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Thoughts, opinions and insights on life, medicine and mental well-being.

Trolleys, Doctors, and Dilemmas

Imagine you are the driver of a trolley and it’s speeding down the tracks. The brakes aren’t working and there is no way of stopping it. Now, on the track up ahead are 5 workers who are idling away eating their lunch. They can’t see you or the train and they can’t get out of the way in time. The train will certainly kill them all. But there is another option; you can move a lever to redirect the train onto a different track, but on this track there is only one person, equally idle and enjoying his lunch. So the question is: Do you stay on the track and kill five people or do you pull the lever and kill the one?

The question above is a variation of a thought experiment, created by British philosopher, Philippa Foot, that sought to explore the different aspects of moral philosophy.

If you allow the train to stay its course and inevitably kill the five workers, chances are you belong to the deontological school of thought.The deontologists argue that morality is based on duties and rules, not outcomes. They say that killing is morally wrong, even if it is to save others. 

On the other hand, pulling the lever to make the train kill one person follows the utilitarian viewpoint, which is to maximize happiness or reduce suffering as much as possible.The more people saved, the better. Utilitarians are concerned with outcomes rather than actions, duties or rules.

Ultimately, it is of importance to note that there is no definitive solution to the trolley problem. Like most other philosophical practices, it is intended to provoke thought and allow for discussion. It also provides insight and forces us to question the reasons behind our actions and inactions.

Why am I spending so much time talking about the trolley problem? Not too long ago, there was an unfortunate incident involving a doctor and the Minister of Health at one of the teaching hospitals in the country where I reside. To summarize, there was a brief moment of heated interaction between the minister and a doctor following allegations of medical negligence. The doctor explained that this wasn’t the case, as the clinic lacked ventilators required to keep the patient alive. The minister however insisted that the hospital should have improvised and made do with whatever resources were available.

In the aftermath of the incident, the doctors at the facility declared an indefinite strike, stating they would only resume duty if their list of demands was met, one of which included the provision of about a dozen ventilators, among several other requirements.

This action by the doctors sparked a debate across social media. Some argued that it is not right for doctors to negotiate with the lives of patients as their primary duty is to save lives regardless of the circumstances. Others maintained that there is a universal standard for the practice of medicine, which can only be achieved with the necessary tools the doctors are demanding.

I am not here to debate the morality of the decision made by the doctors, but to simply point out that sometimes we are faced with real life trolley problems; ones that require us to make tough decisions. If you were a medical doctor in the hot and humid city of Tamale, would you attend to the little child suffering from meningitis despite deeper systemic issues or would you follow the directions of your superiors and wait for the much needed medical equipment?

5 responses to “Trolleys, Doctors, and Dilemmas”

  1. Beauty Dzeble Avatar
    Beauty Dzeble

    I will save the child life first

  2. Benjamin Ackah-Quansah Avatar
    Benjamin Ackah-Quansah

    In our part of the world Ghana the quest to sue for medical negligence is almost non existent. It’s quite unfortunate that with my littr knowledge in medical insurance the cost of medical negligence resulting in budget overrun on a victim should not be taken lightly. Interestingly such cases even though may be investigated and appropriate sanctions applied the cost of that medical negligence hardly get measured appropriately to assess the toll it is having on the scanty resources on already overburdened budgets of such insurance companies. The main reasons in my opinion is that, the government is a major stakeholder in providing insurance through the national health insurance scheme and most likely unlikely to prosecute its own employees (doctors, pharmacists, nurses and others). With the surge in private mutual health insurance companies the narrative has not changed- reasons being that, some of the enquiries into medical negligence remain an internal issue until victims request for legal suit before copies are made available.
    In the scarcity of resources, when a doctor finds himself in a hospital and faced with a classical case of a child with meningitis, the very limited available resources should be relied upon to try and save the child’s life. An excuse of no or limited resources cannot be justified to lose a child. In any legal implications the case will be weighed on its merit. An attempt to save life with limited resources is more sensible than doing nothing in the name of inadequate resources. One can easily defend himself in such instance should the patient die.

    1. William Horsu Avatar

      An insightful reply and a perspective I did not consider while writing this piece,thank you !

  3. Vivian Anagbonu Avatar
    Vivian Anagbonu

    I will first save the patient and continue to demand the right equipment for the job

    1. William Horsu Avatar

      A solution that covers all grounds, efficient.

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