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Help a girl out... take my ethics poll!

Discussion in 'Pre-Medical - MD' started by MollyMalone, Dec 16, 2005.

?

Should you pull the lever?

  1. You are morally required to pull the lever.

    74 vote(s)
    29.1%
  2. You are morally permitted, but not required, to pull the lever.

    154 vote(s)
    60.6%
  3. You are morally prohibited from pulling the lever.

    25 vote(s)
    9.8%
  1. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    Hello fellow SDNers,

    I was wondering if you could help me out by taking a little poll. I'm going to relate a scenario, and I would like you to vote for the option that your gut instinct tells you is the morally correct action to take. Don't worry if you can't think of a specific reason why; I'm interested primarily in your instinct. If you would like to share the explanation of why you feel the way you do, please feel free to comment, though. :)

    You are standing by a fork in a train track. Down one fork you see 5 people tied to the track. Down the other fork, you see 1 person tied to the track. A train is coming. If you do nothing, the train will kill the 5 people. But you are standing next to a lever that, if you pull it, will change the direction so that the train will kill the 1 person instead of the 5.

    To reiterate, your options are:

    Do nothing. 5 people will die.
    Pull the lever. 1 person will die (who would have lived had you not acted).

    What is the morally correct action in this scenario?

    Thanks for your participation!

    (Mods: I realize that the problem and ensuing discussion might be more appropriate for the topics in healthcare forum, but I wanted to get a lot of exposure. I would appreciate it much if you could leave this in pre-allo for at least a day. If you can't, I understand. Thanks!)
     
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  3. kimmcauliffe

    kimmcauliffe Surfer Chum
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    Darkside... I need to sleep on this one. Sick.
     
  4. RexPacis

    RexPacis Junior Member

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    Everything that happens under heaven has its cause and effect. The people are tied to the railtrack FOR A REASON: no one gets tied to a railtrack simply by random chance. If you pull the lever, YOU are directly responsible for causing a person's death. If you don't do anything, you are simply letting the cause exert its own effect. I don't know what difficulty you're encountering, but the bottom line is this: DON'T PULL THE LEVER!
     
  5. tacrum43

    tacrum43 Behold the mighty echidna
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    But perhaps you are there for a reason, and that reason is to pull the lever.
     
  6. jebus

    jebus Membership Revoked
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    Morality isn't about destiny. It's about you and what you do and how your actions affect other people.
     
  7. Gavanshir

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    Just keep your head down and act like you didn't see anything.
     
  8. Thundrstorm

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    This reminds me of a discussion I had in an ethics course once. In one scenario, this guy drowns his toddler-aged niece in the bathtub. In the other scenario, the uncle simply watches her drown and doesn't help her. Is the latter any less morally reponsible? Can NOT doing something be an immoral choice?


    Of course, this example is more complicated... I haven't voted yet. It's a tough one. Unless you're a utilitarian ethicist, in which case you'd save the 5 people. :)
     
  9. it.

    it. 1K Member
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    pull the lever and run like hell to that 1 person and untie him :thumbup:
     
  10. Wertt

    Wertt blinking at brains
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    I think there's a follow up version of this dilemma:

    You are standing on a bridge overtop of the track as the train progresses towards the five people tied to the rails. There is a huge fat man on the bridge with you looking down at the rails. You could push the man onto the track in front of the train, killing him but derailing the locomotive and saving the five others. Or, you could do nothing and watch the train kill the five people.

    Act: kill one, save 5
    Don't act: kill 5, save one.

    I think people are always aversive to actually carrying out an action that would result in a death. Kind of like the distinction between 'letting die' and physician assisted suicide...
     
  11. Slide

    Slide Finally, no more "training"
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    That one is easy for me... definitely push the fat guy, considering that he's not so heavy you can't budge him. The guy will probably die of a heart attack anyway in the near future, so you might as well let the guy use his fat to his advantage.

    I know this is a horrible line of reasoning, but I just am sort of prejudiced against fatties.
     
  12. solitude

    solitude Senior Member
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    You have to pull the lever. The net gain in life is +4 rather than -4. I don't understand how anybody could do otherwise.
     
