Trolley problems are often seen as a gateway into ethics classes. To introduce the foundational concepts of ethics, we typically start with the trolley problem.
The scenario usually goes like this: Imagine you have to decide which track a runaway trolley should follow. On one track, five people are tied up, while on the other track, there is just one person. Which track should you choose? Most people have the prima facie intuition that we should choose the track with one person, saving the five. This strongly supports utilitarianism, as it aligns with the moral belief that numbers matter—more people dying or suffering is worse than just one.
This intuition becomes even clearer when we scale up the numbers. Suppose it’s a scenario of one person versus a million. Here, the judgment feels almost obvious: both outcomes are tragic, but the death of millions is far worse than the death of one. If no other options are available, it seems rational to save millions rather than letting them die.
However, critics of utilitarianism often challenge it with thought experiments designed to highlight its counterintuitive implications. These scenarios introduce norms that generally increase utility in the real world but fail to do so in the imagined case. One such example is the organ harvesting case.
The scenario goes like this: Imagine you are a doctor in a hospital, and five patients are on the brink of death, each needing a different organ transplant to survive. A healthy person walks into the hospital for a routine check-up. If you harvest their organs, you could save the five patients, but the healthy person would die.
Most people, when they hear this scenario for the first time, find the idea of harvesting the organs deeply immoral. The thought of killing an innocent person to save others strikes us as fundamentally wrong.
But why do we feel this way?
We know our intuitions aren’t always trustworthy. This is especially true in cases involving extreme numbers, emotionally charged scenarios, or unusual situations that we’re not evolutionarily or culturally prepared to handle. On deeper reflection, many scenarios that initially feel wrong may become more rationally acceptable under consistent ethical reasoning.
The same applies to the organ harvesting case. If utilitarianism is true, there would be actions that, while generally resulting in suffering, could still maximize well-being in specific cases.
Take the action of “killing an innocent person” in the organ harvesting scenario. In real life, this action would generally cause immense suffering: the victim’s future pleasures are taken away, their loved ones are left grieving. These real-world consequences are why we instinctively recoil at the thought of murder. Our moral intuitions are shaped by these everyday experiences.
However, thought experiments like this ask us to step outside of these real-world contexts and assess the scenario in isolation. When we do this, the calculation becomes less straightforward.
Even if we could justify organ harvesting in the abstract, the real-world consequences would likely lead to greater suffering. For instance, people would lose trust in medical science, leading to fewer individuals seeking medical care and worse outcomes overall. Organ failure is often associated with unhealthy behaviors. If organ harvesting became normalized, people might adopt riskier lifestyles, knowing that organs could be harvested to save them. This would increase the need for organs and result in even greater suffering.
For these reasons, while the imaginary thought experiment might lead us to justify organ harvesting, real-life considerations show that it would likely cause more harm than good.
To better understand these scenarios, we can use two methods: scaling up and looking at the whole picture.
First, let’s scale up the number of beneficiaries. Suppose we increase the number of people saved from five to millions, while reducing the harm caused to the one individual. For example, imagine a scenario where a doctor could save millions of lives by taking just a few drops of blood from one person.
Here, the bigger picture makes the decision clear: millions of people living happily with their families, compared to the minimal harm caused by taking a few drops of blood. Most of us would agree the doctor should act.
Now, let’s scale down by slightly increasing the harm to the individual and decreasing the benefit. Suppose the doctor has to extract a tooth from one person to save thousands. Our intuitions become cloudier as the trade-off becomes less extreme.
Still, the logic of the scaled-up scenario holds. If saving millions by taking a few drops of blood is justified, then the same reasoning applies to saving five lives in the organ harvesting case. Even though the benefit is only slightly greater than the sacrifice, the bigger picture suggests that saving five lives is the morally correct choice.
Reductio 
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