Do the "ends justify the means"?
By Scott Sumner
This question actually has two distinct meanings:
1. Should we do things if benefits of the ends exceed the cost of the means?
2. In various individual cases, does the benefit of the ends actually exceed the cost of the means?
The first question is normative while the second is empirical. To illustrate this distinction, let’s start by considering three cases:
The US government sent young men to their death in Iraq, because the ends were supposed to justify the means.
The US government drafted young men to fight in Vietnam, because the ends supposedly justified the means.
Patients with kidney disease suffer greatly because the benefit of banning kidney sales supposedly outweighs the benefits of ending the transplant kidney shortage.
There are many such examples of “ends justify the means” arguments.
Here’s what I find rather ironic. Most intellectuals are strongly opposed to utilitarianism, which is also an ends justify the means moral system. And popular arguments against utilitarianism often are constructed around thought experiments. “What if torturing someone would make society better off.” Or, “What if taking away a person’s freedom would make society better off?” Or, “What if killing someone would make society better off.” The specific examples that are constructed are often far-fetched.
But as I just indicated, you don’t need to look far to find public policies that rely on similar arguments. The three examples above show that the US government does effectively torture people, or take away their freedom, or have them killed, all for “ends justify the means” reasons. And yet anti-utilitarians present their thought experiments as if it were obvious that no sane person would ever approve of such horrible policies. Apparently that’s wrong, unless the entire US government is insane.
So how should I feel about that fact, since I’m an “ends justify the means” utilitarian? I believe that in all these cases the government has incorrectly answered the second question at the top of this post. That is, they’ve assumed that certain government policies are justified by the rather vague and uncertain benefits they promise, even though there are very clear costs for specific people. And these assumptions are usually wrong. Governments just aren’t very good at using highly coercive techniques to achieve a better world. It’s theoretically possible that this sort of policy might work, but it doesn’t happen very often. (Perhaps the draft was justified in WWII. I don’t know.)
Scott Alexander has a wonderful post on public policy toward pain treatment. He points out that patients in extreme pain often fall into a sort of Catch-22 trap, where asking for pain medication is considered evidence of addiction and is viewed as reason to withhold relief:
Greene & Chambers present this as some kind of exotic novel hypothesis, but think about this for a second like a normal human being. You have a kid with a very painful form of cancer. His doctor guesses at what the right dose of painkillers should be. After getting this dose of painkillers, the kid continues to “engage in pain behaviors ie moaning, crying, grimacing, and complaining about various aches and pains”, and begs for a higher dose of painkillers.
I maintain that the normal human thought process is “Since this kid is screaming in pain, looks like I guessed wrong about the right amount of painkillers for him, I should give him more.”
The official medical-system approved thought process, which Greene & Chambers are defending in this paper, is “Since he is displaying signs of drug-seeking behavior, he must be an addict trying to con you into giving him his next fix.”
Alexander is a psychiatrist and his long post is well worth reading. I can’t do it justice here. In the post, he presents seven cases he knows of where people were needlessly tortured by our drug policies (my terminology, not his). Here are just a couple:
Case 1: Mary is an elderly woman who undergoes a surgery known to have a painful recovery process. The surgeon prescribes a dose of painkillers once every six hours. The painkillers last four hours. From hours 4-6, Mary is in terrible pain. During one of these periods, she says that she wishes she was dead. The surgeon leaps into action by…calling the on-call psychiatrist and saying “Hey, there’s a suicidal person on my ward, you should do psychiatry to her or something.” I am the on call psychiatrist. After a brief evaluation, I tell the surgeon that Mary has no psychiatric illness but needs painkillers every four hours. The surgeon lectures me on how There Is An Opioid Crisis, Y’Know, and we can’t negotiate with addicts and drug-seekers. I am a consultant on the case and can’t overule the surgeon on his own ward, so I just hang out with Mary for a while and talk about things and distract her and listen to her scream during the worst part of the six-hour cycle. After a few days the surgery has healed to the point where Mary is only in excruciating pain rather than actively suicidal, and so we send her home. . . .
Case 4: John is a 70 year old man on opioids for 30 years due to a mining-related injury. He is doing very well. I am his outpatient psychiatrist but I only see him once every few months to renew meds. He gets some kind of infection, goes to the hospital, and due to normal hospital incompetence he doesn’t get his opioids. He demands his meds, and like many 70 year old ex-miners in terrible pain, he is not diligently polite the whole time. The hospital doctors are excited: they have caught an opioid addict! They tell his family and outpatient doctors he cannot have opioids from now on, then discharge him. He continues to be in terrible pain. At first he sneaks pills from an extra bottle of opioids he has at home, but eventually he uses all those up. After this, he is still in terrible pain with no reason to expect this to ever change, and so he shoots himself in the chest. This is the first point in this entire process at which anyone attempts to tell me any of this is going on, so I get a “HEY DID YOU KNOW YOUR PATIENT SHOT HIMSELF? DOESN’T SEEM LIKE YOU’RE DOING VERY GOOD PSYCHIATRIST-ING?” call. The patient miraculously survives, eventually finds a new pain doctor, and goes on to live a normal and happy life on the same dose of opioids he was using before.
Alexander is just one psychologist. If he sees these cases quite often, then I assume there must be thousands of such cases across the US. Of course there are also cases that cut the other direction, where people become addicted to opiates that are not needed.
Now let’s think about this from an “ends justify the means” perspective. When the US government tortures people by denying needed painkillers, they are doing so on the basis that the alternative is worse, that allowing widespread use of painkillers would have even worse consequences. That’s an empirical claim.
But if you are going to use a “what if aggregate utility maximization called for torture” argument against utilitarianism, then I’d recommend using a real example like the war on opioids, not some fanciful example where society obviously would not actually be better off (like “what if torturing babies made people happy.”). We really do torture some people using an essentially utilitarian justification, and yet these drug laws are often supported by people who would be horrified if you called them a utilitarian.
Now as a matter of fact the drug wars are probably wrong, even using a utilitarian criterion. The ends do not happen to justify the means. A few years back the government cracked down on opioid prescriptions. After this occurred, people switched to illegal alternatives that were far more dangerous and death rates soared:
So it’s not at all clear that the war of drugs “works”, even on utilitarian grounds. Indeed it’s even worse than I’ve suggested. It’s not just that illegal alternatives are dangerous and hurt the users; we also imprison 400,000 in the war on drugs, destroying many lives, separating families, and imposing a huge cost on taxpayers. We destabilize countries in Latin America. In the past, some commenters argued that these people are bad and would be doing bad things in any case. That’s true of some, but murder rates in America rose sharply under alcohol prohibition (in both boom and depression years), and then fell in half after prohibition was repealed in 1933 (in good times and bad.) So these laws really do create violence. (In fairness, Prohibition also reduced alcohol consumption somewhat.)
The following claims are all plausible:
1. The true model of ethics is utilitarianism. That’s the right set of goals.
2. Because of cognitive illusions, people relying on utilitarianism are likely to advocate an excessively coercive set of government policies. They’ll see bad things and wrongly assume that, “there outta be a law.” They’ll forget all the negative side effects caused by military drafts, prohibitions, and other forms of coercion.
3. Because many (not all) utilitarians are too optimistic about government effectiveness, natural rights advocates who focus on “negative liberty” will actually construct regimes that are better at maximizing utility than what you would get from an avowedly utilitarian government. (Mainland China might be an example of misguided utilitarianism. Singapore is a much less misguided example.)
[As an aside, there are similar arguments for religion.]
This way of thinking about the issue may explain people like Milton Friedman, who often seemed to waver between utilitarian and natural rights arguments for his preferred policies.