Transcript from Stephen Law's The Philosophy Gym:

One of the Ten Commandments handed down to Moses was 'Thou shall not kill'. But is it always wrong to kill? Most of us believe that there are exceptions to the rule. We believe, for example, that it would be morally acceptable to shoot dead a maniac about to embark on an orgy of killing in a school playground if that was the only way to stop him. Here I discuss another possible exception - that of killing one innocent person in order to save another. Is that ever morally acceptable?

The Case of Jodie and Mary
Not ver long ago, two girls were born connected at the lower abdomen. The parents, from the island of Gozo in the Mediterranean, travelled to Britain so that their daughters could receive specialist medical treatment. British doctours found that one of the two girls - Mary - had only a rudimentary brain. She also depended on her blood supply on the heart and lungs of jodie, her twin sister, who, according to evidence given in court, was a 'bright and alert baby, sparkling and sicking on her dummy'. The prognosis was bad. Leave the girls attached and both would die within months. Separate them and Jodie had a good chance of surviving, if with some physical handicaps. The immediate result of such an operation, however, would be the death of Mary. The doctors wanted to operate. The parents, devout Catholics, objected, insisting that, as it is wrong to kill, and as the operation would clearly result in the killing of Mary, 'God's will' must be that the doctors allow both girls to die. The parents took the case to court. The doctors won the case, and the operation went ahead. Mary died. But Jodie has survived.

A Utilitarian Approach
Should the operation that saved jodie by killing Mary have taken place? Is this the kind of situation in which we ought to kill to save a life? The Manchester doctors involved in caring for Jodie and Mary judged that it is. Interestingly, these doctors have been accused of adopting a well-known philosophical position: that of the utilitarian. Utilitarianism has been developed and refined in various ways. Two early practitioners were Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873), but it continues to have many followers. In its simplest form, utilitarianism is the fiew that the right thing to do when faced with a moral decision is always to maximise happiness.
For example, ought I to steal that small child's sweets? That may give me the pleasure of eating the sweets, but it will deny that same pleasure to the child and cause her considerable unhappiness to boot. Therefore, according to the utilitarian, I ought not to steal the sweets.
In the case of Jodie and Mary, performance of the utilitarian calculation might seem a fiarly straightforward matter. We are presented with two courses of action. We can operate and save Jodie by killing Mary, or we can refuse to operate, with the inevitable result that both children will die. From a utilitarian perspective, it might seem clear that we should operate, for that will at least produce one happy individual rather than none.
How plausible is such a utilitarian justification for kiing Mary to save Jodie?

The Transplant Case
Notoriously, utilitarianism faces a very powerful sort of counterexample. Here's one example.
You are the doctor in charge of two seriously ill patients. One has terminal cancer, and will die shortly. The other has a heart condition that will soon become fatal if a replacement heart is not found quickly. You discover that the heart of the cancer patient would actually make a perfect donor organ for the heart patient. So you can save one of these two lives by killing one patient by giving his heart to the other. Or you can do nothing, with the result that both lives will soon come to an end. What should you do?
From a utilitarian perspective, the morally proper course of action seemse clear. If you operate, one happy individual will return to his family, where he can live out a long and contented life. Fail to operate, and both lives are lost, resulting in not one but two sets of grieving relatives. The right thing to do, therefore, must be to kill the cancer patient to save the hear patient.
Of course, most of us are aghast at the suggestion that the right thing to do in this situation would be to kill one patient in order to save the other. We feel stringly that the cancer patient would be the civtim of a grave injustice were he to be killed so that his heart might be taken. To take this life, even if the result would be another life saved, would surely be morally very wrong indeed.
It seems to follow, then, that the utilitarian view that what is morally right is equivalent to whatever produces the most happiness cannot be correct. And if we reject utilitarianism, then we can't use it to justify the killing of Mary to save Jodie.

