The Healthcare CEO Trolley Problem
What would you do?
Trolley Problem:
A classic ethical dilemma where an onlooker (you) can save multiple people trapped in the path of a runaway trolley — but only by switching the track to kill another.
On the face of it, the answer to the trolley problem seems simple.
Five lives trump one, right?
Well, maybe…
Before rushing to that conclusion, carefully consider the impact of your intervention.
The trolley is already out of control, so inaction changes nothing. As soon as you intervene, you’ve given someone a death sentence who did not already have one.
For better or worse, your intervention directly killed that person.
The others were already in their unfortunate position whether you were there or not.
There’s a classic thought experiment in the field of medical ethics that shines a more obvious light on the issue with the utilitarian “five lives trumps one” argument.
Let’s first reframe the problem:
You’re a transplant surgeon working in a busy hospital and you have five patients waiting on life-saving organ donations.
Each of these patients have exhausted all other options with no improvement, and they’ll inevitably die without a transplant.
A healthy person is sitting in the waiting room.
If you answered “five lives trump one” to the trolley problem, would you be okay with the surgeon harvesting these healthy organs (killing the healthy patient in the process) to save his five dying patients?
Consider why you changed your answer here.
Now, let’s bring this back to the original trolley problem…
You’re an observer with a switch that can turn the track in either direction:
• On one side lies thousands of people seeking essential healthcare.
• On the other side is the CEO of the insurance company denying their claims.
Would you flip the switch?
Although not an accurate depiction of recent events, this might be how Luigi (the alleged CEO-killer) framed this problem in his head.
The aim of an activist is to spark a movement that ignites change — and politically motivated murder undoubtedly gets people talking.
Luigi chose to flip the switch.
He may have felt that he was, in some way, saving the lives of many at the expense of just one.
Or maybe it was an act of anger towards a broken system. Who knows.
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Lift out the switch lever, push it in front of wheels to derail the trolley, then remove the trapped people from the track. In other words, reset the analogy beyond perceived confines.
It's also interesting to consider how judgements of value and worthiness enter the equation. One's choice may depend on their assessment of each potential victim, either inherent value or value toward some goal or ideal.
Of course, fixing the broken "trolley system" would be a preferable option.