Act- and rule-utilitarianism
In this paper, you will exercise utilitarian thinking. You should, in your own words, (a) state
what utilitarianism is, (b) state the distinction between act- and rule-utilitarianism. You
should then carry out (c) an act- and (d) a rule-utilitarian analysis of the following case.
There are two people in your hospital awaiting a kidney. There is one kidney available that
will be a match for both of them. They both have rare blood and tissue types that make it
unlikely that another kidney can be found any time soon that might be a match for either so
this might be the last chance for both.
One individual, John, is a 19 year old male college student, a slightly below average student
majoring in business (when he goes to class). He went to a party, something he does often,
and got thoroughly drunk, also something he does often. He got into his car and went for a
drive. Since he was much too drunk to be driving he lost control of the car and struck a
telephone pole. The impact of the crash has caused both of John’s kidneys to rupture. The
kidney transplant will probably enable him to live a normal life if he is careful and stops
drinking. His family is very wealthy and can easily afford to pay all hospital costs. Dialysis
can keep him alive for a few years at most and the procedure will cause steady deterioration.
The second individual, Paul, is a seventy year old retired janitor. He was also the pastor of a
small rural church for nearly forty years, during which time he was held in the highest
esteem, raising money for the poor, presiding over hundreds of weddings and funerals. You
can scarcely tell he is retired since he has remained almost fully engaged in the activities of
the church. However, he has a number of other medical conditions (most notably
arteriosclerosis) that make it unlikely he will live longer than another five years at most. Each
year will probably make him less robust and less able to keep up his remarkable pace. In
addition, he has no medical insurance, and couldn’t begin to reimburse the hospital for the
costs of his treatment. Dialysis may keep him alive for a year or so, but at his age and in his
condition, it will take its toll.
Who gets the kidney?
Hint: In the case of the rule-utilitarian treatment of the case, you would need to think about
the rules that the hospital might adopt. Here are some candidates (you might think of more):
(a) Give transplant organs on a “first come, first served” basis
(b) Give transplant organs on those who offer more money.
(c) Give transplant organs on the basis of desert (Who was a better person?)
(d) Give transplant organs on the age (Who is younger?)
(e) Give transplant organs on a chance basis (Throw dice!)
. . .
You should bear in mind that it is often be difficult to come to a decisive
conclusion about a case (a lot will depend on the choice of how to quantify the costs and
benefits in a single case. I will be primarily looking at the way you think about the cases, not
so much at the conclusion that you reach. It is more important that you single out the sorts
of factors that would influence a utilitarian judgment than that you reach any “correct”
– ABSOLUTELY NO PLAGIARISM!
Act- and rule-utilitarianism