Is saving people always moral? A Kantian review on an ethical dilemma.
In the second academic year of my bachelor’s degree in digital management, we had to take a mandatory course called: Ethics of AI. As understood by its name, students were given different ethical dilemmas and debates would take place between students. To finish this course, we, as a group, were given an ethical dilemma in a hospital scenario. Patients of this hospital were majorities and minorities. We had to choose between 2 AI medical models, one saving more lives and one saving less lives. However, there was a catch: the first model saved more lives but at the expense of the minority.
Each of these models represents a philosophical point of view. The first model represents utilitarianism which is a form of consequentialism. And the second model represents Deontology.
As the hospital managers, we chose the 2nd model. The model which provides all patients with the same medical standard without any discrimination. I believe while encountering ethical dilemmas, you cannot use mathematics or graphs to prove which choice is better. Rather, it’s better to use philosophy to position ourselves, since in the end it’s about right and wrong, not about profit and loss.
We had 2 main reasons for choosing this model.
WHY MODEL 2?
First, the 2nd model respects and supports human rights. The rights which were declared in Paris 1948 by united nations and then was agreed upon and signed by 192 countries. In article 25th of this declaration it clarifies that everyone has the right to standard healthcare. And in the 2nd article they state that everyone means all human beings without any discrimination. With the second model, everyone is entitled to standard medical care without distinction of any kind. Doesn’t matter if you are a minority or majority, you will be treated the same.
The second reason why we chose this deontological model is that the doctor-patient interaction or relationship is by nature deontological since medical teaching educate this tradition. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.” The second model ensures that no doctor has to break their oath. And as a result, this model will maintain and improve the doctor-patient bond.
WHY NOT MODEL 1?
Alongside these two reasons there were other factors that made us choose this option. Those factors are mostly directed into the disadvantages of the first model.
1. “Act only according to that Maxim by which you can at the same time will that it should become a universal law” -Immanuel Kant
A maxim is a rule that connects an action to the reasons for the action. For example, steal from the rich in order to give to the poor. In the first model the maxim is, decrease survival chance of one in order to increase another’s. We can’t wish that this should become a universal law since every human being has the equal right to live. So, choosing model 1 is a violation of human rights as long as a better option exists.
2. “Act so that you treat humanity, whether in your own person or in that of another, always as an end, and never as a mere means.” -Immanuel Kant
Mere means are things we use for our benefit with no thought to the interest or benefit of the thing you’re using. As humans we are not objects that exist to be used by others. We should treat someone as an end-in-himself/herself to recognize the humanity of the person we’re encountering, to realize that he/she has goals, values, and interests of their own, and we must, morally, keep that in mind in our encounter with them. In the first model, minority is being used as mere means in order to give more chance to majority.
To give you a historical example, about 80 years ago, Mr. Adolf Hitler treated humans as mere means in order to accomplish his goals. He sacrificed more than 200,000 disabled people to maximize the benefit for his majority.
3. A critique of Utilitarianism:
Mr. Bernard Williams, an English philosopher, argues that no moral theory should demand the taking of an innocent life, even if it means saving more lives.
In Mr. Williams Book: “Utilitarianism: For and against”, he does a thought experiment. If we apply his thought process in our scenario, it’s not our fault that the AI model cannot save everyone, and we shouldn’t reduce one’s medical standard to try and rectify the situation.
Conclusion
We do agree that saving more people is a moral act, but unless it doesn’t demand taking an innocent life. Everyone has the right to live, and it is their right to have access to equal medical services. Without human rights, there can be no sustained peace, no stability, no protection from harm. No equality, no democracy, no space to speak up.
We understand that many of you would sacrifice yourself to save more lives, but it sounds fair to you because you had a role in making that decision. We as hospital managers should keep in mind that we are making decisions for other people. It is our primary duty to provide them with justice, fairness and equality. We ensure each and every human being that without any discrimination will be treated the same. Can you imagine a world with no human rights?
