The following are some things to think about over the holidays. I find it interesting that on the news today there were the new style hippies. They have given up on all material things, are avid tattoo flaunters, go to concerts, skate board, don't want to work, don't go to churche (but think that through out the day, as they do, is equarl to church. The only difference is that this young people are pro-life and pro-war. Personally, I have a hard time with how the two things can go together. Since this thought was on my mind, it was not surprising that I stumbled on the following, which no matter what your belief system is can keep you considering things throughtout the holiday and into your New Year's Resolutions.
The trolley problem
The problem is this:
- A trolley is running out of control down a track. In its path are 5 people who have been tied to the track by a mad philosopher. Fortunately, you can flip a switch which will lead the trolley down a different track to safety. Unfortunately, there is a single person tied to that track. Should you flip the switch?
Almost everyone who hears this case agrees that it is permissible to flip the switch. Most feel that this action is not only permissible, but, morally speaking, is the better option (the other option being to do nothing) in this case.
Of course, a simple utilitarian calculation will justify this course of action, but non-utilitarians also usually want to say that flipping the switch is acceptable. Some would also say that flipping the switch constitutes an act of moral irresponsibility and that it is better to not take any action at all, as acting would subject one to being morally responsible for any consequences resulting. But, this viewpoint is contested by those who view inaction as an internal action in itself, and that deliberate failure to act constitutes a form of negligence.
Related problems
The initial trolley problem becomes interesting when it is compared to other moral dilemmas.
The fat man
One such is that offered by Judith Jarvis Thomson:
- As before, a trolley is hurtling down a track towards five people. You are on a bridge under which it will pass, and you can stop it by dropping a heavy weight in front of it. As it happens, there is a very fat man next to you - your only way to stop the trolley is to push him over the bridge and onto the track, killing him to save five. Should you proceed?
Resistance to this course of action seems strong; most people who approved of sacrificing one to save five in the first case do not approve in the second sort of case. This has led to attempts to find a relevant moral distinction between the two cases.
One clear distinction is that in the first case, one does not intend harm towards anyone - harming the one is just a side-effect of switching the trolley away from the five. However, in the second case, harming the one is an integral part of the plan to save the five. [1]
So, some claim that the difference between the two cases is that in the second, you intend someone's death to save the five, and this is wrong, whereas in the first, you have no such intention. This solution is essentially an application of the doctrine of double effect, which says that you may take action which has bad side-effects, but deliberately intending harm (even for good causes) is wrong.
On the other hand, Thomson argues that an essential difference between the original trolley problem and this version with the fat man, is that in the first case, you merely deflect the harm, whereas in the second case, you have to do something to the fat man to save the five. Thomson says that in the first case, nobody has any more right than anyone else not to be run over, but in the second case, the fat man has a right not to be pushed in front of the trolley.
Utilitarians, of course, deny this. But so do some non-utilitarians such as Peter Unger, who rejects that it can make a substantive moral difference whether you bring the harm to the one or whether you move the one into the path of the harm.
The track that loops back
The claim that it is wrong to use the death of one to save five runs into a problem with "loop" variants like this:
- As before, a trolley is hurtling down a track towards five people. As in the first case, you can divert it onto a separate track. On this track is a single fat man. However, beyond the fat man, this track loops back onto the main line towards the five, and if it wasn't for the presence of the fat man, flipping the switch would not save the five. Should you flip the switch?
The only difference between this case and the original trolley problem is that an extra piece of track has been added, which seems a trivial difference (especially since the trolley won't travel down it anyway). So intuition may suggest that the answer should be the same as the original trolley problem - one may flip the switch. However, in this case, the death of the one actually is part of the plan to save the five.
The loop variant may not be fatal to the 'using a person as a means' argument. This has been suggested by M. Costa in his 1987 article "Another Trip on the Trolley," where he points out that if we fail to act in this scenario we will effectively be allowing the five to become a means to save the one. If we do nothing then the impact of the trolley into the five will slow it down and prevent it from circling around and killing the one. As in either case some will become a means to saving others, then we are permitted to count the numbers. This approach requires that we downplay the moral difference between doing and allowing.
Transplant
Here is a case, due to Thompson, where most of us come to the opposite conclusion that we do in the original Trolley Problem:
- A brilliant transplant surgeon has five patients, each in need of a different organ, each of whom will die without that organ. Unfortunately, there are no organs available to perform any of these five transplant operations. A healthy young traveller, just passing through the city the doctor works in, comes in for a routine checkup. In the course of doing the checkup, the doctor discovers that his organs are compatible with all five of his dying patients. Suppose further that if the young man were to disappear, no-one would suspect the doctor.
