1. A utilitarian cannot consistently maintain that we ought to “hit the switch” and also claim that it would be wrong to save the five patients, as saving the five would produce the greatest amount of net happiness over misery in both instances. In the trolley example, utilitarians believe that hitting the switch is the morally correct decision, since the killing of five people would produce more misery than the killing of only one person. Thus, in the medical example, utilitarians must hold the same belief that saving the five patients, while sacrificing the life of one, is morally correct, as you are ultimately producing the greatest amount of happiness over misery. In addition, utilitarians believe that no action is intrinsically right or wrong; only the results of your action make it moral or immoral. Therefore, utilitarians must believe that the purposeful killing of one patient is not intrinsically wrong, and since this sacrifice will produce very good results (it will save five others), then this action is morally acceptable.
2. Utilitarians may argue that killing the patient would be wrong if we’re merely examining the physician’s overall happiness. Medical students take the Hippocratic Oath: first, do no harm. If this surgeon were to murder one person, he/she is deliberately harming their patient, therefore breaking their promise to the oath. How can a physician go against the very oath that makes them a physician? Therefore, in the long run, utlitarians can argue that the physician’s overall happiness would rapidly decline, which would produce more misery than happiness.