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A Discussion on Survival Lottery, John Harris’s Proposal

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The Survival Lottery is a proposal by John Harris outlining an idealisation of organ transplantation. It supposes that organ transplant procedures have been perfected, allowing a ‘lottery’ system to exist whereby every person is assigned a number, and, where there are two or more people whose lives could be saved by the organs from one healthy body (Harris gives the example of patients Y and Z), a computer program chooses a number at random. The person this number corresponds to (referred to as A) is then killed, so that their organs can be given to the dying patients. It is worth noting that the lottery would only be used as a final resort, and that Harris states that “it would be unfair to allow people who have brought their own misfortune on themselves to benefit from the lottery” (Harris, 1975a).

Harris supposes that the value of two lives is greater than that of one, and so we should strive to preserve these two (or more) lives rather than protect the life of one healthy person. Here, he makes no distinction between the fact that to end the lives of the sick patients is to let them die and that to end the life of the healthy person is to kill – the lottery is designed in direct contradiction with the claim that there is a moral distinction between killing and letting die, with Harris stating that failing to kill a healthy person to save two sick patients is killing those patients ‘as sure as shooting’. Although it can be argued that “the doctor has a moral obligation to his patients to save their lives, [but] it is of higher moral obligation that he not kill” (Meglio, 2014), but ultimately, to claim that the lottery is in invalid proposal simply because it ignores the moral distinction between killing and letting die is to take the easy way out.

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Harris himself argues that “the currently acknowledged right of the innocent not to be killed, even where their deaths might give life to others, is just a decision to prefer the lives of the fortunate to those of the unfortunate” (Harris, 1975b). This view is supported by Peter Singer, who says “the charge that it is arbitrary or unfair to be called upon to die just because one’s number has been drawn upon in a lottery can be met by pointing out that it is arbitrary and unfair to die just because one has contracted a kidney disease” (Singer, 1977). While Harris’ paper relies on the assumption that there is no difference between killing and letting die, it also relies on another assumption – that all human life is inherently equal to begin with.

This unmistakably utilitarian view can be proved false – even if killing and letting die are the same thing, the value of the lives at question will not always be the same. Surely there would be uproar of the organs of Prof. Brian Cox were extracted against his will, because his lottery number was drawn, and doled out to a group of young teens in Western Africa who are more than likely to be plagued by illness again; this is the kind of arbitrary transaction that the survival lottery will allow.

In contradiction to the above point by Peter Singer, one can assert fairly confidently that average, everyday citizens would not be best pleased it they were selected for their organs to be used to save the lives of people they deemed less valuable than themselves. We do not like to admit it, but this is a form of judgement that we all make, and one of the many reasons why the survival lottery would not work seamlessly in our society.

On a not unrelated note, it can also be argued that the lottery endeavours to end the lives of the healthy to prolong the lives of sick. Since the elderly “experience enhanced susceptibility to viral infections and subsequent superimposed bacterial infections” (Goldstein, 2010) that could lead to a decline in the functioning of vital organs, it is likely that a far higher number of old people will require organ transplants than the young. If people of all ages are killed to save those who are primarily of an older generation, the survival lottery would undoubtedly lead to a society dominated by the old.

As the lottery is intended to be a utilitarian thought-experiment, this elderly-dominated society is objectionable, as the old are more likely to die sooner of natural ills, and so should we not strive to keep the young alive? Harris says that “there is no reason to suppose that a programme could not be designed for the computer that would ensure the maintenance of whatever is considered to be an optimum age distribution throughout the population” (Harris, 1975c), but adding more and more conditions to the computer programme would lead to the survival lottery becoming unrecognisable as a lottery system.

Additionally, by defining the demographic that the computer may choose people from, would we not be doing exactly what Harris is trying to prevent, and causing people to have to lose their lives because of a variable that is not their fault? If Y and Z do not deserve to die because they have fallen ill, and A does not deserve to die simply because they are healthy, then B does not deserve to die simply because their death would help to ‘maintain an optimum age distribution’.

Another assumption that the lottery relies on is that the two or more lives saved would be of a significantly improved quality, so as to show that the death of a healthy person for their continued existence was worthwhile, but this is not always going to be true. In fact, in most cases it will not be true – even if organ transplant procedures themselves were perfected, as Harris supposes, there is still no guarantee that a new organ will be an instant and effective cure for a person’s illness.

Harris himself could argue, as he does in his paper on equal healthcare opportunities, that “each individual is entitled to an equal opportunity to benefit from any public healthcare system, and that this entitlement is proportionate neither to the size of their chance of benefitting, not to the quality of the benefit, nor to the length of the lifetime remaining in which that benefit may be enjoyed” (Harris, 1999). This is to say that it does not matter whether somebody will die soon after their transplant, or if it will not drastically improve their quality of life, but, for example, if somebody is bedridden and completely dependent on somebody else to function, and will continue to be this way after receiving a new heart from the lottery until the day that they die, is it really worth taking a heart from (and causing the death of) somebody who was otherwise perfectly healthy?

With a ‘public healthcare system’ such as the survival lottery, fairness must be taken into account when applying these equal opportunities. In my opinion, choosing not to kill a healthy third-party in order to save the lives of sick patients is not a ‘decision to prefer the lives of the fortunate to those of the unfortunate’, but is rather a decision to respect the negative rights of the fortunate. Healthy, innocent people need not be a part of the equation when striving to save the sick, and if they are not dragged into the situation in the first place then it is not possible to make a decision regarding preference. Labelling the healthy and the sick as the fortunate and the unfortunate brings about a regressive feeling of hostility towards the healthy, when they do not deserve to be brought into the question at all; in a hospital ward, there are sick people and sick people only.

In conclusion, while the entirety of Harris’s argument can be deconstructed simply by giving substance to the claim that there is in fact a large and important difference between the act of killing and the act of letting die, it is more effective to address the smaller problems within the paper and deconstruct it from the inside, rather than trying to give a be-all-and-end-all argument against the lottery – even Harris himself “intuitively (perhaps emotionally) acknowledges that there is something unaesthetic about the random selection and sacrifice of an innocent third party” (Leiman, 1983). Anybody can say ‘yes, but there is a difference between killing and letting die’ and leave their analysis here, but wiser people will assess Harris’s proposal for everything that it is and say ‘even if there is no difference between killing and letting die, the argument still fails in the following areas…’.

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