On Nicole Varda’s Article: “To Pull or Not to Pull: The Trolley Problem and its Application to Medicine”
I wonder if there is another option to the Trolley problem rather than “to pull or not to pull”. How about the idea of “backing the train up” as a twist on the classic trolley problem? It reframes the scenario, encouraging us to think differently about the ethical implications. Instead of being confined to the forward momentum—choosing one track or the other—it introduces the possibility of retreat or reevaluating the situation altogether. It’s an imaginative way to challenge the binary decision-making of the original problem, which often forces a stark utilitarian or deontological perspective.
Backing the train up could symbolize taking a step back to reassess the broader context, perhaps exploring ways to change the conditions that led to the dilemma in the first place. It shifts the focus from immediate action to systemic thinking, emphasizing prevention over reaction. For instance, in the classic scenario, you’re asked to sacrifice one life to save five. But if you “back the train up,” could you find another solution that avoids the dilemma altogether? Could this inspire more creative problem-solving or alternative paths?
This perspective also highlights the role of agency and time. In real-life moral challenges, we often have the chance to pause, consult others, or innovate solutions that aren’t visible in the heat of the moment. “Backing up” could symbolize slowing down and engaging in reflective, collective decision-making rather than a rushed, solitary choice.
What do you think? Does this reimagining of the trolley problem align with how we should approach ethical dilemmas, or does it raise new challenges about decision-making frameworks? For example, instead of accepting that someone must die, we can imagine backing the train up or finding a route that saves everyone. It reminds us that real life often has extra options that we don’t always consider in thought experiments and at the bedside. It also makes us pause and think about how we sometimes get stuck in either-or thinking. If there’s a way to hit the brakes or move in reverse to protect everyone, why not explore it? Maybe the trolley problem isn’t just about whether to save five people at the cost of one, but about asking if there’s a better way to save them all. It shifts the focus from who we let die to how we preserve life.
On Travis Seideman’s article: “Metaethics Series #1 – Laying the Groundwork”
I’ve always been drawn to the deeper questions about why we do what we do in medicine. It’s not just about following rules or being a “good doctor.” For me, understanding the core of ethics means asking what morality is and why it matters. It’s like looking under the hood and figuring out what drives us to respect our patients’ autonomy or treat them kindly, even when we’re tired or stressed. Sometimes it’s a sense of duty, sometimes a wish to keep our society functioning, and sometimes it comes from our own desire to do what feels right, although I’ve noticed that it can feel awkward to say, “It’s right because it’s right,” but there’s a spark of truth in that simple logic. It makes me pause and remember that at the end of the day, being a good physician is about upholding certain values that we don’t always need to over-explain.
I’ve been reflecting on Pellegrino’s view from “For the Patient’s Good” and how it applied in my own pediatric critical care practice. He focused on the idea that the patient’s well-being is at the heart of all ethical decisions. That resonates with me because it’s not always about following abstract rules. It’s about remembering who’s in front of me and what they need. Sometimes that can clash with a rigid sense of “doing the right thing,” but I’ve found that putting the patient first feels more honest and humane.
I also see virtue as a guiding force. I think being virtuous means honoring our duty to the patient’s best interest, even when it’s not perfectly aligned with a checklist of “right” behaviors. There’s a difference between being right and doing what’s best for the patient. I’ve learned that when those two conflict, I lean on my commitment to care, compassion, and respect for the person who’s counting on me. That’s where I find real meaning in medicine.
I’m not claiming I have all the answers. In fact, I like that moral questions push me to keep reflecting on how I approach my vocation and my relationships with patients. That push can come from within or from outside pressures, but either way, it forces me to think more carefully about my choices. Remember, every decision we make has a consequence and we own it now and forever. This reflection reminds me that medicine isn’t just science, it’s also about who we choose to be when a patient depends on us. I want to remind myself, and anyone else who’s curious, that ethics isn’t some distant, stuffy subject. It’s right here in our daily interactions, shaping our decisions and helping us become the doctors (and people) we want to be.
Dr. David Beyda, MD
Dr. Beyda was appointed Chair and Professor of the Department of Bioethics and Medical Humanism in 2013. He is a Professor of Pediatrics at the University of Arizona College of Medicine – Phoenix, where he also directs the Ethics Theme, as well as the Global Health Program.