Are We Killing the Fat Man? The Corona Trolley Dilemma

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THE TROLLEY PROBLEM

The Trolley thought experiment, first put forth by the philosopher Philippa Foot, pits two schools of moral thought against each other: deontological ethics and utilitarianism. In simple words, the former means doing what’s right and the latter means doing what results in the most or greatest good. There have been many versions of the problem since Foot first devised it in 1967.

Here is the basic case.

 

A run-away trolley is heading towards five people strapped on to the main track ahead. There is a lever where you are standing which will turn the trolley onto a spur and there is one person strapped to the side track. If the trolley remains on course the five will die. If the trolley is switched to the side track, one will die. You are standing next to the switch. What do you do? Moreover, what is the right thing to do?

The version I want to discuss involves the Fat Man. I apologize for the word Fat, because it is offensive, but it was the original term used and is essential to the experiment. What follows is my version, updated to fit the times.

 

The Corona Trolley and the Fat Man

A run-away trolley is heading towards five people strapped onto the main track ahead. The Trolley represents the novel corona virus and is the instrument of death. Assume the five people represent natural COVID deaths, the deaths that would occur given the status quo, that is, doing nothing. The Fat Man is strapped onto the tracks of the spur with two people strapped behind him. The Fat Man represents the US Economy and the two people behind him represent other deaths, such as those from suicide and financial ruin.Flipping the switch means killing the Fat Man who is sufficiently large enough to slow down the Trolley. He will die. The two people behind the Fat Man on the side track may or may not die.

 

 

A MORAL DILEMMA

The moral dilemma involves staying the course on the main track and doing nothing, OR making an intentional decision to switch to the spur. Do five men’s right to life outweigh the Fat Man’s right to life and the potential deaths of the other two?

The utilitarian would find it morally compelling to take one life, or possibly three, over five lives. In such case, you are morally obligated to flip the switch. But what if the Fat Man is a virologist who develops the vaccine for COVID? And what about the two men who might die behind the Fat Man, from suicide and a heart attack from job loss?

Each person should be treated as an end and not simply as a means to an end. Each person has a moral claim to life. Therefore, the deontological philosopher would find it morally wrong to kill the Fat Man, because it requires intentionally flipping the switch. That is, deciding to change tracks treats the Fat Man simply as a means to saving the five people, and denying his right to live.

It is a dilemma. Even from a purely utilitarian view, how can we weigh the collapse of an economy and the destruction and death which results from flipping the switch, against the deaths of the status quo had the economy remained running? That leads me to my next point.

 

CONSEQUENCES OF KILLING THE FAT MAN

In an historic decision, the US has shut down a booming economy because of the pandemic. Killing the Fat Man for most Americans means the lockdown of commerce and stay-at-home mandate, essentially a government-imposed quarantine. Flipping this switch has serious consequences. Let’s consider both good and bad.

THE GOOD

The good consequences are obvious: by not leaving our homes and keeping socially distant, the spread of the virus slows and there are fewer deaths from COVID. People understand what it means to flatten the curve, the science behind the lockdown measures which shows a decreased growth rate of the virus. There are also fewer unintentional deaths, such as those from car crashes or industrial accidents. There’s less air pollution.

THE BAD

Now for the down-side. How do we weigh the destruction to the economy, the business closure, job loss, widespread financial hardship, personal isolation, as well other deaths such as those from suicide? Killing the Fat Man does not prevent the deaths of the two people behind him on the spur. Data show that significant groups of the population are minimally affected by the virus, with symptoms similar to a common cold or flu. Economic hardship and devastation are brutal realities for many Americans, such as those who are single, unemployed, financially ruined; the emotional and mental effects are debilitating, potentially fatal.

I will share two true anecdotes.

The first from the Air Force Times on April first: “Social distancing restrictions at the Air Force Academy have been relaxed after it reported two cadet suicides in less than a week following attempts to slow the spread of the coronavirus.” The cadets who died by suicide were seniors set to graduate this spring. Military culture involves close-quarters living and unit cohesion, espirit de corps or morale an essential aspect to readiness and deployment. After the deaths, the Academy has since lifted the “prison-like” restrictions.

