Doctors are shackled by the stigma of ignorance

A different take on risk and the ethical dilemmas involved, using the trolley problem, where a conductor has to decide whether to throw a switch to divert a hurtling trolley to avoid killing 5 track workers but killing one. The alternate version, is where someone on a bridge can push a large man onto the track and save all the workers – at the expense of one completely innocent life (train workers, by virtue of their occupation, have assumed some risk). Quote:

What’s the answer to this ethical conundrum in medicine? I cannot see that policy makers will stop throwing the switch in the near future, and so as a society we will be forced to accept the tram’s collateral damage. And while this may make sense in an area such as vaccination, where thousands of lives can be saved by sacrificing a very few by throwing the switch, in most everyday less clear-cut medical decisions the answer is less clear-cut. Will doctors rebel against being forced to throw some patients on the tracks in order to save some marginally larger number of others? I don’t think that they have the time or the energy or the incentive to do this, since the framing of the switch-throwing is through the rhetoric of “evidence.”

Right or wrong, doctors are shackled by the stigma of ignorance that comes with not following evidence-based guidelines, and this may act to perpetuate blind compliance. This leaves the patients, for some of whom the right thing will be just to get themselves off the tracks altogether, far away from the hurtling trolley until its brakes are fixed.

Doctors are shackled by the stigma of ignorance.


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