Thompson's trolly/transplant problem

Great Debates
1

Trolly problem-
Suppose you are the driver of a trolly. The trolley rounds a bend, and there come into view ahead are five track workmen, who have been repairing the track. The track goes through a bit of a valley at that point, and the sides are steep, so you must stop the trolley if you are to avoid running the five men down. You step on the breaks, but alas they don’t work. Now you suddenly see a spur of track leading off to the right. You can trun the trolly onto it, and thus save the five men on the straight track ahead. Unfortunately, Mrs. Foot has arranged that there is one track workmen on that spur of track. He can no more get off the track in time than the five can, so you will kill him if you turn the trolley onto him. Is it morally permissable for you to turn the trolley? Why or why not? Now consider this case:

Imagine yourself to be a surgeon, a truly great surgeon. Among other things you do, you transplant organs, and you are such a great surgeon that the organs you transplant always take. At the moment you have five patients who need organs. Two need one lunch each, two need a kidney each, and the fifth needs a heart. If they do not get those organs today, they will all die; if you find organs for them today, you can transplant the organs and they will all live. But where to find the lungs, the kidneys, and the heart? The time is almost up when a report is brought to you that a young man who has just come into your clinic for his yearly check-up has exactly the right blood type, and is in excellent health. Lo, you have a possible donor. All you need to do is cut him up and distribute his parts among the five who need them. You ask, but he says, “sorry. I deeply sympahtize, but no.” Would it be morally permissable for you to operate anyway?

Suppose you believe that it is morally permissable to turn the trolley but not to operate. What is the morally relevent difference between the two situations?

2

I think with the trolley you have only two choices, and must take one.

With the transplants, you can reject the conditions stated, and say, Well they might not die today, and Well, other transplant organs may become legitimately available.

The conditions are stated, and in a logic puzzle you have to go with the conditions, but a transplant surgeon in the real world is not in a logic puzzle.

Who’s Mrs. Foot?

3

Oh, I see there is another thread on the same subject has been closed by samclem as a recap of this link.

Notifying moderator at this time.

4

I am a transplant recipient. Permit me to inject some unwanted reality into your logic puzzle, because there are far, far too many aggrevious errors in your puzzle about transplant surgery as stated, and people should not be further confused about the process.

First. Regardless whether it is morally imperative to operate, given that a doctor has taken an oath to do no harm, one surgeon simply cannot be expected to perform all of those surgeries himself within the time allowed. A liver transplant takes about ten hours of surgery; I have to believe a heart transplant and a lung transplant are each at least that long—and you haven’t even got the organs harvested when your “within one day” begins, so add a few hours on for good measure.

Further reality: even though the kidney transplant operations are technically the shortest to perform, one to two hours perhaps, and two could be done in a day by a single surgeon, patients with acute kidney failure can go on dialysis as interrim therapy until a kidney does become available. Dialysis is effective even if both patient’s kidneys are completely removed and/or non-functional. Unless there’s dynamite in the kidneys…

While a heart transplant is done, the patient’s blood is pumped and heated by a machine. As only a laypatient, I have not heard that this was designed as a long-term solution for a patient waiting for a heart (as is dialysis). I imagine it could probably prolong a patient’s life for the hours necessary until an organ became available. I’m not positive whether intubation and artificial respiration would similarly be available for an acute lung transplant patient; that would depend on the nature of the injury, I suppose.

The worst error: surgeons don’t, don’t, don’t pick donors. They do not change their treatment of living patients to fill some supply-end problem in the transplant business. Only after death has been declared are the harvest teams even contacted that there is a potential donor, they don’t begin to prep or harvest until the family has consented, and this is the important part, they are different doctors from the ones who tried to save the patient’s life.

And last, there are different states on any transplant waiting list, based both on how long one has been on it, and how acute one’s condition is. Patients move up and down this list all the time. Even though there is a chronic shortage of available organs, the availability is triaged so the worst go first. One patient may need a heart transplant before the week is out; he may have to wait an extra day for the sudden case who needs the operation now.

I know you wanted to make this a debate about morals and ethics, but please refrain from perpetuating some of the worst-feared myths about transplant surgery.