Suppose you are standing beside some tram tracks, and you see a trolley coming down the track, and five people are laying down the tracks towards five workers who were laying down on the track and they cannot move their body because their feet and hands were tied. At this time, you can make the tram change lanes and save five people by pulling the lever beside it. Unfortunately, there is also a person tied to the other track, that is to say, if you pull the lever, you can save five people, but the other person will die. Will you still choose to pull the lever?
This is a trolley problem created by philosopher Philippa Foot. It is also one of the top ten most famous thought experiments. It is used to criticize the main theories in ethical philosophy, especially utilitarianism. Because from the utilitarian point of view, most people will choose to pull the lever to save five people, because five lives are definitely greater than one life, which is the best way to minimize the loss of lives. But here’s the problem, once you pull the lever, you become an accomplice of immoral behavior-you are partly responsible for the death of a single person on another track. On the other hand, other people think that if you refuse to pull the lever, your inaction will be equally immoral. Let’s move on to another example, imagining you are visiting an authoritarian country as a tourist. The local dictator arrested five innocent residents and sentenced them to death for alleged rebellion. Now you have a gun, if you shoot the dictator yourself, those five people can be released. But if you don’t do it, they’ll be killed. At this time, would you choose to shoot the dictator to save those five people? Or refuse to sit back and watch all five people be shot? It’s the same question of one for five, but the action of “shooting” the dictator is more like murder. And at the same time, under the double test of humanity and morality, no one can give a perfect answer so far. The above two examples are a moral paradox, which reflects the opposition between good and evil in the result of a moral behavior choice and value realization. You might think this is a meaningless topic to discuss, but philosophers often use these problems as examples to show that the situation in real life often forces a person to violate their own moral standards, and there are still situations where there is no complete moral practice. Since there is no right or wrong answer for the problems mentioned above, this means a moral dilemma can’t be avoided.
Dropping of atomic bomb on Hiroshima in 1945 has been a long debated whether or not it is a moral decision because people argue the use of atomic bomb is destructive while others argue the decision was necessary to end Japan’s future invasions which could save more than those 200,000 people who died in the atomic bombings in Hiroshima and Nagasaki. So how do dropping the atomic bomb can save further lives?
To begin with, Germany has a strong military power over the rest of European countries because Germany had conquered most of Europe and invaded the Soviet Union in 1941. Indicating Germany was the most powerful member in Axis power as well. On the other hand, Japan is on Axis power with Germany, after the Allies defeated Germany, the U.S. is still at war with Japan because of Japan’s attack on Pearl Harbor in 1941. Japan seems to have no fear of fighting alone with Allies since they were not intended to end the war or surrender even though Germany, their powerful alliance declared surrender at the Potsdam Conference held near Berlin on May 7th, 1945. Moreover, the Potsdam Declaration on July 26th, 1945 declared the unconditional surrender of Japan or else Japan would face prompt and utter destruction. Anyhow, Japan did not surrender. Japan’s refusal to surrender states their arm forces were still strong enough to begin another attack on U.S territories. In other words, Japan’s motivations on attacking the U.S. still remained so there will be a potential threat to the U.S. If they do, then as time went by, their aggressions could’ve grown and there is a possibility for the U.S. and Japan to start a battle and could result in massive loss of lives on both sides.
It was clear that if the U.S. did not do any “shocking” or “impressive” actions to Japan it is impossible for them to end their aggressions to invade the U.S. The Potsdam Conference already gave Japan a chance to surrender to prevent battles with the U.S., but Japan didn’t take it. Furthermore, Japan once again demonstrated their resistance to surrender when the U.S. dropped the first atomic bomb in Hiroshima on August 6th, 1945. Also, the Soviet Union declared the war after the bomb in Hiroshima, if Japan already had a taste of how destructive the atomic bomb that was dropped in Hiroshima, they would’ve acknowledged their army had no capacity to fight with the U.S. and Soviet Union, which they could surrender immediately.
As long as Japan does not officially surrender, they can still be a threat to U.S. security. They did not surrender until the second atomic bomb was dropped in Nagasaki on August 9th, 1945. Yet the U.S. decision to drop the atomic bombs were devastating, resulting between 90,000 and 166,000 loss of lives(a cooperative Japan-U.S. organization). Some people are criticizing the U.S. as a “crime against God and humanity which strikes at the very basis of moral existence(Nippon Times). Those who opposed the “use”of atomic bombs considered the U.S. decision was immoral because the atomic bomb was so horrible and destructive to human lives, “Hiroshima was no longer a city but a burned-over prairie” (Hachiya). In contrast, those who believe Japan deserved to be bombed because “it stopped the fire raids and the strangling blockade; it ended the ghastly specter of a clash of great land armies” (Harry Stimson). In other words, even though the use of the bomb was an immoral path to end the war, but it was the fastest solution to prevent further casualties. Meaning the decision of dropping Atomic Bomb in Hiroshima is justified because its purpose is to stop the further wars which could save more than those 250,000 people who died under the atomic bombs.
Just like the trolly problem, there will be trade-offs in both solutions, and none of those solutions have a perfect solution nor can be morally justified.
Philosophy, law and medical ethics are all trying to solve the problem of how to differentiate between saving people and killing others. Although this difference seems simple intuitively, it is much more complicated when treating novel coronavirus’s patients. Ethical medical triage decision-making based on utilitarianism theory has been imposed on health professionals in order to maximize the overall benefits and life expectancy. In addition, the decision to limit the benefits of treatment is not arbitrary, but an indispensable countermeasure to deal with the COVID-19.
After Covid-19 outbreak has spread across the world, many countries became the Epicenter, it sets up a moral dilemma in which it forces the governments and hospitals to explore the limits of moral responsibility. Hospitals were forced to make harrowing choices-whether to save the elderly with lower recovery rate or younger patients with higher recovery rate within the limit of medical resources.
So how should the problem be “fairly” solved? First come first serve seems to be a fair approach, but can this approach maximize the benefits? The answer is no. Early in the pandemic, ventilators in Italy were in short supply, it forced the hospitals to take the utilitarian approach-prioritizing the younger patients’ value to determine which individuals are eligible to use the ventilator. According to a Milanese doctor, she told ITV: “at Niguarda, the other big hospital in Milan, they are not incubating anyone over 60”. As stated by another doctor, Connor McAnish, he says “with so many patients coming in, when someone dies it’s almost as if we say, ‘OK we couldn’t do anything for this person, now we can take another person and see if their condition will improve’.” In addition, the 6 applications to the Covid-19 pandemic devised by Dr. Emanuel and his team suggest maximizing benefits will be the best approach towards the issue-that is, save the younger patients instead of first- come first-serve. These recommendations are as follows:
• Maximize benefits.”
• “Prioritize health workers.”
• “Do not allocate on a first-come, first-served basis.”
• “Be responsive to evidence.”
• “Recognize research participation.”
• “Apply the same principles to all COVID-19 and non-COVID-19 patients.”
Even though Italy prioritizing to save younger patients is such a discrimination in which it indicates elderly are less importance than young people, thus devalues human life and violates the egalitarian principles: all lives are of equal value. But data from Statista has shown mortality rate appears to be much higher for elderly patients, therefore prioritizing the younger patients is a better choice for maximizing the benefits.
In short, we can never get rid of the moral dilemma,whether the hospitals chose to secure individuals’equality or to prioritize the younger patients, both of the methods can’t prevent the ethical conflicts and the harm to others. The value of first-come-first-served principle and utilitarian framework have their own advantages and disadvantages; However, the root cause of the problem lies in the insufficient medical supplies to treat these patients. If these supplies were available, then the process would run much smoothly.