Medical ethics and the trolley problem
Abstract
The so-called Trolley Problem was first discussed by Philippa Foot in 1967 as a way to test moral intuitions regarding the doctrine of double effect, Kantian principles and utilitarianism. Ever since, a great number of philosophers and psychologists have come up with alternative scenarios to further test intuitions and the relevance of conventional moral doctrines. Given that physicians routinely face moral decisions regarding life and death, the Trolley Problem should be considered of great importance in medical ethics. In this article, five “classic” trolley scenarios are discussed: the driver diverting the trolley, a bystander pulling a lever to divert the trolley, a fat man being thrown from a bridge to stop the trolley, a bystander pulling a lever to divert a trolley so that a fat man may be run over, and a bystander pulling a lever so that a fat man falls off from a bridge to stop the trolley. As these scenarios are discussed, relevant moral differences amongst them are addressed, and some of the applications in medical ethics are discussed. The article concludes that Trolley scenarios are not the ultimate criterion to make ethical decisions in difficult ethical challenges in medicine cases but they do serve as an initial intuitive guide.
Edwards SD. Nursing Ethics: A Principle-Based Approach. UK: Palgrave MacMillan Ltd; 2009.
Svoboda T. Duties Regarding Nature: A Kantian Environmental Ethic. New York: Routledge; 2015, p. 24.
Mehring S. First Do No Harm: Medical Ethics in International Humanitarian Law. Netherlands: Martinus Nijhoff Publishers; 2014, p. 29.
Peel J. The Precautionary Principle in Practice: Environmental Decision-making and Scientific Uncertainty. Australia: Federation Press; 2005.
Landsburg S. The Big Questions: Tackling the Problems of Philosophy with Ideas from Mathematics, Economics and Physics. USA: Free Press; 2010, p. 45.
Foot P. The Problem of abortion and the doctrine of the double effect. Oxford Review.1967; 5: 5-15.
Edmonds D. Would You Kill the Fat Man? USA: Princeton University Press; 2014, p. 56.
Rachels J. Killing and letting die. In: Becker L, Becker C. Encyclopedia of Ethics. 2nd ed. New York: Routledge; 2001, Vol. 2, p. 947-50.
Loewy E. Textbook of Medical Ethics. New York: Springer Science & Business Media; 2013.
Thomson J.J. The trolley problem. Yale Law Journal. 1985; 94(6): 1395-415.
Tannsjo T. Taking life: Three Theories on the Ethics of Killing. UK: Oxford University Press; 2015, p. 58, 63, 75.
Atwell JE. Ends and Principles in Kant’s Moral Thought. USA: Springer Science & Business Media; 2012.
Barry V. Cengage Advantage Books: Bioethics in a Cultural Context: Philosophy, Religion, History, Politics. New York: Cengage Learning; 2011, p. 48.
Hupp S,Jewell J. Great Myths of Child Development (Great Myths of Psychology). New York: John Wiley & Sons; 2015, p. 81.
Reichberg G. Thomas Aquinas on War and Peace. UK: Cambridge University Press; 2016, p. 175.
Kelly DF, Magill G, Have HT. Contemporary Catholic Health Care Ethics. USA: Georgetown University Press; 2004, p. 112.
Frith L, Dowrick C. General Practice and Ethics (Professional Ethics). New York: Routledge; 2012, p. 94.
Hope T. Medical Ethics: A Very Short Introduction. UK: Oxford University Press; 2004, p. 15.
Shaver R. Ethical Non Naturalism and Experimental Philosophy. In: Nuccetelli S, Seay G. Ethical Naturalism. UK: Cambridge University Press; 2012, p. 194-200.
Greene JD. Dual-process morality and the personal/impersonal distinction: a reply to McGuire, Langdon, Coltheart, and Mackenzie. Journal of Experimental Social Psychology. 2009; 45(3): 581-4.
Raine A, Glenn A. Psychopathy: An Introduction to Biological Findings and Their Implications. USA: New York University Press, 2014, p. 96.
Bentham J. An Introduction to the Principles of Morals and Legislation. London: New York: Courier Corporation; 2012.
Kelly D. Yuck!: The Nature and Moral Significance of Disgust (Life and Mind: Philosophical Issues in Biology and Psychology). USA: MIT Press, 2011.
Lyons D. Forms and Limits of Utilitarianism. UK: OUP Oxford Press; 1965, p. 121.
Cappelen H. Philosophy without Intuitions. UK: Oxford University Press; 2012, p. 53.
Hamid A. G E Moore. New York: Mittal Publications; 1989.
Hare RM. Moral Thinking: Its Levels, Method and Point. UK: Oxford University Press; 1982.
Button T. The Limits of Realism. UK: Oxford University Press; 2013, p. 164.
| Files | ||
| Issue | Vol 12 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jmehm.v12i3.766 | |
| Keywords | ||
| Trolley problem Medical ethics Non-maleficence Abortion Euthanasia | ||
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