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Comment by curun1r | Hacker News Reader

Making no point about whether further control/regulation is appropriate, I'm not sure I like your logic. Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct.

I sympathize with all the sick people who will die, but they were mostly selected for death naturally. The man who died (or will, as soon as life support is removed) was healthy prior to this study. Much like our justice system is supposed to value not punishing the innocent over punishing the guilty, our medical system is supposed to value not hurting the well over helping the sick. The hippocratic oath embodies this "first do no harm" principle.

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> Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct.

This is a fundamental problem in ethics -- and like many such problems, there is no "right" answer. There is no reason it shouldn't be that way, and no reason it should.

There's a train on the tracks, heading for a group of people, and on a fork on the tracks one person.... etc. (trolley problem).

I recommend this amusing parody of the trolley problem: http://www.mindspring.com/~mfpatton/Tissues.htm

False analogy. These were healthy individuals who opted into a drug study.

> Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct.

That idea, with perhaps taking QALYs or something similar into account, seems like a pretty intuitive goal to me from an ethical standpoint. What do you suggest we should be optimizing for instead?

A collection of people is not a column in a spreadsheet or inventory. The most valuable thing in the world is a human life regardless of callous examples of how cheaply they can be had or taken. Just because you can measure two different systems using a blind metric like "most living people at the end" doesn't make it ethical. Ethics apply to individuals as much, if not more so, as groups.

That doesn't help us choose what to do. A collection of people is important, and another collection of people is important, and one of these collections of people is going to die and we have to choose which one. Platitudes about the domain of ethics don't help us to choose.

That isn't the situation at all. One group of people was going to die regardless. Or was going to suffer a life-long disease. The debate is whether or not killing people that weren't going to die is worth it if your body count is lower at the end. We're not debating whether or not flipping the switch on a train track is ethical.

> The most valuable thing in the world is a human life regardless of callous examples of how cheaply they can be had or taken.

Until I hear that from a sentient creature that is not human, I won't accept it as an universal truth.

We are not worth anything except to each other—value is dative, if you will. The importance of human life is no less true just because it’s subjective to humans.

That's comforting.

Well, there are certainly other ethical considerations than "most warm bodes".

You also have to preserve human rights, for example. You could argue that trialing a potentially deadly drug took away a basic one from these people.

If the target of medicine would be to maximize the amount of living humans, it's most effective method would be forced impregnation. If the target was to minimize the amount of deaths, then the optimal way to achieve it would be to sterilize everyone. It is clear that the solution has to be more nuanced than that.

Medicine should not exist to modify the body count of mankind. It's aim has to be realted to improving quality of life.

> Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct.

To be fair, while that is generally considered the "right thing", it is reasonable to debate it. The question of "at what point does the welfare of the many outweigh the welfare of the few" is a rather complex one.

One question that I think highlights this well is...

> There's a train headed for a group of 5 people that it will kill. You can flick a switch and make it take another track. However, doing so will make it run over 1 (different) person. Do you flick the switch?

Edit: To be clear, I'm not saying I believe that the needs of the many always outweigh the needs of the few. I'm only saying it's not as cut and dry as some people seem to say it is. It's something that should sometimes be discussed based on the situation.

I don't like the train analogy in this case. You are faced with two choices: Kill five people or kill one. Medicine is never that cut and dried. "First, do no harm" is a sound moral position in the later case.

It is when you look at it in aggregate. It's an insight that I think most of the general population misses - that when you start to deal with interests of thousands or millions of people, things start to get much more mathematical.

Consider the more zoomed-out equivalent of the train analogy: your hospital has 6 dying patients; one of them requires a serious procedure, the others need less complicated care. You don't have enough resources to help all of them - you can either spend everything on the single complicated procedure and save one patient, or distribute it to save the other 5. Which do you chose?

Now scale that up to the country-level.

> Medicine is never that cut and dried.

This feels like an incomplete argument to me.

> "First, do no harm" is a sound moral position in the later case.

But it's a black and white moral position that doctors in the real world can't cling to on anything more than a casual basis.

All treatment comes with risks, from mild side-effects all the way to death. Surgery is inherently risky, and people die all the time. Cosmetic surgeons perform surgery all the time without being struck off.