Conclusions One Might Draw
To sum up: the transplant case provides a powerful counterexample to thos forms of utilitarianism that might be used to justify the killing of Mary to save Jodie. But there are at least two further conclusions some might wish to draw.
First, some may conclude that what the transplant case shows is that we ought to abide by God's commandment 'Thou shall not kill' even in those situations where by killing we can save a life. This appears to be the position of the priest at the village from where Jodie and Mary came. In fact, the priest appealed to such a similar transplant case to back up his position.
"It is the same principle as organ donation. Transplants are valid and moral when the donor is dead, but Mary is not dead. She is alive, she is a human being. It is wrong to kill her, no matter how good the intention." - Guardian, 22 September 2000
In the priest's view, killing is wrong, period. It remains wrong even in a situation where the outcome is an innocent life saved. Keith Male, spokesperson for the prolife charity Life, takes a similar view. About the decision to allow the operation on Jodie and Mary to take place, he said:
"This decision is deplorable. It transgresses a fundamental principle of our law that it is never permissible to kill, or commit a deliberate lethal assault on an innocent person, whatever good may come of the action." - Daily Express, 23 September 2000
Secondly, one may argue that what the transplant case reminds us of - or ought to remind us of - is that human beings have moral rights, the most fundamental of which is the right to life. In the transplant case the utilitarian calculation requires that the cancer patient's right to life should be infringed. But that would clearly be wrong. It was similarly wrong to kill Mary to save Jodie, for by so doing we infringed Mary's right to life. As Dr Richard Nicholson, editor of the Royal Society of Medicine's Bulletin of Medical Ethics, argues:
"The issue of what rights accrue to each part of Siamese twins has never been addressed in law. Given the existence of two recognisably human beings, one cnnot argue coherently that they do not both have rights. If both have rights, the two most fundamental rights - to life and to justice - must be respected. So both Jodie and Mary have a right to life and a right to justice, or in other words to be treated equitably. Surgical separation would deny Mary both rights." - Richard Nicholson, Independent on Sunday, 10 September 2000
At this point you might be forgiven for supposing that an overwhelming case has been made for the immorality of killing Mary to save Jodie. But I don't believe that is the right conclusion to draw. Like both the priest and Dr Nicholson, I reject utilitarianism - certainly those varieties that require that we murder the cancer patient in order to save the heart patient. I am also sympathetic to the view that human beings have moral rights, rights that - generally speaking - ought not to be infringed. However, I am not convinced that the right thing to do in Jodie's And Mary's case was to allow both children to die.

The Astronaut Case
Think about the following case.
You haven been sent into space on a rescue mission. Two astronauts are trapped in different secionts of a spaceship, their air running out. You reach the shop with minutes to spare, but the oxygen supplies to to the two parts of the ship are connected in such a way that it is possible to rescue only one of the astronauts by shutting off the air supply to - and thereby killing - the other. Do you allow both astronauts to die? Or do you save one of the two astronauts?
Surely the right thing to do is to save one of the two astronauts, even though you can do so only by killing the other. Here is a case in which it seems very clear to most of us that the right course of action is to kill an innocent person so that a life might be saved.

The Submarine Case
We saw above that Dr Nicholson argues that we ought not to save Jodie by killing Mary because this would involve denying Mary her right to life. While I'm happy to acknowledge that human beings have moral rights, including the right to life, there are clearly circumstances in which such rights should be infringed. Rights ought, generally, to be respected. But not at any cost.
Consider, for example, the following situation.
You're the President of the United States of America. You know that a US submarine crew is, due to an equipment malfunction, unwittingly about to launch a nuclear strike that will result in the deaths of millions of innocent people. The only way of averting disaster is to send a missile to annihilate the submarine and its crew. What should you do?
Surely the right thing to do in this situation is to destroy the submarine, despite, the fact that this would involved denying those on board their right to life.
That the right to life can in some circumstances justifiably be overridden also seems clear in the astronaut case. Would Dr Nicholson insist that, because we should respect these astronauts' right to life, we should stand back and watch both of them suffocate?