As rare as it is to find someone who does not think we should turn the trolley, it is even rarer to find someone who thinks it is permissible for the doctor to murder this patient and harvest his organs. (A rare few utilitarians, such as Alastair Norcross, think that this might be acceptable under certain exceedingly unlikely circumstances.) Yet both cases seem to involve a choice between one life and five. What, if anything, explains this difference in our judgments?
Unger argues extensively against traditional non-utilitarian responses to trolley problems. This is one of his examples:
- As before, a trolley is hurtling down a track towards five people. You can divert its path by colliding another trolley into it, but if you do, both will be derailed and go down a hill, across a road, and into a man's yard. The owner, sleeping in his hammock, will be killed. Should you proceed?
Responses to this are partly dependent on whether the reader has already encountered the standard trolley problem (since there is a desire to keep one's responses consistent), but Unger notes that people who have not encountered such problems before are quite likely to say that, in this case, the proposed action would be wrong.
Unger therefore argues that different responses to these sorts of problems are based more on psychology than ethics - in this new case, he says, the only important difference is that the man in the yard does not seem particularly "involved". Unger claims that people therefore believe the man is not "fair game", but says that this involvedness cannot make a moral difference.
Unger also considers cases which are far more complex than the original Trolley problem, involving more than just two possible courses of action. In one such case, it is possible to do nothing and let five die, or to do something which will (a) save the five and kill four, (b) save the five and kill three, (c) save the five and kill two, or (d) save the five and kill one. Most naïve subjects presented with this sort of case, claims Unger, will choose (d), to save the five by killing one, even if this course of action involves doing something very similar to killing the fat man, as in Thomson's case above.
The Guilty Man and the President
Dr. Robert Jacobson asks,
- "What happens if, on the tracks of one trolley, five men guilty of murder are tied, and on the other, one man is innocent. Should you choose to save the one man, simply because he has committed no crime?"
Jacobson believes that most people will save the innocent man. He also raises this question: Should you save the five guilty men, or the innocent man, who may commit a murder after you save him?
Jacobson again asks a difficult question:
- "What happens if, on tracks one of the trolleys, the President of the United States has been tied by terrorist, and on the other trolley tracks, five average citizens are also tied up. As in the original Trolley Problem, who should you save?"
- "What if the trolley is headed towards five average people you've never met but on the other tracks is your mother?" "Do you flip the switch and save five or save your mother?"
Jacobson, in this instance, is really asking if the President of the United States/your mother is more important than five average citizens.
Neuroethics and the Trolley Problem
In taking a neuroscientific approach to the Trolley Problem, Joshua Greene under Jonathan Cohen decided to examine the nature of brain response to moral and ethical conundrums through the use of fMRI. In their more well-known experiments, Greene and Cohen analyzed subjects' responses to the morality of responses in both the trolley problem involving a switch, and a footbridge scenario analogous to the fat man variation of the trolley problem. Their hypothesis suggested that encountering such conflicts evokes both a strong emotional response as well as a reasoned cognitive response that tend to oppose one another. From the fMRI results, they have found that situations highly evoking a more prominent emotional response such as the fat man variant would result in significantly higher brain activity in brain regions associated with response conflict. Meanwhile, more conflict-neutral scenarios, such as the relatively disaffected switch variant, would produce more activity in brain regions associated with higher cognitive functions. The potential ethical ideas being broached, then, revolve around the human capacity for rational justification of moral decision making.
The "famous violinist" thought experiment
The Stanford Encyclopedia of Philosophy describes her thought experiment as follows:
- Judith Jarvis Thomson provided one of the most striking and effective thought experiments in the moral realm. Her example is aimed at a popular anti-abortion argument that goes something like this: The fetus is an innocent person with a right to life. Abortion results in the death of a fetus. Therefore, abortion is morally wrong. In her thought experiment we are asked to imagine a famous violinist falling into a coma. The society of music lovers determines from medical records that you and you alone can save the violinist's life by being hooked up to him for nine months. The music lovers break into your home while you are asleep and hook the unconscious (and unknowing, hence innocent) violinist to you. You may want to unhook him, but you are then faced with this argument put forward by the music lovers: The violinist is an innocent person with a right to life. Unhooking him will result in his death. Therefore, unhooking him is morally wrong.
- Principle of double effect
The principle of double effect (PDE) or doctrine of double effect (DDE), sometimes simply called double effect for short, is a thesis in ethics, usually attributed to Thomas Aquinas. The principle seeks to explain under what circumstances one may act in a way that has both good and bad consequences (a "double effect"). It maintains several conditions that must be met in order for an action to be considered morally right, even though accompanied by some sort of evil effect:
- the act itself must be good or morally neutral
- the good effect must be a result of the act and not of the evil effect
- the evil effect must not be directly willed, but may be foreseen and tolerated
- the good effect outweighs the evil effect, or the two are at least comparable
Intentional harm versus side-effects
Although different writers state the doctrine in different ways, it always claims that there is a moral difference between courses of action such as the following:
- An agent that deliberately causes harm in order to promote some good.
