The need for Christians to make distinctively biblical moral decisions

I am continuing to reflect on the recent CBHD conference. One of the paper presentations I attended was related to the role of Christian faith and the church in decisions about fertility treatments. Heather Prior and an associate are doing research on how Christian couples in their community make decisions about treatments for infertility including such things as IVF. In the preliminary results she was reporting they found that many of the churches that the couples in their study attended had statements about the use of reproductive technology, but that none of the couples dealing with infertility were aware of those statements. Few had sought any counsel on their decisions from their pastors or others in their church.

I find that concerning. In my interaction with Christian students I have become very concerned that even those with strong Christian faith tend to think about ethical issues using thought patterns they have absorbed from the surrounding culture rather than using distinctively biblical ways of thinking. I don’t think this is limited to students, and this study suggests that it is not. The culture that we live in believes that people should make their own decisions about how they live based on how they feel about any decisions they need to make. It also says that those around them should affirm whatever they decide. I fear that Christians are taking on that same attitude. If we think like the world around us, we will make decisions on things such as reproductive technology based on what we desire and how we feel and expect the church to affirm whatever decision we make. When this happens there is no distinction between the church and the rest of the world.

Those who follow Jesus need to be different from the culture around us. We have access to a solid foundation for making moral decisions and living a life that is distinctive in its goodness. That foundation for making good decisions is found in the Bible and the body of the church. If we are going to be distinctive followers of Jesus we need to recognize that what we feel and desire can easily be affected by our fallenness. We need to turn to scripture and to good counsel from those in the church who have spiritual wisdom and who have thought through ethical issues well from a biblical perspective to help us live in a way that brings glory to God.

Educating the church about how to think about bioethics

Janie Valentine’s post on Monday about a Christian health sharing ministry considering the surgical treatment of ectopic pregnancy to be the moral equivalent of abortion points out a major concern related to the church and bioethics. This is particularly a concern regarding the evangelical Protestant church and bioethics. With its hierarchical structure the Roman Catholic Church has a way of connecting the well considered thoughts about bioethical issues that are expressed by Roman Catholic ethicists with the ministries of the church. Protestant churches, and evangelical Protestant churches in particular, have a significant disconnect between those who think deeply about and write about bioethical issues and those who are doing ministry.

The issue of whether to cover the costs of surgical treatment of ectopic pregnancy illustrates the need for people within the church to learn how to think about bioethics and other ethical issues. It is not that we need to have some established evangelical set of ethical positions on issues, but rather an understanding by people in the church of how to properly analyze and think about an ethical issue. Over centuries of thought Christian scholars have recognized the principle of double effect as a good way of analyzing moral dilemmas in which doing something that is good, such as saving the life of a woman with an ectopic pregnancy results in the unwanted bad affect of the death of an embryo. It is clear that we should not focus solely on consequences and do things that are wrong even to save a person’s life, but it is reasonable at times to do good things that have unintended but foreseeable bad effects. There is a way of thinking about ethical issues that has been well established by Christian ethicists over the years which many in the church are not at all familiar with. That is a problem.

The question is how those of us who understand how to think well from a Christian perspective about moral and ethical issues can communicate that to the church in general. Over the past eight years I have been trying to do that by teaching at a Christian university. My thought has been that if we teach students who will be the future leaders of their churches how to think well about ethics they will help their churches think well about those things. However, what I have learned is that only a small minority of the students at what I consider to be an excellent Christian university actually get enough education in ethics to be able to do that. Somehow we need to convince the church that learning how to think well about moral and ethical concerns from a distinctly Christian way of thinking is important for the life and health of the church and methods to accomplish that need to be established.

Most pressing bioethics issue

In yesterday’s post Mark McQuain asked the readers of this blog what they consider to be the most pressing bioethics issue in the context of a call for our president to establish a bioethics council. He referred to my recent post on reproductive ethics and the manufacturing of children. I think that is important. I also think that abortion including the aborting of children with developmental abnormalities such as Down syndrome, euthanasia, and the treatment of children with gender dysphoria are very important. However, my most pressing concern related to bioethics in our society is freedom of conscience.

