In 1967, an English philosopher by the name of Phillipa Foot, devised a thought experiment in order to test human morality. What came from it was an ethical dilemma aptly named the Trolley Problem. Morals and ethics are a part of our everyday life and shapes nearly every decision we make—both small and large. Each both relate to what we consider “right” and “wrong”, but what is the difference between the two? Morals are principles that come from one’s own beliefs and values. It is the guiding star to how we personally feel in a given circumstance. On the other hand, ethics are guiding rules that come from an external source governing a person’s behavior or conduct.
Imagine a runaway trolley approaching a fork in the tracks. As a bystander, you notice that there is a junction that splits from the main line. On the main line, 5 people are tied to the track. The other has only one person tied to it. Beside you is a lever to divert the train. By pulling the lever, you save 5 lives but doom the life of one. On the other hand, by doing nothing, 5 lives are lost and 1 is saved.
Utilitarian schools of philosophy argue that by pulling the lever and sacrificing one person is the best course of action. However, Deontological ethics believe the very act of choosing to pull the lever is morally wrong. By pulling the lever, you have consciously decided to kill an individual.
More than 50 years later, the Trolley Problem continues to play an important and critical role in morals and ethics in several practices around the world—especially in science, military, and healthcare industries. Thankfully for the healthcare industry, there are tools in place to assist doctors in the difficult task of making split-second, moral decisions similar to the Trolley Problem today.
AccessEMR features checks and balances to protect against medical errors. For example, Prescription Screening support doctors in the decision-making process and help them identify and assess which patients need the most care. For example, if the physician would like to prescribe penicillin to a patient, the system screens the antibiotic, along with any other medication the patient is taking. If the system finds that there are adverse interactions between two drugs, the physician is then notified. In addition to drug-to-drug interactions, AccessEMR is also capable of advising the doctor of any drug allergies the patient may have.
However, while AccessEMR does offer these checks and balances to medical professionals, there may be rare occasions that the best option for the patient is for the physician to ignore these checks. Scenarios such as these are most common in palliative care. Palliative care patients are patients nearing the end of their life and primary care shifts to relieving pain, symptoms, and stress from the patient. Strong pain medications, such as morphine, are sometimes the only solution. Unfortunately, strong pain medication like morphine have strong side effects, leaving the physician with a difficult moral dilemma.
Is it morally right or wrong for a physician to administer pain at the expense of introducing other side effects, such as constipation? What level of pain is the patient currently experiencing? Although the patient may desire a specific procedure, it is ultimately up to the physician to think about whether or not that particular procedure will cause more harm than good for the patient.
What is your opinion on the Trolley Problem? Do you have a story of a loved one in a palliative state? We would love to hear your story and thoughts in the comments below. If you’re interested to learn more about AccessEMR and how it assists doctors in their workflow, you can contact us here.