The second anecdote: Afriend lives in the Midwest and she had to shut down her bakery which employed over 40 people. The bakery has been in operation for 32 years. Many employees live check-to-check and have little to no other financial means. The owner is not able to cover the payroll and rent, despite a successful business before the lockdown. Her county has ONLY one COVID death to date.

As of today, 22 million Americans have filed unemployment and businesses are facing insolvency across the country. Those with government jobs such as politicians, congress and teachers, continue to receive pay. Yet workers in the private sector especially people who are unable to commute online are suffering, with 22 million unemployed. The longer this lockdown goes on the more vulnerable people will become.  To understand the broader risk of death and COVID, let’s review mortality data.

 

 

DEATH STATISTICS AND CONTEXT 

(CDC 2017, 2018, deaths rounded to nearest 1000)

As of April 17, 2020 total US death count for COVID to date is 33,903.

In 2017, about 2.8 million Americans died. The top two causes of death are heart disease and cancer. These account for just under half of total deaths at 1.2 million, or about 100,000+ deaths per month.

The third leading cause is unintentional deaths with 169,936 in 2017. Unintentional deaths include 36,000 deaths from falls, 40,000 deaths from car crashes, and 65,000 deaths from drug overdose.

The flu and pneumonia account for 56,672 deaths in 2017 and closer to 60,000 in 2019. And there were over 47,000 suicides in 2017.

COVID also results in deaths of a number of critically ill or immunosuppressed who would have died from other causes this year. That number regardless of attribution will be evident in the total deaths over a time period.

As of April 16, COVID deaths are trailing behind each of these categories: annual flu and pneumonia deaths, deaths from falls, car crashes, drug overdose and suicides. Deaths due to COVID may outnumber any one category over the course of the year. Recent data show an overestimate of the mortality rate of the virus, COVID-19 Antibody Seroprevalence in Santa Clara County, California.

 

 

LIVING MEANS TAKING RISK

On average, I have a significantly higher chance of dying from heart disease, cancer, and dementia, than from the corona virus, the flu and pneumonia. And, getting in my car puts me at a higher risk of death than dying from COVID.

Here’s the catch.

Being born means risk. Crossing the street. Getting on the school bus. Leaving your house. Driving a car, working in a factory.  And COVID, while insidious and a pandemic, presents greater risk to certain populations, along a certain continuum of all risks.

Switching that lever and Killing the Fat Man has hurt 22 million Americans, it has destroyed businesses, and brought a thriving economy to its knees. Given the context of deaths related to the novel corona virus and total death data, especially with the number of cases decreasing, a forced quarantine for low-risk populations and low-case regions is an unprecedented and egregious infringement of individual civil liberties.

Does the worker and the baker have a right to her job, to earn a living wage, to live, to be free and to pursue happiness?  As a low risk group, should high school and college seniors have to miss their final days and graduation, especially in low-risk areas?

Who has the higher moral claim? The five people on the main track or the Fat Man and the two people on the spur? Do the Air Force cadets who committed suicide have an equal claim to life as the octogenarian in hospice who was waiting to die and died due to COVID?

Anti-viral drugs are beginning to show significant success. And we must and should continue to protect at-risk groups such as seniors and immunosuppressed individuals.

 

***

 

IN CLOSING, Some might argue that we should not equate saving an economy with saving lives.  That if we save just one life, it was worth it. Yet we make those decisions every day.  We could ban automobiles, swimming pools and bathtubs and save tens of thousands of American lives every year.  But we don’t. We instinctively have understood these trade-offs and yet, in this case, something has gone awry and people are pilloried by the media for suggesting that the economy is an important discussion. The decision makers who are politicians and government employees have no concern whether their paycheck will arrive at the end of month. And, just eleven years ago, in 2009, the H1N1 Swine Flu is believed to have killed 12,000 Americans and the idea of shutting down the economy never entered the conversation.

Perhaps it is the fear of the unknown virus, images of the Hollywood movies Contagion and Outbreak haunting people’s sub conscious.  Perhaps it is the social media mania, or politics.  Regardless of the reason, we must have this discussion.  The case to not kill the fat man or the two people on the track behind him needs to be heard.

 

NOTEWORTHY FACTS

The US death rate has been increasing annually since 2008 from its low at 8.124 to its current rate of 8.88.*  The rate means 8.88 deaths per 1000 each year. Italy’s death rate is 10.658.

