by Dr. Jasmine Kaur
Imagine you’re in the driver’s seat of a runaway trolley speeding down a track. As you look ahead, you see that the trolley is headed straight for five people who are tied to the tracks and cannot move. Your only option is to pull a lever that will divert the trolley onto a different track. But here’s the catch: this second track has only one person tied to it.
So, here’s the heart-wrenching decision: do you pull the lever and sacrifice one person to save five, or do you let the trolley continue on its current path, resulting in the deaths of five?
Philosopher Philippa Foot first presented this dilemma to explore the ethics of choosing between sacrificing one life to save many versus not intervening and letting more people die. Foot concluded that diverting the trolley, though morally difficult, seems acceptable when viewed from a utilitarian perspective—minimizing overall harm by choosing to kill one rather than five.
However, Foot also considered a more complex situation: a surgeon who must choose whether to sacrifice a healthy person to save five terminally ill patients through organ donation. Here, the ethical response shifts. Even though saving five lives might seem to justify killing one, many people, including Foot, believe that actively causing harm to an innocent person is morally unacceptable, even in the face of a greater good.
Foot’s analysis reveals an important distinction between negative and positive duties. Negative duties are those we have not to do something, such as not causing harm. Positive duties are obligations to do something, like helping others. According to Foot, negative duties hold greater moral weight. This is why, in the case of the trolley, it is deemed acceptable to divert it, whereas in the case of the transplant, it is not.
The trolley dilemma pits the duty of not harming against the duty of helping. In the case of the transplant, killing the healthy person violates the negative duty of not causing harm, even if it would save more lives. The ethical principle of non-maleficence—do no harm—overrides the positive duty to help the five patients.
In today’s digital age, similar ethical questions arise, particularly in healthcare and AI. For example, AI systems that allocate scarce medical resources—like ventilators or medications— face decisions reminiscent of the trolley problem. These systems must balance the benefits of saving more lives with the ethical implications of potentially depriving some patients of needed care.
Another crucial area is the use of personal health data. While leveraging data can enhance public health interventions and improve outcomes, it must be done with strict attention to privacy and consent. Just as Foot’s trolley dilemma challenges us to weigh the moral implications of our actions, modern digital health decisions must balance the collective benefits with individual rights.
As you navigate these ethical landscapes, whether in technology, healthcare, or beyond, remember that every choice carries weight. The trolley dilemma serves as a powerful reminder that our decisions, even when made with the best intentions, can have profound consequences. Reflect on how you can make choices that not only aim for the greater good but also honor the dignity and rights of every individual affected. In a world increasingly driven by technology, let’s ensure that our ethical compass guides us towards a future where innovation and humanity move forward hand in hand.
References:
1. Andrade G. Medical ethics and the trolley Problem. J Med Ethics Hist Med. 2019 Mar 17;12:3. PMID: 31346396; PMCID: PMC6642460.
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