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Looks at a two more approaches to justifying the Principle of Irrelevant Utility advanced in Ch. 8 with respect to the question of saving different groups of lives. Once again, it involves combining objective and subjective views. Here the combinations are designated ‘Sobjectivism²’ and ‘Sobjectivism³’. Sobjectivism² differs from Sobjectivism¹ (which was presented in Ch. 8), in that it pits the various subjective points of view against each other differently, taking into account each person's moral responsibility, rather than only his interests or desires. Sobjectivism³ provides an alternative principled distinction between losses of lives in order to distinguish relevant from irrelevant utilities: that certain utilities would be irrelevant in a life‐saving choice situation if they would receive no proportional weight on their own, no matter how many individuals were involved.

In the situation that we have to choose between the numbers of lives saved (is it right to save the greater number?), Ch. 6 argues against the existence of the conflict between considerations of the right (e.g. justice, fairness) and considerations of the good (e.g. maximizing lives saved). This is the aggregation argument put forward in Ch. 5. The argument is presented in two ways: the modest way is to show that considerations of the right do not demand equal chances; the strong way is to show that considerations of the right require us to count numbers of lives in order to save the greater number and to engage in substitution of lives that are equivalents from a certain perspective. In discussing the modest approach, consideration is given to what makes a policy unfair and the significance of the distinction between direct and indirect need for aid.

Considers arguments for the following radical claim: the fact that we could save a greater number of lives is not a reason to save some people rather than others when we cannot save everyone. Against this view, an argument is presented that claims to prove that it is worse if more die than if fewer do, but then a counterargument is given that considerations of justice and fairness might stand in the way of preventing this worse state of affairs, requiring us to give to a group with the greater number of people and to a group with the smaller number equal chances to be saved. This means there would be a conflict between considerations of the right (e.g. justice, fairness), and considerations of the good (e.g. maximizing lives saved). The arguments offered are based around the claims of John Taurek on conflict situations in which some can be helped and some cannot: his brand of consequentialism, which involves an evaluation of outcomes relative to an individual's interests combined with an agent‐neutral theory of permission to act. The aspects addressed all centre around the aggregation argument — aggregation vs non‐aggregation.

Much of the work of aid agencies aims to prevent threats to life, rather than to save lives. And even when an aid agency’s activity does save life, it might be doubted whether my contribution to an agency’s pool of funds will itself benefit anyone significantly. However, whether or not that is true, an argument from the life-saving analogy will still support a collective requirement of beneficence on us as a group; and fairness will require me to contribute to discharging that requirement. The collective activity to which I should contribute includes both preventing threats and saving lives.

Examines cases in which the choice faced is not between different numbers of lives but between equal numbers of lives when saving one group but not the other would be accompanied by some additional lesser good; the aim is to investigate whether and under what conditions substitution of equivalents and aggregation are incorrect and, accordingly, under what conditions additional utilities (goods) should be irrelevant to the choice made. Distinctions are made between direct and indirect need for aid and between extra utilities that would come to persons whose lives are at stake and those whose lives are not at stake; distinctions are also made between different types of irrelevance — one type based on different spheres of interest and considerations of fairness, and the other on relative insignificance of effect. Five principles for the second type of irrelevance, describing which extra utilities should be relevant and why (the Principle of Irrelevant Utility), are examined in this chapter and the following two (Chs 9 and 10); cases are dealt with in which not only each person has a right to have his life preserved, but also in which we merely take an interest in each person's special interest in his own survival; these three chapters also re‐examine the justification for counting numbers of lives. In connection with defending the Principle of Irrelevant Utility, the concept of ‘Sobjectivity’ is introduced, and a detailed description given of how subjective and objective, personal and impersonal, and partial and impartial perspectives interrelate when decisions are being made as to which extra utilities to count and which not to count. Ch. 8 looks at one possible justification for the Principle of Irrelevant Utility: that concerned with the particular combination of the objective and subjective that is to do with how we view the interests of those involved, here designated Sobjectivity¹; it makes the point that we should not always make the move to substituting equivalents, since that move is not necessarily appropriate in those cases where, in helping one side, we can do all the good that we would do if we helped the other, as well as additional good.

