simply out of retribution. I thought the context made that distinction rather self-evident.
    - BurningFrog 5y ago
      There is definitely a shortage of transplantable pig hearts. This is the first such heart ever.
      - krisoft 5y ago
        There is shortage yes in the sense that the heart didn’t come from just any pig. It is a specific, modified breed which made the procedure more likely to succeed. The donor pig was also probably raised in more sanitary conditions than most other pig would be. There is not a huge supply of these transplantable pig hearts at the moment. But if the procedure proves to be viable and the long term consequences make it favourable we can scale up transplantable pig heart production. The reason we are not transplanting pig hearts to thousands of patients right now is not because of any such supposed shortage though, but because the procedure is not proven yet. The experiment in question is set out to provide data to help answer that question.
        BurningFrog 5y ago
        Yeah, I don't think we disagree about anything real.
  - joshuamorton 5y ago
    > We deny people waiting for organ transplants medical treatment regularly. Yes, but not for their moral failings. We deny care for health reasons, as generally speaking the goal is to optimize for additional healthy years of life.
  - 5y ago
dghlsakjg 5y ago
In the vaccination example: it is based on triage. Which is based on predicted outcome and resources available. If you have one hospital bed and two COVID patients that are looking like they will die if they don’t get admitted you treat the one with the greater chance of survival. Being vaccinated is predictive of a higher survival rate…

woodruffw 5y ago

> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. The majority of ethicists agree that normative statements can express true statements. But the positive/normative distinction is also not important here: medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine. It's not interested in what any individual does thinks should or shouldn't be the case: you do no harm and you always render treatment in accordance with your means.

burrows 5y ago
> The majority of ethicists agree that normative statements can express true statements. What do you think is a good candidate for such a statement? My impression is that arguments must proceed from axioms, positive axioms aren’t helpful because the statement is normative and normative axioms just reproduce the issue. > medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine. What is the meaning of “lexical ethics”? Google didn’t return anything helpful. I believe the essence of the claim you are making is that, “There is a powerful enforcement body that will only permit doctors to practice medicine if they do no harm and render treatment in accordance with their means.” I think this a positive claim about human behavior, a proposition potentially belonging to the set of sociological or historical facts. I suspect the family is talking about the way things ought to be, “Heart transplants should go to good people”. And you are pointing out that the doctors are responding with a positive claim, “That’s not what we do here.”?
- woodruffw 5y ago
  > What do you think is a good candidate for such a statement? Here's an intuitive one: "you shouldn't kick puppies." Most people think that expresses a true statement (not that "most people" is itself indicative of truth value). In terms of my own ethics: "act only in a way that you can will be universal law." Of course, not everybody agrees with that one, but I think it's an awfully good candidate. We can talk about if and how those proceed from axioms, but I suspect that'll be a long thread :-) > What is the meaning of “lexical ethics”? Sorry: lex is in lex, legis, "law." Medical ethics don't concern themselves with normal moral objects or even moral laws in the deontological sense; they are literally a book of rules that doctors (broadly) are not allowed to disagree with. So yes, I think it's correct to read the doctors' responses as a positive claim: they're pointing out that it's a category error to appeal to their (potentially true!) moral beliefs.

polishdude20 5y ago

The first argument is a slippery slope. What crimes disqualify you from getting a heart? How much repentance do you have to go through the get qualified back? Who judges that?

fennecfoxen 5y ago
You’d can’t just have a list of disqualifying crimes. You’d need to balance things out a proper social credit score. With an indirect death penalty attached, yes. Can’t think of how this could go wrong at alllllllllllll
- MisterMower 5y ago
  The guy should have got the death penalty for attempted and arguably successful murder (the victim later died of a stroke directly attributable to the wounds he received from the stabbing). 10 years for stabbing a guy multiple times to the point of putting him in a wheel chair is a slap on the wrist. Funny how a lot of problems work themselves out when swift justice is delivered. This whole thread doesn’t exist in that alternative, more just world.
  - femiagbabiaka 5y ago
    In the article I see a few pictures of the guy with his large, seemingly happy family. Getting rid of the opportunity for that to happen would be like creating another tragedy from the ashes of the first. I don’t know where you’re from, but in America a lot of folks share your view. But our use of the death penalty hasn’t eradicated crime. So then one has to wonder if the possible benefits are worth the price.
    - Chris2048 5y ago
      > with his large, seemingly happy family If we take that into account, then do loners without friends/children/family not deserve the same consideration?

graderjs 5y ago

The weird thing about saying "Do not save those who took another's life" is that you are saying, "The person took a life. That's bad. We should punish them for the bad thing." Then saying, "Let's take their life to punish them." (not saving a life you could being essentially the same as life taking, to me, here). To me, you are undermining your view that life-taking is bad, by engaging in it yourselves. To me, this is a paradox. You seem to be standing up for your belief in the badness of life-taking, by doing something against those who do it, then you do something which goes against the very thing that you are trying to protect--which, to me, makes it seems like you are merely pretending to protect. So, to me, their moral claim (?) that they are somehow "better" than this life-taker, and therefore have a right to say/do this life-save withholding, is completely undermined by their action of said withholding (or proposal to do it). On the other hand, my ape-brain very much endorses the logic of revenge and sees no problem with an eye for a eye. It will teach people a lesson, let them know they can't mess with us, and let them know there are consequences if they try. Hopefully, my ape brain says, that will make us safer and rest easier, in future. But the logical/rational part of me trying (but maybe failing) to consider this from an ethical or moral point of view, says, "Nah, that doesn't work."

