Through this compelling short story, the author forces us to ask an age-old question about the cost of happiness and the kind of cost that we are willing to pay to ensure that we live lives that know no sadness or sickness or pain. Through the distressing picture of the young girl who is somehow made to suffer greatly in exchange for the goodness for all, Ursula Le Guin puts utilitarianism in its extreme form under the microscope:
They all know that it has to be there. Some of them understand why, and some do not, but they all understand that their happiness, the beauty of their city, the tenderness of their friendships, the health of their children, the wisdom of their scholars, the skill of their makers, even teh abundance of their harvest and teh kindly weathers of their skies, depend wholly on this child's abominable misery.
The question is of course whether this is a fair price to pay for the happiness of the majority, and whether this is a fair exchange: the extreme suffering of one for the happiness of many. Is this just? The way in which the title of the story and its ending focuses on those who think it is not and who leave this city and its happiness out of protest suggests that the author disagrees.