- An agent that promotes some good in such a way that harm is caused as a foreseen side-effect.
The doctrine of double effect stems from an application of the Hippocratic moral norm, "First, do no harm." and Aquinas' First Precept (Principle) of Natural Law "Good is to be Done and Promoted and Evil is to be Avoided" [Summa Theo I-II Q94 Art 2].
The doctrine has practical applications, for example in just war theory, where the deliberate targeting of civilians to demoralise the enemy may be ruled out, but the bombing of munitions plants may be allowed, even if both actions cause the same number of deaths and end the war in the same length of time.
The doctrine is relevant to certain medical cases. The administration of a high dosage of painkillers is sometimes allowed for the relief of pain in cases of terminal illness, even when this will cause death as a side effect. Some (including most Catholic ethicists) hold that this is morally different from deliberate euthanasia for the relief of pain.
In some circumstances it is possible to argue that the doctrine of double effect is a redundant doctrine; for example within palliative or terminal care. It is possible to argue that since the use of analgesia is better understood (in terms of both pharmacology and delivery of medication) and titration of analgesic dose to the pain experienced by the patient is possible, then the desired effect (analgesia) can be achieved without the undesired effect (respiratory suppression). Thirty years of palliative care experience and research has shown that it is invariably possible to manage pain or distress with titrated doses of drugs, without hastening death. This experience has been countered by the claim that that intent cannot be proven in such situations. In reality intent is very easy to identify by reviewing the drug records in any situation where drugs have been given for severe pain and/or distress: - a palliative care physician will use multiple, small doses of an analgesic or sedative, titrating the dose to the patient and the pain or distress, usually subcutaneously or orally for comfort and avoiding serious adverse effects. - other doctors give large doses, invariably intravenously, ignoring serious adverse effects (such as death!) The intent of a palliative care physician is relief without harm, while the second is relief at any cost.
These observations should not be surprising. If a patient receiving chemotherapy develops neutropaenia (a dramatic fall in the infection-fighting white blood cells), there is a risk that they may die from overwhelming infection. If the patient does die, no one shrugs their shoulders and says, 'Oh well, double effect.'! The death would be considered a serious adverse event which needs investigation. Caring for dying patients is no different, and death following treatment for pain or distress would be considered as seriously as death from neutropaenia.
Other examples
A vaccine manufacturer typically knows that while a vaccine will save many lives, a few people will die from side-effects of taking the vaccine. The manufacturing of a drug is in itself morally neutral (assuming that no unethical research practices are used, and that workers are compensated fairly, etc.). The lives are saved as a result of the vaccine, not as a result of the deaths of those who die of side-effects. The bad effect—the deaths due to side-effects—does not further any goals the drug manufacturer has, and hence is not intended as a means to anything. Finally, the number of lives saved is much greater than the number lost, and so the proportionality condition is satisfied. Some moralists add a fifth condition, namely that there must be no alternative. Therefore, if it were possible to find another morally-acceptable way of saving lives, without the risk of death from side-effects, it would not be permissible to produce this vaccine.
The Principle appears useful in war situations. In a just war, it may be morally acceptable to bomb the enemy headquarters to end the war quickly, even if civilians on the streets around the headquarters might die. For, in such a case, the bad effect of civilian deaths is not disproportionate to the good effect of ending the war quickly, and the deaths of the civilians are not intended by the bombers, either as ends or as means. On the other hand, to bomb an enemy orphanage in order to terrorize the enemy into surrender would be unacceptable, because the deaths of the orphans would be intended, in this case as a means to ending the war early, contrary to condition. Whether the Principle applies to the bombing of Hiroshima and Nagasaki is a highly controversial question.
Controversy
Despite some apparent plausibility, the doctrine of double effect is controversial. Utilitarians, in particular, reject the notion that two acts can differ in their permissibility, if both have exactly the same consequences.
A major argument against the DDE is the hypothetical case where some evil must be done to bring about an enormous good. For example, suppose a nuclear bomb has been planted in a major city, and a terrorist involved in its construction (being held in custody) knows where it is. Although he is reluctant to give up the bomb's location, his interrogators can exploit his attachment to his family by torturing them before his eyes, in order to extract the information which would save millions of lives.
Many find it difficult to oppose deliberate evil as a means to an end when the stakes are so high. But if evil acts for good ends might be permissible in extreme cases, then where to draw the line becomes a difficult question - just how high must the stakes be?
In the past few years in the UK, at least two doctors undergoing murder trials for giving large doses of opioids to ill patients, have used the defence of double effect[2].
**** All of the above is from Wikipedia and the photo from the amount of times it has come to me from others, I believe is a public domain shot.
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