Utilitarianism can easily deal with downside risk by adding a discounting factor to the moral worth of higher utilities. (E.g. Instead of aggregating utilities

Utilitarianism can easily deal with downside risk by adding a discounting factor to the moral worth of higher utilities. (E.g. Instead of aggregating utilities by summing them all up, sum their logs, and pick the action that leads to the highest log-sum.) The real problem that Rawls's theory (and other alternatives) solves is the issue of aggregation in itself. If you could save one life at the cost of many, many headaches, a utilitarianist must say that, given sufficiently many minor headache sufferers, you must prevent the headaches. This seems implausible — some believe that no matter how many headaches occur, you must save the person's life instead. Also, this is a nitpick, but it is a common misconception that trolley problems are problems on whether you should turn the trolley or not. In most trolley scenarios that philosophers study, the correct answer (to turn or not) is really quite clear, and ethical theories tend to arrive at the same answer. The real trolley problem is a meta-problem: why is it in situation X we think it acceptable to turn the trolley, but in situation Y which is very similar, we think it not acceptable? What is the morally distinguishing factor between X and Y? For example, we think that it is appropriate for a bystander to turn a trolley to kill one, saving five lives. But most philosophers also think it inappropriate for a doctor to kill one healthy patient, harvesting her organs to transplant into five sick people, saving their lives (your example). In both circumstances we kill one to save five, but the second seems unacceptable. What is the morally distinguishing factor? And what are the morally distinguishing factors in more complicated trolley scenarios?