  13. jon stewart

    jon stewart Senior Member
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    what if just started dieting and excercising and you didnt know this??
     
  14. odrade1

    odrade1 UASOM alum
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    I have heard this claim before. This reflects the fact that many people seem to feel that by not actively doing something they are not actually choosing one outcome or the other. This is false. Here's why:
    There are always two outcomes: death of 5 or death of 1. Once you have the knowledge of how the people are situated & how the rail controls work, you have already found yourself in a situation where will be choosing one outcome over another. Choosing one outcome (death of 5) requires taking no bodily action on your part. Choosing the other outcome requries taking a bodily action. The fallacious reasoning of the "don't pull" argument above rests on an assumption that choosing an evil outcome that requires an physical action is morally worse than choosing an evil outcome that does not requrie an action.
    If I have to guess, this assumption is as popular as it is due to the "extra" weight we apply to the visible, tangible world. Pulling a lever is (psychologically) more real of an event than *not* pulling a lever, though both are ontologically real events. In plain English: a choice is a choice is a choice, regardless of *how* involved your bodily movements are. This should be reason enough to disabuse you of the notion that not pulling the lever = not being involved = no moral wrong.

    more later
     
  15. it.

    it. 1K Member
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    suppose that one person was your mom/significant other/etc

    it can get pretty complicated, depending on how one judges the worth a life, inherent and extrinsic
     
  16. SuzieQ3417

    SuzieQ3417 Senior Member
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    :thumbup: Well said...I agree in the importance of choice in this situation.
     
  17. Flopotomist

    Flopotomist I love the Chicago USPS
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    Just to throw a wrench in the mix (darn philosophy majors like me like to do that)...

    If you argue that the morally correct choice is to sacrifice the one to save the five - can you extrapolate the arguments used to justify this position to other situations?

    Suppose as a physician, you had one healthy patient, and five patients that needed organs to live. Would you be morally obligated to sacrifice the one healthy patient to harvest his organs for the other five? If not, what is different here than the train scenario?
     
  18. EZMcFlo

    EZMcFlo Senior Member
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    Exactly, or if the five are really old, and the one is a newborn baby.
     
  19. SuzieQ3417

    SuzieQ3417 Senior Member
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    In the train scenario someone is going to die regardless of what decision you make. The same does not apply to the scenario you just listed.

    Edit: Nevermind, no it doesn't. I read the post too quickly without thinking (apparently my brain shuts down after finals week!)
     
  20. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    Hee! I was waiting to see if someone would bring this up.

    This one, too.
     
  21. Chinorean

    Chinorean Senior Member
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    Well the big difference here is that the 5 patients aren't really dependent on the one guy to live...we have organ transplant lists and organ donors and a lot of outside factors that give them more hope than the people on the train.
     
  22. Flopotomist

    Flopotomist I love the Chicago USPS
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    Not true, 5 people will die without new organs. If we are doing simple "moral calculus" this results in a net loss of 4 versus a loss of 1 if we sacrifice the organ donor. I was just trying to point out that there are problems when we start to apply simple numbers as a guide to morality.
     
  23. Flopotomist

    Flopotomist I love the Chicago USPS
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    The way my counterscenario is presented, the 5 patients will die but for the sacrifice of the one organ donor. Just as the train scenario is presented, you must decide based on the facts presented, and not alter the scenario.
     
  24. SuzieQ3417

    SuzieQ3417 Senior Member
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    You're absolutely right. I realized this as soon as I posted. I hate when I don't think things through before opening my mouth. :)
     
  25. But, we don't know anything about the people on the track, why they are on the track, etc. Maybe this is the new form of killing of people on death row. The 5 people on the track may have done really, really horrible things- serial murderers/rapists and some new law has sentenced them to "death by train." And maybe the 1 person on the other track is some innocent little kid who has been captured and tied to the track (perhaps by a very intelligent accomplice to the 5 death row persons, who anticipated that you would show up when you did and that you would see the 5 people on the track and pull the lever, killing the innocent child and freeing the 5 death-row killers, who are now free to kill/rape more people). Do you see how much damage you have done by pulling the lever?