It is important that we express clearly the value of human life and how that impacts how we understand the ethics of things such as reproductive technology, abortion and euthanasia, but we are living in a time in which many do not listen to reasoned arguments about what is right. Much of our society believes that what is right is determined by how they feel and they desire to be free of any limits on what they can do. They also believe, somewhat contradictorily, that they should be affirmed in being able to do what they desire by having society help them do it; even if that means that others need to do things that they believe to be wrong. Our society is losing the concept of any objective moral values. Without objective moral values it does not make sense for someone to refuse another person’s request for help in fulfilling their desires based on conscience, particularly conscience informed by an objective understanding of right and wrong. If there is no objective standard on which to refuse such a request the refusal must involve some sort of personal rejection of the one making the request.

Thus we have ACOG saying their members must affirm patients who desire an abortion. Canadian physicians may soon be required to affirm their patients’ desire for euthanasia. There is a push for physicians, psychologists and others to be required to affirm the desire for a confused child to be identified as having a gender that is in conflict with the child’s biological sex. As Cheyn Onarecker has discussed in his posts yesterday and last week, there are some prominent ethicists who give reasoned, although faulty, arguments against rights of consciences for physicians.

The elimination of rights of conscience threatens the ability of not only Christian physicians but all people of strong moral conviction in all professions to practice their professions without violating their consciences. If allowed to go unchecked the demand to affirm every request by every person in the name of pluralism and personal liberty will leave every profession in our society without those who are most conscientious. It will also lead to the demise of ethics as a disciple. If our society really believes that there are no objective moral truths and everyone should be free to pursue his or her desires and enlist others in that pursuit, then any statement that an action is wrong will not be seen as a particular understanding of what is right and wrong which can be civilly discussed, but as an unfounded personal attack on someone who desires to do that action. Thus there will be reason to shut down all ethical discussion and the discipline of ethics will be forbidden.

In Defense of a Physician’s Right to Conscientious Objection, Part 2

Guest post by Cheyn Onarecker, MD

Today, I am continuing my comments on the recent editorial against conscientious objections from the New England Journal of Medicine (subscription required). My previous objections to the elimination of protections for conscientious objections included: 1) the importance of maintaining the traditional balance that has always existed between the needs of the patient and the physician, and 2) the fact that medical societies make decisions on the acceptability of certain procedures that are influenced by society and do not represent the views of a large percentage of its members. I will now add a couple more reasons.

Third, it is impractical and unreasonable to demand that persons considering a career in medicine should be prepared to violate their moral convictions. When the Church Amendment was passed in 1973, allowing physicians to be exempt from performing abortions, there was no outcry from the AMA or any other medical society denouncing the law or declaring that rights of conscience were unethical. Since then, the number of laws and provisions to protect conscience rights have increased, not decreased. Philosopher Mark Wicclair explains that modern medicine, in general, has accepted the right of conscientious objection, and no young person entering medicine today believes that their moral and religious convictions are incompatible with a career in medicine. In fact, the AMA issued a directive to medical schools to excuse students from performing activities that violate their ethical beliefs. Not only that, but how would physicians be able to predict that someday their chosen specialty would develop a controversial treatment? Stahl and Emanuel assume that a medical student could choose radiology, but what does the future of radiology hold? Many physicians have stated that they would rather leave practice than to be forced to do procedures or make referrals against their conscience. With widespread physician shortages already affecting the care of our citizens, what sense does it make to eliminate large numbers of talented young people from a career in medicine because they want to practice medicine conscientiously?

Fourth, by rejecting physicians who practice medicine according to their conscience, we exclude the very professionals we need to prevent medicine from drifting from its ethical moorings. The history of medicine is full of ethical catastrophes, and Stahl and Emanuel cite eugenics and the classification of homosexuality as a disease as recent examples. But, according to the authors, medicine returns to its ethical path through a self-correcting process of “reflective equilibrium,” as if by some magical force, the profession spontaneously changes course and begins to right the wrongs that had been committed. But no magical force or automatic process stopped the forced sterilization of women in the early 20th century. Men and women, guided by their conscience, fought for decades to change the hearts and minds of citizens and the medical profession. Where would we be if they had passively complied with the accepted practice of the day? If we remove such men and women from our profession, who will be the agents of reform when medicine deviates from its proper direction in the future?

