Andrade Gabriel
Assistant Professor, Department of Ethics and Behavioral Science, School of Medicine, St. Matthew's University, Cayman Islands.
J Med Ethics Hist Med. 2019 Mar 17;12:3. eCollection 2019.
The so-called Trolley Problem was first discussed by Philippa Foot in 1967 as a way to test moral intuitions regarding the doctrine of double effect, Kantian principles and utilitarianism. Ever since, a great number of philosophers and psychologists have come up with alternative scenarios to further test intuitions and the relevance of conventional moral doctrines. Given that physicians routinely face moral decisions regarding life and death, the Trolley Problem should be considered of great importance in medical ethics. In this article, five "classic" trolley scenarios are discussed: the driver diverting the trolley, a bystander pulling a lever to divert the trolley, a fat man being thrown from a bridge to stop the trolley, a bystander pulling a lever to divert a trolley so that a fat man may be run over, and a bystander pulling a lever so that a fat man falls off from a bridge to stop the trolley. As these scenarios are discussed, relevant moral differences amongst them are addressed, and some of the applications in medical ethics are discussed. The article concludes that Trolley scenarios are not the ultimate criterion to make ethical decisions in difficult ethical challenges in medicine cases but they do serve as an initial intuitive guide.
所谓的电车难题最早由菲利帕·福特于1967年提出，作为一种检验关于双重效应学说、康德主义原则和功利主义的道德直觉的方式。从那以后，大量哲学家和心理学家提出了其他场景，以进一步检验直觉以及传统道德学说的相关性。鉴于医生经常面临生死攸关的道德决策，电车难题在医学伦理学中应被视为非常重要。本文讨论了五个“经典”电车场景：司机使电车转向、旁观者拉动操纵杆使电车转向、将一个胖子从桥上扔下以阻止电车、旁观者拉动操纵杆使电车转向以便一个胖子被碾过，以及旁观者拉动操纵杆以便一个胖子从桥上掉下去阻止电车。在讨论这些场景时，阐述了它们之间相关的道德差异，并讨论了在医学伦理学中的一些应用。文章得出结论，电车场景不是在医学案例中艰难的伦理挑战中做出伦理决策的最终标准，但它们确实可作为初步的直觉指南。