Continues the exploration of ‘Sobjectivity’ addressed in Ch. 8 and 9 as applied to justifying the Principle of Irrelevant Utility with respect to the question of saving different groups of lives, and advances two more combinations of objective and subjective views, here designated ‘Sobjectivism⁴’ and ‘Sobjectivism⁵’. Sobjectivism⁴ is a move in the direction of aggregating significantly lesser losses of life, and distinguishes costs from equivalents; Sobjectivism³ (presented in Ch. 8) in combination with Sobjectivism⁴ is viewed as most accurately representing commonsense morality (rather than Sobjectivity¹ (Ch. 8) or Sobjectivism² (Ch. 9)). In the fifth type of Sobjectivity, Sobjectivism⁵, everything of concern to individuals is always allowed to be aggregated on the scale of equivalents, no matter how small — the approach is just straightforwardly utilitarian in aggregating everything. Overall, the chapter contrasts the permissibility of aggregating certain extra utilities as costs that inhibit the saving of lives with the impermissibility of aggregating these extra utilities as equivalents to and so substitutable for lives. The results obtained on irrelevant utilities are applied to the paradox of group beneficence, and the distinction between extra utility that is distributed over many people whose lives are not at stake and extra utility that is concentrated on the person whose life is at stake is considered further; in conclusion, a brief comparison is made between Sobjectivity and contractualist moral reasoning.

Deals with the problem of the acquisition and distribution of organs for transplantation and allows the application of the foregoing theoretical discussion of saving lives and relevant/irrelevant utilities. As an aid to dealing with categories that are of current concern to the medical community, Ch. 11 starts with a summary of the recommendations of the US Task Force on Organ Transplantation on acquisition and distribution of organs, and discusses and criticizes the total‐brain‐death criterion for death. The next section of the chapter discusses the role of informed consent of the original organ owner and his family in relation to the State in the task of acquiring organs, as well as the moral possibility of sale, trading, and taking of organs. The last section of the chapter considers the morality of more controversial proposals for acquiring organs: ‘donation’ from foetuses, donation from live donors where there is significant risk to the donor, and (the most radical) killing some persons for the sake of acquiring organs for others.

Examines two alternatives to the ‘majority rule’ situation described in the Ch. 7, i.e. that numbers count in any consideration of saving lives. It looks at two procedures that, other than straightforwardly saving the greater number of lives, still consider the number of people that can be saved. The first is what the author calls the ‘Ideal Procedure’ for non‐Taurek situations, in which some compromise between conflicting groups is possible; this can only be used when there is some chance of saving everyone. The other procedure is an alternative way to give numbers weight: distribution by proportional chances. Finally, the difference that present vs future need may make is considered.

Many writers have followed Peter Singer in drawing an analogy between assisting needy people at a distance and saving someone’s life directly. Arguments based on this analogy can take either a subsumptive or a non-subsumptive form. Such arguments face a serious methodological challenge.

The chapter examines the saving and investment decisions of nineteenth-century British shopkeepers using data on 332 census-linked probated decedents dying between 1859 and 1891. Previous research indicates that the nineteenth-century US agricultural sector experienced a transition from bequest saving to life-cycle saving. The chapter tests the potential impact of bequest, life-cycle, and deferred compensation motives on wealth-holding to determine whether late nineteenth-century British shopkeepers reached the transition stage between bequest and/or deferred compensation to life-cycle saving, as shown by Roger Ransom and Richard Sutch for the case of the US agricultural sector. The results reveal evidence of an altruistic bequest motive.

This chapter examines utilitarian and egalitarian approaches to the distribution of scarce life-saving medical resources, or distribution of life. It shows how utilitarianism is able to endorse substantial aid to the disabled based on the assumption that disability significantly reduces welfare, which suggests the possibly counterintuitive conclusion that disabled lives are less worth saving, on utilitarian grounds, than are non-disabled lives. In addition, the chapter discusses the views of Peter Singer and other utilitarian bioethicists regarding disabled and non-disabled lives. In their book The Allocation of Health Care Resources, Singer and fellow utilitarian bioethicists John McKie, Jeff Richardson, and Helga Kuhse agrees with the notion that utilitarianism requires health-care allocators to discriminate against disabled people in the distribution of life. For Singer et al., such discrimination, known as “double jeopardy,” is a proper result of the health-care allocation theory that seeks to maximize quality-adjusted life years.

The failure to save someone’s life directly is wrong because it is a failure of beneficence. The features that make it a failure of beneficence are also features of not helping people at a distance: they are present when the help we can give is indirect as well as when it is immediate. So not helping people at a distance is wrong too (although it is not necessarily as wrong). The methodological challenge of Ch.1 can be answered.

The final chapter explains the relationship between the two parts of the book: it explains how Part II has refuted the iterative argument for the Extreme Demand in Part I. It also explains the qualified nature of the conclusion that has been reached: it is a conclusion about the requirements of beneficence, not justice; and it is not the conclusion that morality can never demand extreme personal sacrifices. The implications for direct life-saving action are discussed, and the main strengths of the book’s argument are surveyed.