The Trolley Problem Meets COVID-19

[david_myers]

A classic moral psychology dilemma invites us to contemplate a runaway trolley headed for five people who are tied to the tracks and destined for death—unless you pull a lever that diverts the trolley to a side track where it would kill one person. So, do you: a) do nothing and allow five people to die, or b) take an action that causes one person’s death?

Utilitarian ethics would admonish you to pull the lever and save lives. But doing so, says an alternative “deontological” perspective, would involve you in a moral wrong and make you actively responsible for someone’s death. 

The trolley problem is now playing out on the world stage in the medical ethics surrounding COVID-19 vaccine development. Developing a safe and effective coronavirus vaccine will reportedly take many months, as researchers vaccinate thousands of people with a trial vaccine or placebo, then allow time for the natural course of events to expose some to the virus. Meanwhile, hundreds of thousands of the world’s people may die, and rates of poverty and its associated ills will soar.

Some ethicists, and 35 U.S. Congress members, have therefore proposed speeding up vaccine development with “human challenge” experiments—double-blind clinical trials that expose minimally-at-risk young adult volunteers to the virus, with all volunteers then being followed for a medically supervised quarantine period. This is not a mere hypothetical idea: Thousands of people have already volunteered to participate.

So, should we proactively expose a relative few to infection in hopes of sparing the lives and livelihoods of so many more? This real-life trolley problem offers a provocative discussion topic for your class or dinner table. Here are arguments I’ve heard on each side of this issue:

• We should not solicit volunteers for experiments that infect people, even young adults:
• Exploitation. Young people have a natural tendency to believe themselves invincible, and we would be exploiting their natural “unrealistic optimism” in asking for volunteers. With the offer of pay, poor people might be especially vulnerable to exploitation.
• History. The horrific history of unethical medical experimentation provides a cautionary tale. Remember the revolting medical experiments done by the Nazis on those unwilling and the Tuskegee syphilis experiment on those unwitting.
• Unintended consequences. As a recent Science article explained, we don't yet know anything about potential long-term health consequences from having been afflicted with COVID. There have been questions about whether people who get very sick, for example, will ever recover full lung function, and many of those placed on ventilators suffer lingering neurological deficits. There have also been reports of young COVID sufferers experiencing kidney damage, blood clots, circulatory problems (“COVID toe”), and a post-infection inflammatory response.
• Unethical. “I cannot imagine that this would be ethical,” said one vaccine researcher. We should not induce humans to serve as guinea pigs in an experiment with unknown consequences. Would you want one of your own children to volunteer for a human challenge experiment? What about the Hippocratic oath: “First do no harm”?

• We should conduct human challenge experiments:
• Little risk. The risk to younger adults would be minimal. Among COVID deaths in the U.S., very few—.001—have been to people ages 15 to 24. 
• Humanitarian purpose. If, by taking less lethal risk than taken each year by driving a car, young adult volunteers could save countless thousands of lives, is that not a net good? Don’t we owe it to our at-risk elders?
• Mere acceleration of exposure. One could conduct the experiment in a city—or a country such as Sweden—where volunteers might simply be accelerating the timeline for their likely exposure and subsequent likely immunity.
• The moral logic. Where is the moral logic in sending young adults into combat zones, where the risks are vastly greater and the moral outcome often more ambiguous, while denying young volunteers their wish to serve humanity? “If healthy volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research,” argue ethicists Peter Singer and Richard Yetter Chappell, “there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks.”

What do you (or your students or companions) think? And what risk/benefit ratio might change your answer? 

• If you oppose a human challenge experiment, is there some minimal level of risk and some magnitude of benefit that would lead you to support it?
• If you support a human challenge experiment, what level of risk or what constraint on the benefit might lead you to oppose it?

[2/16/2016 P.S.: A UK human challenge investigation of COVID vaccine efficacy is now seeking volunteers: https://ukcovidchallenge.com/]