    Thus, we must refrain from pulling the lever and trust that things are going to happen as planned... ;)

    (Okay, it's a stretch... but "5 people tied to 1 track and 1 person tied to another track...?" Also a stretch...)
     
  26. SuzieQ3417

    SuzieQ3417 Senior Member
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    This is why doctor's embrace the "first, do no harm" mentality. It would be inappropriate to kill a healthy patient to save five, because you would be intentionally harming someone. By not doing anything (not killing a health person), you are not imposing intentional harm on an individual, although five sick people will die.
    It is easy for most people to say "pull the lever" as opposed to physically pushing someone to achieve the same effect, probably due to the emotional connection/separation from the situation in those two instances. We talked about this in my psych class. Normal people react in this manner, but don't serial killers or other criminals have different responses? (I must not have been paying attention in class that day, I can't remember)
     
  27. Posted above before I saw Flops posts... guess this just kinda goes along with that.
     
  28. dr1day

    dr1day Member
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    This question reminds me of Dean Koontz's book Velocity. A guy receives an anonymous note saying that if he goes to the cops and elderly lady will by killed. If he does nothing a young, blond will be killed. He gets these notes throughout the whole book and has to "choose" who will die based on his action or inaction. It was an interesting read.

    Sorry, I don't have an answer to your question.
     
  29. TheMightyAngus

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    What are the ethics regarding your switch of avatar-allegiance from Yale to UCSF?
     
  30. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    :laugh: Since I've not officially told either that I will matriculate if accepted, I think it's ethically OK for me to beg them both. :D
     
  31. anglswings

    anglswings AnglsWings
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    Why cant we just go un-tie them very fast???? if only. Its a hard ? t answer bc i agree with every agrument everyone is making. But i went with the first. i know this could possibly make me a bad person. but im sorry. :(
    .
     
  32. Jon Davis

    Jon Davis I killed the bank.
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    This option, "You are morally permitted, but not required, to pull the lever" provides the most moral leeway. Totally looking at it objectively, which can be a moral thing in a society, 1 is better than 5 (essentially 1 death versus 5 deaths). It really comes down to the individual's own value systems versus the society that he/she belongs to. The certain list of values one has will ultimately decide whether the lever is pulled or not. This is an option that weighs heavy one anyone's head (that would look at this situation is a dilemma, because some may not).

    In addition I think the value systems of each person, which differs, creates the conflict or flaming between people. There is certainly not a right or wrong answer. If you don't agree with someone's stance, just respect their opinion, because they were brought up in a different world than you.

    P.S. DarkSide, if you want, I permit you to use any of part of my post for studies. (If I have given you anything of value at all, heh :laugh: )
     
  33. WholeLottaGame7

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    But what if the plan were for you to pull the lever and save the 5 people? That line of argument doesn't really hold up.

    As other people have hinted at, the "action vs no action" argument is similar to the "withholding treatment vs withdrawing treatment" argument. Which legal precedent has found to have no difference.

    I'd have to say save the 5 and let the 1 die. But as someone mentioned, you can play with the variables and make it squirrely. What if there were 5 90-year olds and 1 2-year old? Or 5 terminally ill patients and one healthy one? Ohh decisions decisions.
     
  34. bubbleyum

    bubbleyum Senior Member
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    :laugh: :laugh: :laugh:
     
  35. bubbleyum

    bubbleyum Senior Member
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    if you go by the "heaven" logic, then you know nothing happens without a will behind it.
    what if you were placed there at that exact opportune moment for a reason? maybe you are meant to pull that lever and save 5 lives.

    you just never know what's going to happen. that one person tied there could potentially invent some vaccine that saves millions of lives in the future, etc etc. so then could saving that person's life be more valuable than the other immediate five in the long run? nobody knows.

    in any case, it's a lose-lose situation. you are either directly responsible for one person's death, or passively watched 5 people die. which in a lot of people's eyes is just as horrible/worse.
     
