> By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expense

> By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care. To a degree yes, absolutely. If moral actions “improve the valence of conscious experience” in some utilitarian sense, most people take a lot of immoral actions every day. When you think of morality as more of a direction rather than an absolute “you either are or are not a sinner,” you can view the average person, and yourself, as deeply immoral, yet still get value from the understanding because you know the correct direction to move in if you want to improve yourself or society. With this definition, it’s easy to compare the morality of two people. To what degree did each exercise agency in order to either neglect a responsibility to do good, or to actively do harm? The person who deliberately did more harm could be said to be worse in their moral character. Now imagine a person chooses to become the head of a health insurance company in order to make large amounts of money, while aware of the fact that their industry produces profit by minimizing the coverage they pay out and that this will inevitably deny some people who ought to get coverage coverage; and, furthermore, that this wrongly denied proportion is much higher than it needs to be in order for their company to exist and pay its costs. Now imagine that, in response, this person actively uses their agency to worsen their company’s contribution to this situation for the gain of themselves and other relatively wealthy higher-ups at their company instead of taking any action within their means to better the situation. We can reason that this person is, when you sum up the raw quantity of harm they’ve deliberately caused, morally worse than the average person, who will likely have done vastly less deliberate harm over their life. Is an extrajudicial murder the solution? Probably not, in that it won’t directly produce the needed changes to move society in a marginally more moral direction. That being said, I sure won’t be shedding any tears, and I’ll shed much less than I would for an absolutely morally mediocre Joe Schmoe.