A recent Annals of Internal Medicine article about teaching medical ethics under Nazism concludes that the lack of “eternal values” in medical ethics allowed them to be coopted by the politics of the day. Those who expressed any conscientious objection to the prevailing thoughts were systematically removed from medical leadership, resulting in practices that are universally condemned today. Dr. Joe Gibes critiques this study in his April 21st article for the TIU Bioethics Blog. He appropriately concludes, “It is precisely because society, government, and politics are so fickle, that it is vitally important that the practitioners of this art cling tenaciously to the universal values stated so simply and starkly in the Hippocratic Oath: I will not kill, whether in the womb or out of it.”

Finally, since they suggest that healthcare professionals should ignore their conscience and follow the dictates of their professional organizations, Stahl and Emanuel appear to be defeating their own arguments. Following their logic, because most of the professional societies oppose their views and accept physician’s conscience rights, the authors should simply keep quiet. Their article, however, implies that they believe there are times when physicians should take a stand against the status quo. Even by their own standards, conscience must have more than just a limited role in medicine. To eliminate the right of conscience would be to jeopardize the ethical foundations of the profession. Instead, we ought to look for ways that we can accommodate those rights in order to provide excellent care to our patients.

In Defense of a Physician’s Right of Conscientious Objection

Guest post by Cheyn Onarecker, MD

In their recent “Sounding Board” piece in the New England Journal of Medicine (subscription required), Ronit Stahl, PhD, and Ezekiel Emanuel, MD, PhD, denounce the rights of physicians and other health care professionals to opt out of certain procedures because of a moral or religious belief. The interests and rights of the patient, they state, should always trump those of the clinician. The only role for conscientious objection, in their view, is a limited one, when the appropriateness of a treatment or procedure is being debated.

Once a professional society determines that a treatment is acceptable, the physician must comply or get out of medicine altogether. Stahl and Ezekiel lament that the American Medical Association (AMA) and other medical societies support conscience rights, but, I believe the arguments they advance to eliminate such rights are not convincing and would jeopardize the future of medicine.

First, although the well-being of patients is one of the primary goals of medicine, there has always been a balance between the needs of patients and physicians. Otherwise, physicians would work 24 hours a day, with no time off for family, friends, or other pursuits. Physicians would be expected to respond to all patient requests, day or night. The question is not whether physicians should put patients’ needs above their own, but where the line should be drawn between the needs of the patient and the physician. In emergencies, a patient’s needs triumph, but other situations are not always so clear. When it comes to requests for treatments that violate a physician’s deepest moral convictions, no physician should be forced to cross over the line.

Second, the decisions by medical societies regarding the appropriateness of certain treatments and procedures do not occur in the idealized manner described by the authors. Anyone who has sat in a hospital department meeting knows how decisions are often made. The person, or persons, with the loudest voices and the most influence can carry the day. I have experienced the wholesale politicking that occurs at national society meetings, where resolutions that have been defeated for years are suddenly adopted as organizational policy because, finally, enough delegates were cajoled into a “yes” vote. And to say, as Stahl and Emanuel do, that medical debates are not affected by cultural and political factors is to ignore history. Physician-assisted suicide (PAS) did not become a legal medical practice in Oregon because the AMA determined that it should be so. In fact, the AMA, the largest physician organization in the country, opposed the practice. No, PAS became legal, because the state legislature passed a law. Likewise, abortion became legal due to the decisions of nine judges.

Given that professional societies can be influenced by shifting social and political trends, we should accommodate the right of a physician to rely on her conscience to decide on controversial practices. For example, the fact that abortion-on-demand is legal does not erase the truth that half of the population and a large percentage of physicians do not support the practice. Physicians who object to elective abortions are considering the well-being of the baby as well as the mother. A 51 percent vote by the members of their professional society will not change their conviction that an abortion would take the life of an innocent human being without just cause. Female genital mutilation (circumcision) is accepted in some parts of the world. If such a practice were to become legal and accepted by some professional society in this country, would those who object to the procedure remain silent and comply? In the milieu of the diversity of moral perspectives in our culture, a physician must sometimes rely on her conscience as a guide to ethical medical practice. I have several more thoughts on this topic that I will continue tomorrow in my next post.

