What Does The Trolley Problem Have In Common With The Pandemic?

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The trolley problem is the name given to a thought experiment in philosophy and psychology. It has sprouted a number of variations, but it goes something like this:

You are riding in a trolley without functioning brakes, headed toward a switch in the tracks. On the current track stand five people who stand to be killed if the trolley continues on its path. You have access to a switch that would make the trolley change to the other track, but another individual stands there. That person is certain to be killed if the switch is activated.

So, do you switch tracks or not? (Thanks to Merriam-Webster for the definition.)

The ethical and moral question comes down to this: you can save one person or five.  Is it better to save more people or less? What would do you do? Are you obligated to throw the switch to kill the fewest number of folks, or can you simply sit back and let whatever happens happen? As the one that throws the switch, are you morally culpable for the death or deaths? Like most philosophical problems, the Trolley Problem is not designed to have a solution.

The Trolley Problem is not unlike the moral dilemma in which our medical professionals are faced as they battle to save coronavirus patients. Think of our doctors and nurses in the ICU deciding who should get the plasma treatment, the next freed-up ventilator, a dose of remdesivir, or a trial vaccine?  They are making split second judgement calls, much like the person on the trolley who throws the switch, and they know how morally culpable they are.

Earlier this month, the NY Times ran an opinion piece, “You Can Save One Person or Five. But Not All Six”. In the article, Dr. Hershovitz discusses the situation in which hospitals find themselves as they treat Covid-19 patients. Hershovitz teaches moral philosophy, and he refers to John Taurek’s 1977 paper “Should the Numbers Count?” which addresses this same medical scenario.

“Imagine, Professor Taurek said, that you have a limited supply of a lifesaving drug. Six people will die if they do not get it. But one person’s situation is more dire: To survive, he needs your entire supply. The other five each need just one-fifth of it. So you can save one or five. But you can’t save all six. Most people would save five, reasoning that saving more people is better than saving fewer.”

Dr. Hershovitz goes on to explain what Professor Taurek would do. “He argued that the numbers don’t matter — that we shouldn’t seek to save more people. He said he’d flip a coin to decide whether to divide the drug among the five or give it to the one who needs it all… Why? Professor Taurek observed that the stakes are the same for all six people: Each will die without the needed dose. If we direct the drug to the patient who needs the entire supply, it’s true that more people will die — five instead of one. But no one dies five times; each person dies just once.”

The argument here, like the Trolley Problem discussed above, is an ethical dilemma.  More lives saved versus a few.  It’s theoretical.  I can’t fathom a medical professional tossing a coin to decide the fate of their Covid-19 patients. The culmination of a doctor’s knowledge and experience gives him/her an advantage over a coin toss. Since a doctors’ mission is to save more lives not less, it’s a no-brainer to intuit their actions – which is not undermining the difficulty of the situation.

While I appreciated Dr. Hershovitz analyses and his comments, his closing remark made the most impact on me:

“Like so much else these days, morality feels a bit muddled.”

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