According to the CDC s of April 17, deaths from all causes for the pandemic period beginning 2/11, are down, to 92 percent of Expected deaths.

 

**Check out Dave Edmonds’ Would You Kill the Fat Man? The Trolley Problem and What Your Answer Tells Us About Right and Wrong

Deaths and Mortality, CDC

Data are for the U.S. 2017

  • Number of deaths: 2,813,503
  • Death rate: 863.8 deaths per 100,000 population
  • Life expectancy: 78.6 years
  • Infant Mortality rate: 5.79 deaths per 1,000 live births

Leading Causes of Death 2017

Data are for the U.S.

Number of deaths for leading causes of death

  • Heart disease: 647,457
  • Cancer: 599,108
  • Accidents (unintentional injuries): 169,936
  • Chronic lower respiratory diseases: 160,201
  • Stroke (cerebrovascular diseases): 146,383
  • Alzheimer’s disease: 121,404
  • Diabetes: 83,564
  • Influenza and pneumonia: 55,672
  • Nephritis, nephrotic syndrome, and nephrosis: 50,633
  • Intentional self-harm (suicide): 47,173

Source: Deaths: Leading Causes for 2017, table 1 pdf icon[PDF- 2 MB]

 

US Death Rates

* Number Deaths per 1000 people. Rate has been increasing annually since 2008

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source – Megatrends, United Nations World Population Prospects

 

 

CDC – Provisional Death Rates for COVID-19

 

 

 

Apr 18, 2020

14 Comments

  1. Paul USMA ‘91

    False choice. A society with a robust social safety net and competent governance can avoid both mass death from disease and massive economic destruction with a coordinated response… thereby avoiding the false utilitarian choice. The philosophy which must be avoided is the amoral and ahistorical Libertarian one.

    Reply
    • mylinhshattan

      Thank you for writing. It is a thought experiment and a simplistic one with broad assumptions. The reality is far too complicated to be modeled. I agree with you that measures should include appropriate stockpiles, appropriate hygiene procedures and managing at-risk populations. My intention with using this model is twofold. (1) to expose the moral dilemma involved with economic shutdown, that “right action” and “good consequences” are slippery — that neither side (the lockdown or the status quo) has a monopoly on virtue. (2) Mortality data — people simply do not have context of the broader statistics on death and the risk of death from ALL causes.

      Reply
      • Paul Miles

        Thanks for your reply. Yes, there is no simple solution and a balance must be found. Things are going well with virus containment here in Hawaii. We have the advantage of geographic isolation and a good public health system, but our economy depends on tourism (we are screwed). A friend and fellow outrigger canoe racing teammate is the state MIT trained epidemiologist. Instead of either-or questions I think it best to look at examples of good governance that have worked in this crisis- like South Korea doing massive testing and Some European countries paying the salaries of workers until they can go back to work. Aloha

        Reply
        • mylinhshattan

          Hi Paul! Sounds like a mixed bag on Hawaii with isolation and a strong health system but a volatile economic reality. The either-or dilemma where I’m sitting near the epicenter in NYC is helpful as a thought exercise for understanding. The government chose full lockdown mode and folks can be bipolar on the issue. Robust social support is wonderful in theory, but not realistic for a first-of-its-kind pandemic. Meanwhile, workers not at-risk have a right to life, liberty and the pursuit of happiness. I’m not sure these groups would have accepted this infringement of civil liberties before the advent of social media, and likely may not the second go around. That said, I’m gaining confidence in the data I see about the decreasing mortality rate, the improvement in infrastructure/support, and the advance anti-viral success from Gilead and the malaria drug. I’m glad to have the dialogue, been writing folks in unit chat, online, personally much of today. Wishing you good health and better spirits. BEAT COVID AND ALL THE REST! MyLinh

          Reply
        • Larry Maglio

          Why didn’t the “authorities” at the CDC call for isolating those at risk with “co-morbidities” like Governor DeSantis of Florida? Never before was the entire population restricted like this. Why? Is this disease so different? Is it suspected to be a man-made biowarfare agent? Is that why its properties are not consistently characterized? At one time children were not impacted, then they were. Young were not impacted then they were. The germs kinda “float” in the air and do not have to be projected through a sneeze. Why do I feel that we are being played because the authorities are pro-WHO and global government types, avoiding to check out the obvious. The Chinese had to “disrupt” the disrupter and the communists are not a moral bunch. This was too convenient to stop the Trump train. Now they make no bones about it – they don’t want Trump re-elected. Am I being too simple in my analysis?