Mailbag

Brief comments on four short articles from this week, on disparate topics:

James Capretta of the American Enterprise Institute (meaning he is politically right of center) pleads in the Journal of the American Medical Association (JAMA) for compromise between Republicans and Democrats on further healthcare policy reform.  Arguing that the House-passed American Health Care Act (AHCA) may never pass, he believes that a better result politically and for public policy would be if legislators could, in essence, split the difference between the AHCA and current law, the Affordable Care Act (ACA, aka “Obamacare”) on some points where he sees some agreements in principle.  He proposes: 1) a hybrid approach between the ACA’s income-based tax credits for health insurance purchase and the AHCA’s age-based approach; 2) ensuring continuous insurance coverage for people with pre-existing conditions by modifying the ACA’s penalties for not being insured to fall more heavily on higher-income people; 3) setting limits on the favorable tax treatment of employer-paid health insurance premiums; 4) automatically enrolling uninsured people into a bare-bones, no-premium plan from which they could opt out in favor of re-enrollment in a different plan (a proposal that sounds to me a lot like the Democrats’ “public option” with a guaranteed fight over scope of coverage); and 5) limiting Medicaid expansion to tie it to reform of the program (something that sounds to me a lot like what I understand is currently in the AHCA).  Mr. Capretta knows a lot more about health policy than I, and has been at it a lot longer.  His ideas seem reasonable.  But he admits that bipartisan compromise “may be wishful thinking,” and I must confess that my reaction to his article is, “when pigs fly.”

The editors of Nature smile on Pope Francis’s meeting with Huntington’s disease researchers and patients.  Many of the latter group, they note, are poor Venezuelan (who there is not poor—and oppressed—these days?) Catholics who greatly aided research with tissue donations “with little tangible reward.”  The editors further cite the Pope’s encyclical Laudato si, with its acceptance of the existence of anthropogenic climate change, as a hopeful sign that the Catholic Church will one day use its considerable influence to compromise on “sensitive issues” such as sanctity of human life from conception, and embryo selection.  Still, “there is a chasm between religion and science that cannot be bridged.  For all its apparent science-friendliness, Laudato si sticks to the traditional Vatican philosophy that the scientific method cannot deliver the full truth about the world.”  The editors call for “fresh dialogue” between science and religion—by which they mean capitulation of the latter to the flawed-on-its-face epistemology of the naturalist.  I’m not buying.

Another provocative piece in JAMA tackles ethical concerns about drug company marketing of treatments for rare diseases.  The specific concern is “disease awareness” campaigns.  The authors cite a collaboration between Incyte, the manufacturer of the only FDA-approved treatment for a rare disease (there are older, “grandfathered,” treatments of modest effectiveness), and the producers of the soap opera General Hospital, in which a character has said rare disease and (not quite like Huey Lewis) wants a new drug.  The authors ask:  Is disease awareness marketing in disguise?  Do disease awareness campaigns promote sales of specific drugs?  Does awareness of rare diseases really help, when, unlike common diseases, more aware people can get effective treatment at an earlier point in the disease history, but with rare diseases, they might only be overdiagnosed, overtested, and overtreated.  Hmmm.  The authors allow that the courts have protected direct-to-consumer drug advertising as free speech, but assert a duty of the medical profession to ensure that information to the public is not only true in a narrow sense but also not misleading.  They conclude with a bit of an overreach: “[D]irect-to-consumer advertising is a massive medical intervention with unproven public health benefit, dubious plausibility, and suggestive evidence of harm.”  The suggestion is that “disease awareness” campaigns ought to be regulated by the FDA.  I have to say I’d find it amusing, to say the least, for the FDA to be regulating soap operas—a candidate for Mad magazine’s “Scenes We’d Like to See.”

Wesley Smith blogs that Ontario is moving toward creating mandatory policies regarding assisted suicide that have the strong possibility, if not likelihood or certainty, that doctors will be required to help provide aid in dying or refer “in good faith” to other doctors who will—essentially steamrolling any conscience exemptions.  He sees in this a deliberate, tyrannical program to destroy the soul of medicine, extinguish thoughts of the sanctity of life, and cleanse the medical profession of religious or Hippocratic practitioners.  So do I.  Follow the link and read his post.

How to make Nazi doctors

Most people who go into medicine have as at least part of their motivation the desire to help other people. I’m sure this was as true in 1930’s Germany as anywhere else. So how did a cadre of Nazi doctors come not only to commit crimes against humanity, but also to defend the moral correctness of their conduct when placed on trial for those crimes? The answer is complex, but one way was through the teaching of medical ethics.