Then there's abortion, euthanasia, and refusal to treat people without medical insurance.

If we really followed the prescription to "First, do no harm" then really we would have to stop doing surgery completely. If giving someone a drug which hasn't conclusively been proven to be safe is harm then cutting someone open certainly is. Someone may die from an unproven drug. Someone may also die from complications from surgery or anesthesia. But surgery will certainly leave a hole in their body.

"first do no harm" is closing your eyes and acting as if you don't know those 5 people are going to die, because you don't want to face the risk you'll kill 1. And in terms of life-years saved, the expectation is much better than that for medicine.

Treating lives as some fungible resource where the ends justify the means and whatever process results in the most living people at the end shouldn't be correct

Ultimately, this is an issue of individualism vs totalitarianism. Once you let go of the (western) idealist view that every individual should have full freedom of choice on how to direct their own life, a whole host of different approaches to life and state are available to you.

I like the link you made between the judicial presumption of innocence and the Hippocratic oath. It's given me a new perspective to entertain.

Let's not beat around the bush here. The issue is whether people have the right to take these risks for themselves. No one makes you sign up for a medical trial.

Actually, I don't much like this attitude. The company offers between 100 and 4500 euro to participate in trials (max earnings 4500 per year), though I don't know what they offered for this particular trial.

We can wonder why people sign up for this when the only recompense offered is [a small amount of] money but its likely due to a desire for money, caused by a lack of it -- we can only suppose that if these folk had enough money already then they wouldn't have signed up to this. It would be interesting to see the demographics of the participants of drug trials like these and I'm guessing that excess wealth and ennui aren't significant features there.

Its always worth keeping in mind that choices which may seem to be unpalatable to you are likely to be much less so to other people for reasons they don't necessarily have any control over.

So because they're poor, they shouldn't be allowed to make their own decisions? Honestly, the philosophy would be more equitable if we just extended this thinking to the whole population, right? Let's ban drinking, ice-climbing, skydiving, smoking, sweet cars, and burgers, just to get started. Because we know better than them.

The risks are understood for medical trials. Maybe they're not acceptable to me, but they are to someone else. Who am I to tell another man what risks he can take with his own life?

> So because they're poor, they shouldn't be allowed to make their own decisions?

I'd phrase it differently. Because they're poor, a certain level of financial incentive to participate in a dangerous activity may fundamentally become coercion.

You're pulling a rhetorical trick with the definition of the word "coercion". Coercion usually means forcing someone to do something without giving them the option to be left alone. That kind of coercion is widely agreed to be bad, so the term "coercion" has a strong negative connotation. Paying test subjects to take experimental drugs is not coercion in that sense, and it's not widely agreed to be bad. You're trying to make it sound bad by expanding the definition of coercion to cover it, but you haven't provided a justification for why this kind of "coercion" should be considered bad--except that it kind of resembles "coercion" in the usual sense.

Unfortunately, this kind of rhetorical trick is pretty effective. My options for responding are to either argue with you about what the word "coercion" means (which is a meaningless argument) or to claim that "some kinds of coercion are OK" (which sounds really bad taken out of context). But even though it's an effective argument, it doesn't contribute to the conversation; people who already agree with you will think it sounds convincing, but people who don't agree won't be convinced. Would you consider elaborating on your argument by explaining why you think that paying patients to participate in drug trials has the same negative features as "coercion" in the usual sense?

I'm especially skeptical when the solution to the supposed "coercion" is good old-fashioned real coercion by the state.

What about allowing people to sell a kidney or part of the liver? An a cornea?

Anything else would be extremely unethical, not to mention completely irresponsible. Communism was and is a flawed ideology in making sure we had food to eat - what kind of monster would suggest we use capitalism to give us everything else, except what will save peoples lives? How many people have to be murdered waiting on a transplant list when we know that allowing the sale of organs means they don't have to wait (https://en.wikipedia.org/wiki/Kidney_trade_in_Iran)?

But most people who sign up for medical trials are not terribly well informed of how dangerous the drug is. They are also usually from the poorest part of society (except terminally sick people hoping the latest trial may bring a cure.)

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