The Trolley Problem BreathesOctober 24, 2009
This fantastic real-world account from the New York Times deserves closer examination. Check out this killer scenario:
A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.
New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan — actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.
Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.
The original trolley problem, for those unfamiliar with our sordid and incestuous body of literature in philosophy, is neatly summarized here. The NYTimes doesn’t offer us an exact parallel to the trolley problem, but I do like that we’re asked whether we should remove the ventilator of the man suffering from cystic fibrosis. (And why not? Shouldn’t we just turn the trolley to save the five? Ethics is a breeze!)
Yeah, so, I think the Times could be clearer on the scenario. From what I gather, the dude isn’t sick with H1N1, he’s just unlucky enough to have the opportunity to stumble into the hospital at the wrong time. Let’s assume that.
Also, it’s not clear if it’s his ventilator or the hospital’s ventilator. If it’s his ventilator, I think a lot of people would say that he shouldn’t have it taken from him. It’s just a contingency that he’s in the hospital at that time. Seems reasonable. He owns it.
If the ventilator is on loan from the hospital, I suspect fewer people would say that the hospital has no jurisdiction to take it from him, but I suspect that most would argue that the hospital still ought not to take it from him. They might argue along “first in time, first in right” style reasoning.
The question is: why would this ever be a guideline at all? Seems in both cases that the ventilator should stay with the man whose life depends on it. Doesn’t make sense to send the ventilator to another room, to save one H1N1 patient, only to have this guy die, particularly since his death isn’t linked directly to H1N1 and it’s not a question of simple ventilator allocation.
Suppose instead a different scenario. Suppose that our hypothetical cystic fibrosis patient is using a special sort of ventilator that could be used to save five people. Maybe H1N1 requires different pressures or something. What then? Do the numbers change our conclusion that he ought to be allowed to keep his ventilator?