 Notice, too, that this patient-centered libertarian version of deontology handles Trolley, Transplant et al. differently from how they are handled by agent-centered versions. The latter focus on the agent’s mental state or on whether the agent acted or caused the victim’s harm. The patient-centered theory focuses instead on whether the victim’s body, labor, or talents were the means by which the justifying results were produced. So one who realizes that by switching the trolley he can save five trapped workers and place only one in mortal danger—and that the danger to the latter is not the means by which the former will be saved—acts permissibly on the patient-centered view if he switches the trolley even if he does so with the intention of killing the one worker. Switching the trolley is causally sufficient to bring about the consequences that justify the act—the saving of net four workers—and it is so even in the absence of the one worker’s body, labor, or talents. (The five would be saved if the one escaped, was never on the track, or did not exist.) By contrast, on the intent and intended action versions of agent-centered theories, the one who switches the trolley does not act permissibly if he acts with the intention to harm the one worker. (This could be the case, for example, when the one who switches the trolley does so to kill the one whom he hates, only knowing that he will thereby save the other five workmen.) On the patient-centered version, if an act is otherwise morally justifiable by virtue of its balance of good and bad consequences, and the good consequences are achieved without the necessity of using anyone’s body, labor, or talents without that person’s consent as the means by which they are achieved, then it is morally immaterial (to the permissibility of the act but not to the culpability of the actor) whether someone undertakes that act with the intention to achieve its bad consequences. (This is true, of course, only so long as the concept of using does not implicitly refer to the intention of the user) (Alexander 2016).  And in assessing the culpability of risky conduct, any good consequences must be discounted, not only by the perceived risk that they will not occur, but also by the perceived risk that they will be brought about by a using; for any such consequences, however good they otherwise are, cannot be considered in determining the permissibility and, derivatively, the culpability of acts (Alexander 2016).