An article in the April 18th Annals of Internal Medicine tells a cautionary tale for teachers and learners of bioethics. Entitled “Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism,” the article details how the Nazi party developed a curriculum for teaching ethics in medical schools that “was intended to explicitly create a ‘new type of physician’ . . . trained to internalize and then implement the Nazi biomedical vision . . . shifting the focus of ethical concern and medical care away from the individual patient and toward the general welfare of society or the people.” The curriculum included lectures in racial hygiene, the science of heredity, population policy, military medicine, and the history of medicine. Only long-standing members of the Nazi party were appointed lecturers. The lecturer at Berlin University, Rudolf Ramm, wrote the ethics textbook used in the curriculum, which emphasized physician paternalism in practicing their moral obligation to rid society of certain groups, and asserted that every (Aryan) person in Germany had a moral duty to stay healthy.

The article’s authors write, “The Nazis neither ignored nor abandoned medical ethics. Instead, they implemented their own version of it in order to substantiate their health policies and secure physicians’ allegiance. . .  an ethic that turned away from the individual and instead emphasized the well-being of the community. . . [They] reinterpreted the Hippocratic Oath for their purposes . . . [drawing] an analogy between the German people and a sick patient . . . so that the Hippocratic Oath seemed to fit with Nazi medical ethics: Exterminating Jewish persons, disabled persons, or patients with hereditary diseases was acceptable in order to heal the organism of the German people.”

The article’s authors draw the conclusion that “we should not rely on the existence of ‘eternal’ or ‘universal’ values in medicine because it is not the medical profession alone that determines the medical ethos but also the moral climate in society, the system of government, and its political goals.” However, this seems to me backwards; it is precisely because society, government, and politics are so fickle that it is vitally important that the practitioners of this art cling tenaciously to the universal values stated so simply and starkly in the Hippocratic Oath: I will not kill, whether in the womb or out of it. I will protect patient privacy.  I will treat everyone with the same regard, regardless of their status. Real Hippocratism should have been a resistance movement against Nazism; it should be again now against the forces that are threatening to deform the medical ethos. If we do not hold fast to these values and teach subsequent generations of doctors to do the same, we will find — we are finding — that we are playing variations on a Nazi theme: for the eugenic ideals inherent in Nazism, the idea that it is morally acceptable to kill some (unborn) people to benefit others, and the belief that there are lives which are not worth living, ideas which have “laid the groundwork for medico-ethical transgressions in the past, remain in play across time.”

What are the Ethics of Avoidance?

Mark McQuain, in his February 21st blog post, discussed an interesting article which proposed that ethical decisions be made by robots. Although the author’s specific arguments invite numerous responses, underneath these arguments lies the question: why does modern man spend such effort to use technology to rid himself of yet another intrinsic function of his existence?

It seems to me that this wish to pass off ethical decision making is a prime example our drive to divest ourselves of difficult, painful, messy, and often guilt-inducing work in our moral and spiritual lives.

J. Budziszewski described this problem in his book What We Can’t Not Know when he wrote, “…two universals are in conflict: universal moral knowledge, and the universal desire to evade it.”

If we look closely, behind the artfully constructed arguments heavily refined in postmodern academia, is an unspoken motive of moral avoidance–the desire to distance oneself from the emotionally painful or otherwise costly consequences of man’s existence. Technology has already been used quite well to help us avoid other discomforts— why not to help us avoid emotional discomfort as well?

For example, how many instances of discussion of physician-assisted suicide are really driven by the physician’s, family’s, and government’s sense that their lives would be so much easier if this person would just die before things got messy? How neatly this prevents emotional strain on the part of everyone besides the patient. The all-too-well-developed arguments invoking “compassion” and “dignity” are in fact contrived as a veneer to cover this motive.

And here abortion is the close cousin of assisted suicide– far better to promote “choice” than to deal with the unpleasant social consequences of unwanted pregnancies. Think of all the tough decisions we can avoid!

