Thank you for taking the time to write a response!

If an individual in the military is ordered to do something, which they do not wish to do, will they not oblige nonetheless for fear of the repercussions of refusal? If so, then, they have done so for an ultimately selfish reason — the motive being to avoid punishment.

Yes, some parents who discipline their children do so though they find it entirely disagreeable. I also dieted to lose weight for most of this year, though I don’t particularly enjoy it. There are a great many things we do as a short-term sacrifice for a long-term reward, such as dieting or disciplining our children. I’m sure that parent will feel the thrill of accomplishment many times over when they eventually see a happy and independent adult before them.

The decision of which life to save is an extreme situation. Of course, any empathic doctor will feel the sting of a patient who died under their watch, but it is reasonable to expect that they should also get some degree of relief, pride, or joy from having saved a life as well. If a doctor fails to save lives they could’ve have, they are much more likely to be tormented by thoughts of their own inadequacy and badness than anything else. They have failed to act selflessly effectively and so they have failed to act selfishly effective. (As their patients suffered under their incompetence, so now do they suffer because of that incompetence.) Had they, however, succeeded in being selfless, by saving lives, then they will also have succeeded in being selfish, as they will be proud of themselves for it and happy to have aided others, per the social instinct.

There are, of course, some depressives and those who do not altogether fit the mold of the average human, who might serve as deviations from these typical psychological reactions, but if we were to include the insane and other clinical cases, there could be no real consistency to human behavior, which obviously, for the vast majority, there is.