Can there be one answer to an ethical dilemma?

Trolley

Imagine this: You’re the driver of a trolley filled with people. Up ahead you see five people chained to the tracks, unable to move. If you pull a lever, you can change the direction of the trolley towards a different track, but in doing so you’ll kill a bystander who does not have time to step out of the trolley’s way. What do you do: kill one person or five?

When you phrase the question that way, it seems obvious that five saved lives are better than one. But the Devil’s in the details, as they say, and the phrasing of a question says a lot more than the ‘correctness’ of an answer.

No wonder medical school’s infamously ask aspiring physicians questions like these. Saving lives can be quite literal in many medical situations, and (fortunately or unfortunately — depending on who you ask) the residing physician assumes responsibility for the outcome of a patient’s recovery. So much so, that many even compare physicians to ‘gatekeepers’ who decide a patient’s fate as if it’s a binary choice as simple as opening or closing a door. It is easy to see why a relationship between medicine and ethics has to exist, but harder, it seems, to define that relationship.

Recently there have been attempts to redefine ethical medicine — and ‘health’ more generally — by appealing to social sciences. As the humanities have had to defend their place in education, many public figures on both sides of the argument have agreed on the necessity of applying humanities skills in STEM fields. Critical thinking, cultural understanding, and the ability to translate field-specific terminology into layman terms are just a few skills learned in a humanities education that are indispensable in healthcare settings. While a comprehensive understanding of the science behind health is invaluable, a humanities education alongside that specialized knowledge could create positive implications that reach far beyond improving bedside manner.

Discussions like these have led many health professionals and researchers towards efforts that could bridge the gap between religion and health specifically, as the two intersect more often than not and especially when an individual’s confidence in their health is shaken by illness. The July 2018 volume of The American Medical Association’s Journal of Ethics titled “Religion and Spirituality in Health Care Practice”, is a good example of one attempt to rebuild this complicated relationship. But, after reading the edition (which asks questions like “How should clinicians respond to requests from patients to participate in prayer?”), I couldn’t stop asking myself:

Aren’t ethical questions supposed to have more than one answer?

In my mind, the point of an ethical dilemma is to contextualize and complicate, something several articles in this AMA volume didn’t seem to do. Though the situations they evaluated were highly specific, the authors tended to generalize one possible answer into the universalized, ‘correct’ answer. For example, in response to the question of praying with a patient, the journals’ commentators only explore situations in which the provider agrees to participate in prayer. Though the contributors acknowledge that denying participation is an option, they rely on broad assumptions that imply that the correct response is not only to participate in prayer but that even in the type of prayer performed can be assumed.

I appreciate the authors’ efforts to encourage critical, self-reflective thinking, but find serious fault in the ways that this article assumes support for a particular religious majority by leaving terms like ‘prayer’, ‘health’ and ‘religion’ unsignified. Not many people realize that half the conversation within the field of ‘religious studies’ revolves around figuring out what ‘religion’ even means in the first place. Realizing that even specialized scholars cannot agree on a definition of their field (which I feel obliged to add is not unique to religious studies) makes the use of these terms as if they are self-evident in the AMA more obviously problematic. The problem for me is first; that there are endless situations in which a providers’ definition of ‘proper’ healthcare might conflict with their patients, but, secondly and, more importantly; that there are endless conflicting definitions at play within these dilemmas.

Image from page 769 of "Treatise on the diseases of the eye, including the anatomy of the organ" (1868)

So then, how on earth are we supposed to answer ethical questions if the terms we use don’t always describe what we think they seem to? That, my friend, is one question that one sector of religious studies is trying to figure out. The point here, though, is not to ask questions so they provide one answer, but to ask them in a way that could be more or less useful based on the context of the situation. So back to the trolley, who would you save? Einstein or five criminals? But what if the criminals are falsely accused, or had stolen a loaf of bread to feed their starving family? But if you kill Einstein, how does WWII end? Does it end at all?! For me, issues of ethics are about realizing there was no simple choice to begin with, but many choices whose ‘correctness’ was contingent upon the circumstance. Frustrating, I know, but isnt there something comforting in knowing there’s never a right answer? Or to put it more optimistically, knowing that there are many right answers?

It’s safe to say that you’ll never actually drive a trolley and have to choose between saving one person or five, but actually, isn’t this something we’re doing constantly? We are continually using comparative skills to qualify the choices we make (e.g.: I will eat Chipotle for dinner because I worked out earlier). But just because the choice is made does not mean it’s more or less right than another option. Contextualizing and historicizing the information presented to us must be done to make informed decisions. Whether you‘re a practicing physician or a grad student writing a blog post, the way you phrase a question and the way questions are presented to you, matter. And no, there’s never one answer to an ethical dilemma.

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