Fat man appears to have significant dilemma

Shahar Madjar, MD

No matter how hard she tried, Dr. Margaret Wise could not suppress the image of the fat man standing on the bridge.

She had learned about the fat man as a medical student, during a Bioethics 101, a class she elected to take in the summer semester of 1991.

Dr. Wise remembered the lesson vividly. The bioethics professor, a man with a long beard and round black glasses stood in front of a group of students, about two dozens of them, and described the problem — he called it the Trolley problem — as such:

Suppose you are standing along the side of railway track. A trolley is coming down the track. Ahead, there are five people tied up to the track. They are unable to free themselves and there is no one that can help them escape.

Without any intervention, the trolley would run over the five people and they would die. Now, you are standing a few steps from the track next to a lever. If you pull the lever, the trolley will be diverted to a different track where there is only one person tied up to the track.

What would you do? The professor asked the students.

Margaret initially thought that the Trolley problem was not difficult: If she does nothing, the five people tied to the main track would die. If she pulls the lever, diverting the trolley onto the side track, only one person would die. Pulling the lever and saving the lives of four people, she thought, would be the most appropriate action.

“But what if,” the professor asked, the way philosophers do when they want to prove that the initial response to a problem is not necessarily the most appropriate ethical solution — “what if the person tied to the different track is of particular value to society, say a beloved leader, a doctor who can save the lives of many, or an artist whose works inspire millions of people … or, what if the person tied to the different track is your beloved father, your sister, your son? Would you still divert the trolley?

The classroom fell silent. And Margaret was not so sure anymore.

“Let’s complicate the problem even more,” the professor said as he introduced the fat man dilemma. “Imagine a similar situation — the trolley is moving along the track toward five people tied to the track. But there is no other track, and no lever! Instead, you are standing on a bridge over the track. Next to you stands a very fat man. You can push the fat man off the bridge and onto the track. The fat man would definitely die, but his heavy body would ultimately stop the trolley and save the five people tied to the track. Would you push the fat man onto his death, in order to save the lives of five people?

Margaret knew that although the arithmetic of the two situations was similar — after all, a net of four lives would be saved by her either pulling the level, or pushing the fat man – she could not push the fat man to his death.

“Not so simple anymore, ha?” The professor laughed briefly.

“Now consider an even more difficult dilemma,” the professor continued. “Suppose you are already a doctor, and suppose there are five patients waiting for a transplant. One of them needs a heart transplant, two need a kidney, another needs a liver, yet another needs a lung transplant. Without a transplant, they would all die. During the course of your day, you examine another man whom you see for a routine checkup. You find out that not only is he in a perfect health, but he would be a perfect matching-donor for all five patients. Suppose the man is just a drifter that passes through town. He has no family and no friends, and should he disappear, nobody would inquire about him. Would you support killing the drifter to save the lives of the five people in need of transplantation?”

Dr. Wise could not fall asleep. The image of the fat man on the bridge kept appearing in her mind. And so did the image of the bioethics professor with his trolleys and the unaccounted-for drifter whose theoretical murder can really save lives. She knew that tomorrow, at the bioethics committee she would be faced with a real case: the case of conjoined twin girls attached to each other from the xyphoid bone to the pelvis. One is well; the other is sick but still alive. Doing nothing will most likely result in the death of both girls. Surgically separating the twins will most likely result in the death of one twin and the survival of the other. Would sacrificing one twin in order to save the other be justified?

Dr. Wise tried to turn off the image of the fat man. She sank into her bed and her eyes closed. Tomorrow is a big day, she thought just before she fell asleep — time for decision.

I shall return.

EDITOR’S NOTE: Dr. Jim Surrell is the author of “The ABC’s For Success In All We Do” and the “SOS (Stop Only Sugar) Diet” books. He has his practice at the Digestive Health Clinic at U.P. Health System-Marquette. Requests for health topics for this column are encouraged. Contact Dr. Surrell by email at sosdietdoc@gmail.com.