The Covid Trolley Problem

The Covid Trolley Problem

 

 

Every student of modern Anglophone philosophy is familiar with the “Trolley Problem”, a thought experiment designed to tease out our moral intuitions when confronted with life-and-death dilemmas. 

 

It goes like this. You (the agent) just happen to be at the junction of a narrow-gauge railway, where a hand operated lever can switch the direction of travel down either of two branch lines. The track services a quarry high in the hills behind you. You glance up the line and, to your horror, you see that a big trolley full of rocks has broken away from its station and is hurtling down the track. You turn and, to your further horror, you see that there are 5 people walking along the branch which the trolley will career down. You can save them by moving the lever and diverting the trolley down the other branch. But, horror piling upon horror, there is a solitary walker on that line, who will be surely killed if you switch the trolley’s direction.

 

What would you do…? Before you answer (and it is said that most people would pull the lever and switch), note that, as posed, the dilemma essentially involves stick people – barely more than numeric digits.

 

Once one starts populating each line with more plausible human types, it becomes apparent that the dilemma is potentially very complicated and admits of various responses. Consider:

 

-       The single individual is your spouse, or parent, or child;

-       The single individual is a very young child, and the 5 are very old;

-       The single individual is the Queen, or Nelson Mandela, or someone else greatly admired and/or loved;

-       You are aware that a group of lethal terrorists are being hunted in the area. The 5 could be them, and the single individual a pursuing policeman..

And so on.

 Many readers will recognise the influence of the inimitable Bernard Williams in these remarks. He was an impassioned opponent of moral generalities from which an agent is to deduce the right action in particular circumstances.

 

In an example that is very near to the Trolley dilemma, Williams considers whether, in some catastrophic scenario, an agent may choose to save his or her wife instead of another victim. Williams writes, in a famous (and to me unforgettable) passage:

 

“[A decision to save the wife is usually justified by] the idea that moral principle can legitimate his preference, yielding the conclusion that in situations of this kind it is at least all right (morally permissible) to save one’s wife… But this construction provides the agent with one thought too many: it might have been hoped by some (for instance, by his wife) that his motivating thought , fully spelled out , would be the thought that it is his wife, not that it was his wife and that in situations of this kind it is permissible to save one’s wife.”

Moral Luck, 1981, p18

 

Williams believed that an agent’s decisions, including moral decisions, are grounded in the in the agent’s deepest commitments. He would not have avoided the Trolley dilemma. Indeed, his work contains discussions of similar problems. But he insists on at least two matters: the particular circumstances and commitments of the agent are critical to his or her decision; and that an excruciating choice is just that – a choice which leaves someone wronged, or dead, and that there is no “morality system” that can absolve the agent of regret or guilt.

It’s one thing to weigh stick people in the ethical scales. Numbers may well triumph. Change the characteristics of the people and numbers become a factor among others in forming the agent’s judgment, even if numbers are often the most important.

 

Life and death deliberations like that posed by the Trolley do not end with decisions that lie easy on the moral conscience. There’s almost always an awful fate for some, or someone. . The agent hopes that he or she has, in the circumstances, made the least worse decision. Unfortunately, depending on which of many moral viewpoints has the decision in frame, the agent will always be harried by contradictory philosophic traditions. As we see next.

 

Numbers in the moral scale need not be numbers of persons. In the Covid emergency, debate has arisen about numbers of years- the old versus the young. Instead of the trolley switcher, there’s the doctor, who has to decide which very ill patient on an actual A&E trolley gets treatment, when it is limited by availability of equipment. Treat the young before the old?

 

In recent issues of Prospect magazine this question has been directly debated by a philosopher, Peter Singer, and a Church of England priest (June 2020), and discussed by another philosopher, Julian Baginni (March 2020). Peter Singer is a Utilitarian philosopher in the classic tradition. He believes that the Good (definition to be supplied) should be maximised. He argues that there is no doubt that the potential for life, measured in years, is a Good. Saving younger lives maximises the overall Good. Saving older lives fails the maximisation test.

 

Singer’s debate antagonist balks at this, worrying about the quantitive nature of the argument, which ignores other human qualities and worth. Although she undoubtedly expresses the deep unease many feel at the stark Utilitarian position, she doesn’t quite articulate a strong contrary argument. Demurring, whilst many will share the demur, still leaves a sense that the utilitarian has had the better of the argument in narrow terms.

 

Baginni, although writing before the debate just mentioned, puts a more precise finger on the worries.

 

He starts by acknowledging that cost-benefit analysis is an essential public health tool. There are always trade offs to be made between priorities and resources – and these trade offs may cost lives. Looking more broadly at public policy difficulties of measurement arise – should, say, the funding of the Arts be diverted to Health? Here one is not comparing like with like - in Utilitarian terms they are different sorts of Good.

 

Implicitly against the Singer position, Baginni argues that there is no objective way of measuring the quality, or worth, of any life, at any age. The quality and worth depends on so many variables. People suffering from incurable and physically debilitating conditions may exemplify worth and still lead a life full of quality. Consider the astrophysicist Stephen Hawking. (Baginni cites another but similar example.) Certainly, Baginni concedes that clinicians have to make difficult decisions about treatment choices. But in the end, he says, it should be about survival chances, if it is about anything. Age is of course a big factor, but it is not the (de)terminator.

 

This resonates well, especially with an ageing reader, or blogger. But in desperate clinical situations, which have occurred and are occurring in too many countries, doctors have to make dreadful, and desperately quick decisions. It is no wonder that age becomes a crude decision tool. If you’re 60 or 65 years old – go away, the hospital won’t accept you; if you’re in hospital and 60 or 65 years old – sorry your ventilator is needed for someone younger.

This is decision making far removed from philosophic debate. It is not about the morally best, or better. It is about managing resources amid lethal chaos. It is making what may average out as the least bad choice. The individual patient, in such dire circumstances, goes back to being a stick person.

 

July 2020