  36. odrade1

    odrade1 UASOM alum
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    In my view, you cannot always apply this principle to new situations. Of course this (example you give) is a form of one of the standard dilemmas of applying utilitarian theory; the chief flaw in utility theory is that it is usually unable to accomodate other features of moral dilemmas that humans find morally important. Your example brings these to light. It introduces a wealth of possible further moral considerations: Patient rights, violation of the doctor-patient relationship, the use of people as means, the right of self determination--where possible, etc. Something is amiss if we cavaleirly decide through moral calculus that the healthy guy should have his organs harvested.

    One of the best discussions I ever encountered on this topic arose in a book I read that compared several classic, established moral theories (utility, social contract, etc.) against recent feminist perspectives on moral theory. One of the author's conclusions was that our moral intuitions tend to contradict each other in a certain way: often the day-to-day moral decision making is best served by paying attention to the moral worth of individuals, relationships betwen individuals, and the moral responsibilities that arise from those relationships. The extreme fairness of utility theory and the abstract explanantions of harms in social contract theories fail to capture much of what is morally important about your interactions with family, friends, and neighbors. (or between a doctor and her patient). The contradiction (in our moral sense) arises because abstract moral theories also make sense. For example, we WANT our congressmen to make decisions that help more people than they hurt, or that please more people than they infuriate. (Isn't this one of the assumptions behind democracy anyway??) The author suggested that one way to resolve this conflict is to recognize that feminist-type relational-centered reasoning works better at one scale, and the anonymous, abstract, impersonal moral theories work better at a different scale.

    I would go so far as to say that there *would* be a certain amount of good obtained by sacrificing the one guy to save the 5. However, we have to recognized that there are many more features of the situation that may invalidate such a choice (the patient's right to self determination may be a side constraint that cuts short any further considerations), or that plenty of harm may be had due to the other implicit moral features of the example. These other harms (violation of the doctor-client relationship, the horror of cutting up a healthy person for their organs, etc.) probably outweigh the good obtained through the sacrifice.



    This is why it should be legal to grow cloned human tissue. Or--more controversially--to grow cloned bodies with deliberately altered brain tissue, to prevent the development of structures prerequisite for personhood.
     
  37. MiesVanDerMom

    MiesVanDerMom D.o. or Die
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    I've never seen the dilema in this question. I would of course pull the lever. Not pulling the lever is a decision and so is pulling it. This whole acting/not acting this is a load of crap. You're acting either way, so reduce the death toll.
     
  38. kirexhana

    kirexhana Make Me A Sandwich.
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    wait.. why would there be a healthy patient? the fact that they're hospitalized means that they're not healthy.

    i think the one guy on the train track has to be analogous to a patient that is not completely healthy, otherwise, why are they at risk on the train track in the first place? so then the question becomes, choosing between 5 people that need organs and 1 person that is at risk for something who needs all of his organs to even get a chance to live. ow... my head...
     
  39. IDforMe

    IDforMe Not recovered...
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    Hmmm. I think that there will always be a way to rationalize choosing whether or not to pull the lever based on the weighing each hypothetical situation you could throw out here. 1 vs 5 die, Healthy vs Ill, etc., etc., etc. The one thing that remains constant is that there is no right answer, only the one morally best for each individual making that decision.

    That said, my first thought was to only pull the lever halfway, in effect, derailing the train before it could crush anyone. If pulling the lever halfway, untying the people and other options were not possible, then I would have to say in this particular instance, health, mental status, age, etc. all being equal (we're talking 1 Joe Blow on one track, 5 Joe Blows on the other) I would have to pull the switch to save as many people as possible.

    If anyone has read up on medical disaster triage, this is what makes it so hard emotionally. As Doctors, we will be expected to give the most rapid and intensive care to those who are most ill. In disaster situations, you have to focus on how many people you can save; meaning those with minor injuries who have the best prognosis with a minimum of care are the first people you help, and those who are most critical with the worst prognosis have to be handled later... although admittedly, many of them might die before someone is able to help them.
     
  40. laboholic

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  41. QuikClot

    QuikClot Senior Member
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    This is the only hypothetical which challenges the moral obligation to pull the lever in any signigant way -- it's a good one.