Exceptions to 'Though Shall Not Kill'
The village priest argued that it is always wrong to kill, no matter what good may come of it. He also used a transplant case to back up his position.
But what would the priest say about the astronaut and the submarine cases? Would he insist that we ought to allow millions to die rather than destroy the submarine? Would he say that the two astronauts should be left to suffocate? For these are the only courses of action left open to one who insists on following God's commandment 'Thou shall not kill' without exception.
Yet to take this extreme view is perverse, isn't it? Is it really 'God's will' that we should stand back and let both astronauts die?
Of course, if it's allowed that the astronaut case is one in which it's morally acceptable to kill to save a life, then its no longer clear why Jodie's and Mary's case should be considered any different. Indeed, to my moral eye, the case of the conjoined twins looks essentially similar to that of the astronauts.
Those who believe that we should follow God's commandment without exception may bite the bullet and insist that it is wrong to kill even in a situation in which the result would be millins of lives saved. They might try to make their position appear more palatable by maintaining that death is not the end. The same biew has been expressed by some commentators on the twins' case. They have suggested that it only seems heartless to follow God's commandment and allow both girls to die while we forget that both children can look forward to eternal life with God.
This defence of the judgment that both girls ought to be left to die may appeal to some. But in order for it to be a rational defense, we need to provide good grounds for supposing that such an afterlike really does await us. It won't do simply to assert that it awaits. It is, to say the least, unclear whether any such grounds exist.

Why the Manchester Doctors Need Not Be Utlitarians
We have seen that it is sometimes wrong to kill the innocent to save life. But we have also seen that the astrounaut and submarine cases appear to show that it's sometimes wrong not to kill the innocent to save life. To accept that there are situations in which ti's right to kill the innocent to save life does not require that one embrace utilitarianism. Dr Nicholson suggests otherwise. He supposes that the Manchester doctors who thought it right to operate must be utilitarians.
"What has so far held sway among the professionals...is a crude utilitarian approach. Any life is better than no life, goes the arugment, so separation must be the right answer." - Ibid
But as should now be clear, the doctors who believed it was right to save Jodie by killing Mary need not be utilitarians. Indeed, they may reject utilitarianism precisely because they recognise that, as the priest points out, it is obviously and intuitively wrong to murder a cancer patient to save a heart patient.

Respecting Both Sets of Moral Intuitions
The priest introduces a live transplant case in order to appeal to a certain moral intuition. We feel, intuitively, that it would be wrong to murder, say, a cancer patient in order to save a heart patient.
Our intuition about this sort of case is then used to justify the conclusion that it's always wrong to take an innocent life, no matter how good the intention. It then follows that it was wrong to take Mary's life to save Jodie's.
But the intuition to which the priest appeals - that it's wrong to kill in the transplant case - does not entail that it's always wrong to take an innocent life. And, in fact, there are equally strong intuitions that the priest overlooks. There is the intuition that it is right to take an innocent life in both the submarine and astronaut cases.
Once one starts appealing to such moral intuitions, one cannot arbitrarily pick and choose among them. If we are expected to respect the intuition regarding the transplant case, then surely we ought also to respect the intuition concerning the submarine and astronaut case. But then the priest's justification for not killing Mary to save Jodie collapses.
In fact, as I say, the Jodie and Mary case seems, intuitively, to be morally much more like the astronaut case than it does the transplant case (or, at least, that's how it strikes me). So this sort of appeal to intuition seems in the end actually to support the killing of Mary to save Jodie.

A Difficult Challenge
The challenge facing those who, like me, wish to respect both sets of moral intuitions lies in explaing why it is acceptable to kill one astronaut to save the other, but not acceptable to kill the cancer patient to save the heart patient. We recognise intuitively that it is sometimes right to take an innocent life in order that life might be saved, and sometimes not. What's not so easy is to justify drawing the line where we do. What's the essential difference between the astrunaut and the transplant cases? I'm not sure I can answer that question adequately. You may have ideas of your own.

-- Agree or disagree with the author's thesis? Comments, opinions?