          Reply
  2. mylinhshattan

    Thank you for writing. It is a thought experiment and a simplistic one with broad assumptions. The reality is far too complicated to be modeled. I agree with you that measures should include appropriate stockpiles, appropriate hygiene procedures and managing at-risk populations. My intention with using this model is twofold. (1) to expose the moral dilemma involved with economic shutdown, that “right action” and “good consequences” are slippery — that neither side (the lockdown or the status quo) has a monopoly on virtue. (2) Mortality data — people simply do not have context of the broader statistics on death and the risk of death from ALL causes.

    Reply
  3. Moni

    Mylinh,
    Hey classmate! Love you girl! As a school trained economists I see your points. Humans are so complex. Money drives the world! I too am a numbers gal.
    As a nurse on the front line I feel the pain and emathetically feel for families who are losing loved ones.
    In short I do not have any answers. But I am so proud of your intellectual stimulation surrounding the issue.
    I am exhausted but untiring, i am scared but not terrified. May God have mercy on us. May we extend grace and kindness to eachother!

    Reply
    • mylinhshattan

      Moni! Thank goodness for nurses and folks like you on the front line. And thank you for writing the kind comments. I think we will learn and love and be better next time. Folks are dying and folks are hurting, and we will figure out a way to accommodate the at-risk population and put back together this broken economy. Wishing you good health and friendship, ML

      Reply
  4. Katrin

    I think we need to stop or slow down the train long enough and help the 5 people and the fat man and his two companions to free themselves to get to safety. In that scenario we don’t have to make a choice.
    We could have slowed down that train by the end of January already. Now we need to scramble.
    We need high numbers of testing, Kontakt tracing, quarantine and social distancing. So another month of quarantine would be helpful because time was squandered. Hopefully we find the right antiviral drug as a stop gap until a vaccine is developed.
    I am in the high risk group.

    Reply
  5. John Stark

    Getting ready to blow some minds in my work crowd with this piece. I’m gonna drop it like a grenade in our room. I’ve been trying to make this case for the last few weeks but I’ve been unable to put it together coherently.

    Everyone remembers Spock said :

    “The good of the many outweighs the good of the few.”

    Few remember that Kirk corrected him. When Spock came back and asked why they had risked so much to save him, Kirk said:

    “Because the good of the one outweighs the good of the many, Spock.”

    Still, we are confronted with bad choices. This is the Kobyashi Maru of our generation: and there is no workaround. It is simply a test of our character.

    Reply
    • mylinhshattan

      Hi John – I love the reference to Kobayashi Maru. I am glad you will share this because the conversation is necessary. Civil discourse is vital for a free nation and a media fueled by incendiary invective hurts the possibility for rational citizens to engage, stoking emotions and peddling panic in a time when reason and research must prevail. We can avoid ad hominem attacks and focus on the issues and challenges at hand, a better way to move forward, and an improved response next time.

      Reply
  6. D DuVaught

    This compares to national strikes in many other countries with the purpose of going against the government/bringing the government down.

    Reply
  7. Jim Delaney

    I am finding that the real insensitivity [around the collective coronavirus response] lies in the ignorance and stubbornness of those self-righteous zealots who refuse to see the virtue in both sides of this discussion.

    Thank you for your article. It was passed along by Don Brewster, a fellow First Wave member.

    Reply
    • mylinhshattan

      Hi Jim – thanks for writing. Yes, this has been deeply troubling and was part of the motivation for this variant of the Trolley Problem. It also explains the strong response because it touched a nerve on both sides. The Corona Trolley is not a math study on COVID, but a thought experiment on a moral dilemma and I think that is what bothers those who believe they own the moral high ground, espousing as much in the news, on social media and elsewhere. The judgment, the lampooning, the accusations of ‘murder’ made it clear that much of the public had little context of the broader risks for all causes of death.

      Reply

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About the Author

Mylinh Shattan is a writer who has lived on three continents, served in the Army, worked in corporate America, and taught in college. She loves adventures, in the world and in the mind. Literature is relevant and learning is a lifelong pursuit, so you might as well have a bit of fun along the way.

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