    The distinction between the two situations is that in the train example, someone has placed both groups in deadly peril. You arrive in a deadly situation and are obligated to do your best to make it less deadly, but the moral responsibility from the deaths that result do not necessarily attach to you.

    If a police officer kills a store clerk with a errant shot during a robbery attempt, we may assign him some moral responsibility based on carelessness or incompetence, but the lion's share of the responsibility (as well as a murder charge) is correctly assigned to the robber who created the deadly situation.

    Similarly, in triage, you may very well have to chose to forego a time-consuming but lifesaving proceedure to save more lives in the time you have. You are not, however the cause of that person's death.

    Taking the life of a person in cold blood to benefit others is morally wrong. Saving as many people as possible from a deadly situation not of your making is a different proposition.
     
  42. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    I just wanted to give a big thank you to everyone who responded!

    This scenario, known as "the trolley problem" in ethics, is the topic of a paper I'm writing for my Modern Ethical Theories class. In one of the articles we studied, the author asserted that the majority of people she talked to subscribed to the "permitted but not required" option and I wanted to see if a poll on SDN would show similar results. I appreciate your time and your comments.
     
  43. justskipee

    justskipee Senior Member
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    This is an example of "choiceless choice," for that person there is not good option, but what should guide their decision. This idea is brought up by Maimonides, a jewish philosopher, and poses the ethical question of giving up some life to save more. In the situation posted, there is no correct decision because what if the single person on the other track is your daugher or family member...then its not just a number of dead issue. During the Holocaust Nazi's would force Jews to make decisions like this. For example, tell a family that they can only keep one child, which child do you want to save. If they won't choose, the whole family will be killed. It is these scenarios that go beyond our ability to understand or to imagine. Just hope you never have to be in a similar situation.
     
  44. Orthodoc40

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    "The needs of the many outweigh the need of a few, or the one" - isn't that what Spock says at the end of Star Trek 2?

    Anyway. You asked what my INSTINCT would do: provided I didn't have any other information, like the 5 people are all mass murderers, or the 1 person is a child molester, or anything like that, my INSTINCT would be to help save the one person, because they are alone, and need someone else's help. But my REASONING would be to save the 5 people, because those 5 people are connected to many other people, and the effective loss would likely be that much larger.
     
  45. BuckyBoy_DDS

    BuckyBoy_DDS Member
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    Do nothing...
     
  46. QuikClot

    QuikClot Senior Member
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    That Rambam, always thinkn'. :love:
     
  47. joshinjosh

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    let fate decide. ini mini miny mo.
     
  48. MoosePilot

    MoosePilot Y Bombardier
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    I agree that there are real differences.

    Transplant recipients [edit - btw, I don't proofread very well at all when I post quickly] are not suddenly completely out of danger.

    The one person tied to the railroad track is in a similar situation to the other 5, just currently less dire. So it's not like he's a completely healthy patient.

    What if you had six patients on life support. The electricity for the life support machines was routed through a fuse box. The fuse for five patients blew, while the same type of fuse was in use on a circuit that only one patient was plugged into. You only have time to switch the fuse or not.

    That's a more similar scenario.
     
  49. Flopotomist

    Flopotomist I love the Chicago USPS
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    Moose, I think you missed my point. I was not trying to come up with an identical situation in a different setting (which you very creatively did). I was attempting to show that if we use strict utilitarianism in this situation, that we risk adopting a theory with severe problems.
     
  50. MoosePilot

    MoosePilot Y Bombardier
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    I agree and I think your scenario did a good job of that. That's why I think each instance has to be its own case. Certain overarching principles can apply, but ultimately, it's like porn. I know it when I see it.
     
  51. 71263

    71263 Guest
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    Everybody here is forgetting the obvious answer here:

    Step 1: Pull the lever (5 people are saved)

    Step 2: Run like hell to the other side of the track

    Step 3: Pull the other guy off the tracks before the train hits (1 person saved)

    Net survival: 6/6, everyones happy!! :D
     

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