Sometimes tricky situations are imagined to test Utilitarianism. Since Idle Theory is a variant of Utilitarianism, substituting idle time for happiness, and bearing in mind that to kill someone is to deprive them of their expected remaining idle time, how would Idle Theory cope with the following doctor's dilemma?

The traditional form of utilitarianism is act utilitarianism, which states that the best act is whichever act would yield the most utility. A common alternative form is rule utilitarianism, which states that the best act is the one that would be enjoined by whichever rule would yield the most utility.

To illustrate, consider the following scenario: A surgeon has six patients: one needs a liver, one needs a pancreas, one needs a gall bladder, and two need kidneys. The sixth just came in to have his appendix removed. Should the surgeon kill the sixth man and pass his organs around to the others? This would obviously violate the rights of the sixth man, but utilitarianism seems to imply that, given a purely binary choice between a) killing the man and distributing his organs or b) not doing so and the other five dying, violating his rights is exactly what we ought to do. *

In this case, with utility replaced by idle time, the question is: which act yields the most idle time (where remaining lifetime is taken to be idle time)?

In the first option, the sixth patient is killed, and is deprived of his remaining lifetime of, say, 20 years. The other five patients then, say, live on for another 20 years. And so the time gain is 5 times 20 years for the survivors, minus 20 years for the killed sixth patient, all in all totalling 80 years.

The other option is to save the sixth patient, and let the other five patients die. Here the sixth patient lives on for 20 years, and the other patients are let die, and so the net time gain is a mere 20 years.

Given these two options, it is clearly better for the sixth patient to be killed so that the other five can live.

But are these the only two options? Let us look more closely.

It must be assumed from this question that the other five patients are, despite their need for new organs, still alive. If they were not, then the proposed transplants would be purposeless. And if they are still alive, then they can be expected to continue living for some time longer.

So a third option would be for the sixth patient to have his appendix removed, and be discharged, and gain another 20 years of life. The other 5 patients are then allowed to linger until one of them dies, at which time his organs are transplanted to the other four patients, so that they live on for 20 years. In this case the net time gain is 5 times 20 years for the survivors, plus 1 year (or 1 day) for the first one to die, all in all totalling 101 years. There is no minus number in this total because nobody has been killed.

Of the three options, the third option is clearly the best, in that it provides 21 more years of life than the next best option.

(There is a slight complication to this third option, which is that if one of those needing kidneys dies first, the other patient needing a kidney will get no transplant. But since the other three patients are going to be opened up, one of them will probably be able to spare one of the two kidneys each has to save him. But even if this were not the case, and they had no kidneys to spare, and the other patient needing a kidney promptly dies, then the total time gain falls from 101 years to 81 years, which is still one year better than the 80 years of the first option.)

And furthermore, this solution only requires the doctor to do what he would ordinarily do, and treat each of his patients as best he can, as circumstances present themselves. Indeed, the doctor never ever really faced any dilemma at all.

The Doctor's Dilemma is, in many ways, a trick question. Part of the trick is to present only two options - either killing or saving the sixth patient -, when in reality there are a number of alternative avenues which can be explored. It is also a trick question in that it removes the element of time from the dilemma: the fact that all the patients, however infirm, have some life expectancy, however short.