In this thought experiment, you are a doctor, and you work on a roadside hospital. Only you and another doctor are working in the hospital, and a woman who tried to commit suicide arrives at the hospital. She needs surgery, so the other doctor takes her to the operation room. He receives an emergency call, so he needs to leave the hospital and assigns you the surgery on the suicide attempt. While you’re in the middle of the operation, a pregnant woman comes in at a critical stage. You are alone in the hospital, and you need to choose between helping the pregnant woman or continue the surgery. There is a chance the pregnant woman and the baby will not survive even if you do the surgery on them, but the attempted suicide victim will survive. What would you choose?

How would a Utilitarian and a Kantian solve this thought experiment?

  • 4
    Hi, welcome to Philosophy SE. Please visit our Help Center to see what questions we answer and how to ask. Is this a HW question? We usually ask questioners to offer their thoughts on the issue in such cases.
    – Conifold
    Commented Nov 14, 2017 at 21:36
  • One should be clear: The question and the thought experiment are completely arm-chair. In practice, all these considerations won't be important - the surgeon will decide as it seems appropriate to her in the very moment. And she may have been a Utilitarian or a Kantian the evening before when having a beer or two. Commented Jan 14, 2020 at 14:59

4 Answers 4


Kantianism, assuming we're talking about Kantian ethics and use the definition that "the rightness or wrongness of actions does not depend on their consequences but on whether they fulfil our duty." It is surely your duty, above all else, to finish operating on someone once you have started!

Utilitarianism; the greatest happiness to the greatest amount of people. The future being uncertain, I will take the maximin approach from game theory (i.e. take the course of action with the best 'worst case') if you stop operating and switch patients, the worst case is that all 3 people die. If you continue operating, the worst case is that 2 people die.

In both models, you should finish your current operation first.

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    Can you give any text that argues for minmax approach in context of utilitarian ethics, please? Also, your first paragraph does just contain a pseudo-quote. I do not want to be overly critical, given that there are worse answers here, but I think this one has potential with a bit of elaboration and sources.
    – Philip Klöcking
    Commented Nov 15, 2017 at 13:59
  • The minimax approach is a way of assessing the potential outcomes... as we don't have percentage chances of survivability in each case, I suppose it's the best we have... not sure what texts would describe how to apply utilitarianism with uncertain outcomes.. I'll see what I can dig up!
    – JeffUK
    Commented Nov 15, 2017 at 15:01


Switch to the pregnant woman. The suicide-attemptor probably has an unhappy life, so saving it will have low utility. Plus, he might just go kill himself anyway.


a. It is unclear how the universalizability principle applies here (as it usually is). You can make either choice seem wrong, depending on how you choose the "maxim".

b. The end-in-itself formulation of the categorical imperative would probably support continuing to work on the suicide victim. Working on the pregnant woman requires abandoning the current patient for the purpose of saving the pregnant woman. This could be said to be treating the suicide victim as a mere means, or failing to treat the suicide victim as an end in himself. It requires taking the pregnant woman's life to "outweigh" that of the suicide victim. Kantians would reject the idea of some life or set of lives outweighing others.

(b) is still questionable, as one could make a parallel argument that working on the suicide victim fails to treat the pregnant woman as an end in herself. But my assumption would be that to change what you're currently doing requires a justification, and that is where the claim of one life "outweighing" the other would enter in.


This is an interestingly and painfully complex situation.


There seems little scope for a rule utilitarian resolution here. Take rule utilitarianism to be the requirement to act on a rule which, if adhered to by everyone, would (probably) produce the greatest amount of good.

'Good' can be interpreted in a variety of ways (happiness, pleasure, the satisfaction of interests or preferences among them). Interpreting the nature of good is not the problem here; rather the problem is that no rule of sufficient complexity is likely to be available in this situation. The moral life would be impracticable if rules had to accommodate such detailed circumstantiality.

Then the option appears to be act utilitarianism. I take this to be the requirement to do that action which will (probably) produce the greatest amount of good. 'Good' again is open to latitude of interpretation.

It can only be down to the act utilitarian to think her or his way through the situation and to decide what, all things considered, will produce the greatest good. What that decision will be will depend on assessments of probable consequences (that's built into act utilitarianism as defined above) but beyond that it is too situational for an outsider to fix objectively what the doctor - 'you' - should do. The doctor must trust to 'moral luck' that she or he has made the right, or at least a defensible, act utilitarian decision.

My formulations of rule and act utilitarianism are rough and approximate but more sophisticated and qualified formulations would not deflect the points I've made.


I think a similar indeterminateness, for quite different reasons, impacts the Kantian agent. The clearest light is thrown not by the 'Groundwork' but by 'The Metaphysics of Morals' ('MM'). In MM II.1.9 Kant observes that 'The supreme principle of the doctrine of virtue is : act in accordance with a maxim of ends that it can be a universal law for everyone to have. - In accordance with this principle a human being is an end for himself as well as for others' (MM, tr. M. Gregor, Cambridge, 1996, 157). Familiar stuff but he adds that if the moral law 'can prescribe only the maxim of actions, not actions themselves, this is a sign that it leaves a playroom (latitudo) for free choice in following (complying with) the law, that is, that the law cannot specify precisely in what way one is to act' (MM, II.1.7 : Gregor, 153).

I should argue that whatever maxim the doctor adopts in choosing between the options you identify, that maxim could respect 'The supreme principle of the doctrine of virtue ... : act in accordance with a maxim of ends that it can be a universal law for everyone to have' and treat all the human beings involved as ends for themselves as well as for others.


John Rawls in one of his early papers referred to the need, or at least the desirability, of a 'decision procedure' for ethics. Given the need for the ethicist, not to simplify the moral life but to represent its real complexity, I find reassurance in the failure of either utilitarianism or Kantianism to cut a knife through the dilemma you describe and specify a single, determinate solution.

J. Rawls, 'Outline of a Decision Procedure for Ethics', The Philosophical Review, vol. 60, No. 2 (Apr., 1951), pp. 177-197.


Superficially a question of triage comes in. That is what you ostensibly prompt. Yet, even if one says, Kant himself would say that we don't know what would happen to the woman-giving-birth, she may be OK, on her own, along with the healthy infant, and so one should stay with the fatally wounded, ignoring the false sense (subliminally insistent in your account) that "punishment" would sway us away from the duty to save a life, one must forgo all of this. In fact, what matters is the question what does Nature demand? The question then is, is it possible to derive a principle from nature, i.e., with the higher reasoning capacity. Perhaps there is no such thing as a higher reasoning faculty. Utilitarianism relies just as much on reason as does the Kantian system. Except, in Kant there is a specific account of how the noumenal is reached. The cheap versions of Utilitarianism, such as Singer's, ignore the need to derive the whole system from the human qualifiable argumentation and rationality. Pretending that the sciences have a ghostly and independent ability to produce moral principles on their own, without the human, namely the principle of quantifiable pain.

The historical issue, rather than the metes and bounds set by this or that arbiter of the theoretical standing of Utilitarianism, versus, not Kantianism, but Natural Law, is Catholicism versus Deism. True, Utilitarins are not Deists, such as Mill, yet, they assume a ghostly sense of what reason is. They are Deists in effect, when viewed from the contemporary attitude. They don't have (this is one way to vaguely approach a understanding of the transformation) the doctrine of "bounded rationality", for example.


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