nautilius 5y ago
So, thieves cannot be fined for their crimes (take their money after they took someone else's), kidnappers cannot go to jail (take their freedom after they took someone else's) - because it would undermine, what exactly? That makes no sense.
- graderjs 5y ago
  Well it makes sense to me. Your reading is a little bit uncharitable. Seems almost like you didn't make any effort to understand it, and just rather pretend that it's stupid...Sigh. But I suppose I could have helped you by saying the other part which I think about this: That's why the legal system is so important. We need a way to do these things, that's not about individuals getting revenge. So...you kill Alice, then society takes it up with you, through their legal/punitive officers--rather than Alice's family. But even so...that doesn't fully resolve it for me, the paradox I see there. But at the same time, I get your point of view. I mean, what that means we can't punish anyone? Because we don't want to seem bad, by pushing back against the bad people? Are you saying we just turn the other cheek? That's crazy. Yeah, I get that...But I think it's important...You do some crime, and I say, "I have to get back at you". But no, I'm the one that has to be moral. Individuals have to be moral. The state doesn't have to be moral in the same way. But we can't let that spill over to individuals otherwise everything collapses. I mean, I'm not saying I can resolve this right here--and your strong reaction to what I said, indicates that I have raised a complex, subtle point that's not easy to resolve. People face stuff like that, it's difficult, so they react strongly, or emphatically, like you did. So I think we need the state, the organs of the state, to be able to enact this violence on our part (take their money, their freedom, their life--maybe? I'm not sure about the last one). Then we can afford to be moral and live up to that, and that's good overall. It's not perfect but then what other options do we have?

skissane 5y ago

> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. Can you offer a valid argument for the truth of your own principle, that it is impossible to offer a valid argument for the truth of any normative principle? I think your own position is a normative principle, and hence your position is self-refuting. To call an argument "valid" is to make a normative claim; it is to claim that a rational agent ought to accept it. To call an argument invalid is to claim that a rational agent ought not accept it. Rationality has as much oughtness as morality does, and hence is a normative discipline just as morality is.

burrows 5y ago
Thank you for prompting me to reevaluate my position. Initially I claimed, “There are no valid arguments for normative claims.”, I would like to amend my claim. Def: An inferential system is a tuple of axioms and inferential rules. Def: An argument is a non-empty ordered sequence of statements. The last statement is called its conclusion. Claim: If an inferential system produces an argument for a normative claim, the system is either inconsistent or permits inference from positive statements to normative statements or the argument proceeds from normative axioms. Proof. Suppose S is a consistent inferential system and that A is an argument in S from S’s axioms to a normative conclusion. If S has only positive axioms then A makes inference from positive to normative statements. QED Corollary: There are no arguments for normative claims that don’t proceed from normative axioms in consistent systems that don’t permit inference from normative to positive statements.
- skissane 5y ago
  You are saying that, a valid deductive argument with a normative conclusion must either have a normative premise, or else rely on a logic whose inference rules permit normative statements to be inferred from non-normative ones. I agree with you there. But you haven't explained how this (obviously true) statement is relevant to the original discussion, about the morality of providing life-saving medical treatment to perpetrators of serious crimes.
  - 5y ago

geoduck14 5y ago

>The doctor is saying “Our principle is that we don’t use the patient’s past violence or convictions to determine whether they should get a heart or not, so the stabbing doesn’t disqualify David.” >Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative. I'm pretty sure someone mentioned that the Dr's pov is that the doctors don't punish crime. Someone else does that. If they have a crime worthy of death, someone else determines that and administers that punishment. The Dr's stay out of that conversation.

vidarh 5y ago
Exactly. If the law was changed to allow judges to impose "denial of transplants" as a punishment, then one might consider that a good or bad thing, but in that case it would be the courts not the doctors who makes the determination, and the legislative who'd be ultimately responsible for the rule existing. As long as there is no such law, it's not for doctors to impose such restrictions.

bawolff 5y ago

I mean one of those principles generalize, the other does not. I would argue making medical decisions based on ad-hoc principles is unjust.

sersi 5y ago

When evaluating principles, the trick is to extrapolate from each principles what society would be like if they were followed. The first one “Our principle is that people who stab Ed should not get a heart, therefore David should not get a heart.” means that there is no rehabilitation for ex-cons, that doctors have the power to condemn people to death based on their past by refusing a life saving procedure and that in the case of new research like this one, doctors cannot have access to the best candidate. Extrapolating the second principle means living in a society where the judicial system decides the punishment and people pay their due afterward, potentially reducing recividism. It means that when doing an experimental procedure that requires very specific candidates, the doctors have to pass on an ideal candidate delaying discovery.