DDA and the Survival Lottery

Joseph Adamo

Philosophy and ethical discussions open the mind to critical thinking and reasoning as

well as assist individuals in discovering their own beliefs. “The Doctrine of Doing and

Allowing,” also known as the DDA, is one of the many ethical doctrines that help foster many

belief systems, providing a guideline when challenged by moral decisions. The DDA is a deontic

doctrine, meaning that it respects people’s rights and overall autonomy, even if it leads to a

worse outcome – deontic beliefs do not believe that the ends justify the means. The DDA states

that “it is worse to cause harm than it is to allow the same harm to occur.” Individuals who

accept the DDA are opposed to any activities that violate people’s liberties and free will, even if

a violation of one’s rights will promote the general happiness of more people. To further assess

this point of view from the DDA, we will evaluate the “Survival Lottery,” an article written by

John Harris, to see whether the DDA provides a valid objection to it or not.

The “Survival Lottery,” is a philosophical article written by John Harris. In the Survival

Lottery, there are two patients in need of an organ transplant, represented by Y and Z. A third

perfectly healthy person exists who is represented as A. Patients Y and Z are doomed to die

without an organ transplant as Y needs a new heart while Z needs a new pair of lungs. These two

patients believe and argue that person A should become the “donor,” and should therefore die to

save both the patients’ lives. They argue that there should be no preference given to healthy

individuals over sick ones because “both share equal innocence,” and the choice to not kill

person A is “a decision to prefer the lives of the fortunate to those of the unfortunate” (Harris). In

other words, a doctor’s decision to not kill a healthy individual is ignoring their concerns and

will therefore be responsible for their deaths. To balance the equality and fairness of their
proposition, Y and Z propose a lottery – one where every individual is given a number, and when

several patients need an organ, the lottery will roll a number and an individual will be

involuntarily volunteered as a donor. Patients Y and Z believe that this will create a society

where people will have a longer life, and that it is the fairest approach to saving life (Harris).

Not only would those who support the DDA oppose the Survival Lottery, they would also

consider it unethical. According to the DDA, “it is worse to cause harm than it is to let the same

harm occur;” therefore, it would be more acceptable to let Y and Z die than to kill person A.

Even though two lives could be saved at the cost of one, the survival lottery is not ethical

because it violates person A’s liberty and autonomy as an individual. The means that are used to

kill the chosen individual is not specified, and even though the selected individual would likely

be given a humane, pain-free death, a supporter of the DDA would still not find it acceptable.

The means that are used to kill the chosen individual is irrelevant as doctors would still be

actively harming and euthanizing.

In the case of the two patients, Y and Z, a supporter of the DDA would simply let them

die – this does not mean that Y and Z are being profiled, discriminated against, or disrespected in

any way; rather, it is impossible to satisfy their need for an organ within a humane reach, and

they therefore cannot be saved. This approach contrasts the utilitarian approach the survival

lottery takes as it does not try to save the most people; instead, it stems from the Kantian belief

that upholds person A’s autonomy from the involuntary unfairness of the lottery. Kant even

describes the dangers that an event such as the Survival Lottery could present, saying that “the

danger arises when we stop respecting people for what they do and reduce them in our minds to

mere tools for our comfort and success” (Rosenstand). This further reverberates the fact that a
supporter of the DDA would have to reject the Survival Lottery as person A would be used as a

mere tool to prevent death, where his organs are valued over his individuality.

Although the DDA provides a compelling case that objects to the Survival Lottery, it

does not object the concerns of Y and Z fairly; rather, the underlying problems of the Survival

Lottery go deeper. To object the Survival Lottery by claiming that sacrificing one healthy

individual is wrong, then it ignores the concerns and arguments of Y and Z – the DDA objects it

due to the violation of personal rights, leaving Y and Z unanswered in their concerns of utility

and fairness. If the DDA does not project a strong enough case against the Survival Lottery, then

what is wrong with it? To examine the Survival Lottery properly and find its underlying

problems, it needs to be analyzed from several standpoints, including those from the utilitarian

point of view, from the biased point of view of Y and Z, and from the various unfair results that

such a lottery could create.

Firstly, the Survival Lottery is not a logical system from a utilitarian point of view, nor

does it promote the best outcomes. The Survival Lottery assumes that everyone’s life is of equal

value, but according to utilitarianism, “the most acceptable outcome is one that maximizes utility

and happiness,” and the lottery does not do this (Vaughn). To demonstrate this, an example can

be made where two average high school students need organ transplants, otherwise they will die.

The lottery will select an individual at random as a donor, and in this case, it chooses a

researcher working to advance treatments of a disease. The value of the researcher is very high

according to utilitarianism as he is making great advancements towards treatments while the

value of two high school kids are relatively low as they are not actively benefitting society in

their current state. Although they have potential to do things, that is not a guarantee and potential

is not a measurable factor, and that is the major flaw of utilitarianism. To say that their lives are
more important than the researcher is false in the sense of utility, so even if they are both saved,

what is the overall purpose besides prolonging their lives? The Survival Lottery expresses this

flaw in its methodology, and therefore the maximum happiness and utility could never be

achieved because of its immeasurability. To bypass this flaw, an individual would need to be

reselected to maximize utility, but then the lottery would not be random or fair, and the lottery

would not work as intended, where it only selects individuals based on usefulness.

Another aspect to analyze is the point of view from Y and Z. It is not fair to accept the

Survival Lottery from the viewpoint of Y and Z due to the obvious bias that is presented in their

arguments. They believe that their “individuality and innocence” is not being respected under the

current system, and to ignore them would be to actively cause their death (Harris). Their

arguments, namely this one, are always made from the point of view of self-preservation because

they are in a dire situation – a situation where they do not need to properly evaluate the

consequences of the lottery because they are in a highly beneficial position. If the same

proposition for a Survival Lottery would be made to healthy individuals, a more reasonable,

unbiased point of view could be gathered as they would have to weigh the effectiveness and

weaknesses equally.

Lastly, there could be many selections that the lottery could make that would lead to

unfair, tough ethical decisions. For example, since all individuals are given a lottery number,

then that means that Y and Z are also in the pool of available individuals. If the lottery is drawn

and Y is selected, would it be permissible to kill him to give Z his lungs? In this case, one life is

traded for one life, and there was no net gain in life. To exclude Y or Z from the pool in the first

place makes the lottery preferred to sick individuals over healthy ones, and therefore Y and Z’s

argument that they are as deserving of life and equally innocent as healthy individuals is false.
 To conclude, the DDA expresses its concern to the Survival Lottery through the premise

that lives are inherently valuable and free from involuntary judgement, and should therefore not

be taken away, even if more lives can be saved. The DDA expresses the importance of autonomy

and freedom, and objects actively harming others, despite the greater possible outcome. On the

contrary, the Survival Lottery provides a thought provoking argument that helps individuals

question what they value more – life, reason, and respect, such as what Kant believes, or utility.

These doctrines and articles serve a valuable purpose in critical thinking, and reasoning skills,

and should therefore continue to be argued and debated.

 Bibliography

Harris, John. "The Survival Lottery." 1975

Rosenstand, Nina. The Moral of the Story, An Introduction to Ethics. 1944: McGraw-Hill

Education, Book.

Vaughn, Lewis. Doing Ethics, Moral Reasoning and Contemporary Issues, 4th edition. 2016:

Norton & Company, Inc, Book.