Of course, if there are ways to reduce or mitigate ethical dilemmas, it is reasonable to pursue those. But the article does not describe avoidable dilemmas, only a desire to avoid poor decision-making. The author states, “I don’t want it to be human. I want it to be true to its code.” But this is really avoidance of the difficult task of developing one’s own code. It is avoidance of moral decision-making, and of the hard consequences across one’s entire life once one does adopt a code. Such as if one decides to become a Christian–quite a few lifestyle decisions to make, if one truly means it. How easily we might avoid such personal decisions if we rely on a computer code instead of a personal code. But the problem is not lessened, it is just passed to others. In this article’s case, it’s passed into the hands of programmers. Or, unless computer programmers have taken a larger interest in ethics that has been heretofore apparent, into the hands of their ethics consultants.

What drives man to such avoidance? We could find any number of man’s base drives among the reasons–selfishness, greed, sloth…but among these must be fear. Fear of emotional inadequacy, fear of being wrong, fear of one’s own mortality, fear of the tough personal consequences if one were to admit what is in fact is the right thing to do. Too little in our society, or in man’s existence itself, do we admit that we are just plain afraid.

March for Science

If anything can be gleaned from the early days of the new administration in Washington, it is that a lot of Americans appear eager to march. The sheer numbers of marches chronicled since the election and into the nascent days of the victors’ succession would impress John Philip Sousa. The newest entry is the “March for Science,” an event to be held on April 22nd, a day now also known as “Earth Day.”

The march, like virtually all of the marches, is a reflection on the new administration. “The mischaracterization of science as a partisan issue, which has given policymakers permission to reject overwhelming evidence, is a critical and urgent matter.” So states the website, with rhetoric that heats up from there. Its organizers plan worldwide marches with a “Teach-in” along the National Mall in America’s apparent scientific capital, Washington, D.C. It would seem unlikely that this venue will protect it from partisanship.

It is, of course, ludicrous to believe that science is ever truly separated from politics. From before Newton to the Scopes trial, science has been linked to the political dialogue. In our age, science still carries great weight in any argument (perhaps second only to empathy), and politicians, corporations, and just about every one else will use science as needed to advance an agenda. And we should not think scientists are dispassionate about the work they do, or free of political impulses. And certainly federal funding of research, awarded broadly by politicians and specifically by government agencies, necessitates a tighter relationship than most scientists would have traditionally found comfortable.

I don’t want to be misconstrued as being overly critical of the concerns expressed in the call for the march. The principal issue with which the organizers are united is not particularly veiled. While this is not the forum, and a suburban small animal veterinarian is hardly the description of someone whose opinion on climate change should be sought, I do grieve the polarization on this issue that seems to fall along political lines. The left-versus-right divide would make some absolute enemies of the free market and others absolute enemies of science. We have lost the ability to have a nonpartisan discussion on this issue (or many scientific issues) in the public square, because to do so means we must accept an agenda. Whether you agree with it or not, the organizers of this march certainly have one, and it would not be fully embraced by many scientists (nor does some of it have much to do with science).

Beyond this, part of what I see missing in the aims of such a march is any reflection on what science can and cannot do. Science, at its core, ought to be a deeply humbling endeavor. Science uses empirical evidence to help show us how things work, from the cosmos to the quark. And sometimes new empirical evidence shows us that the earlier evidence was insufficient or outright wrong. Science tells us about the world around us and gives us tools to make new things possible, but cannot tell us if something is ethical. Bioethics emerged as a discipline, in large part, to evaluate and make judgments on the consequences of scientific discovery. Science is not itself a good or bad thing (though it can be done well or badly), and it cannot effectively determine either from within. Modernity taught us wrongly that science was its own arbiter, and we are not soon to recover.

I don’t know how to get all that on a placard, so I won’t find a way to attend the march. Marches don’t lend themselves to nuance. That’s a pity. I’d proudly march in celebration of scientific discovery that is ethical and recognizes its own limitations, its promise and its risks. I have spent twenty-five years in practice using science to try to bring health and happiness to my animal patients and their human companions. I often find it frustrating when a long-standing treatment is shown to be ineffective based on new scientific evidence. But I am compelled to respect that, and I change what I have done. Science is one of the greatest means for revelation that God has granted us. My faith in general, and my eschatology in particular, tell me that I have have profound responsibilities to care for the Earth and its inhabitants. The “March for Science” reminds me that agreement on the means of doing so remains supremely difficult.

AI and the Trolley Car Dilemma

I have always hated the Trolley Car dilemma. The god of that dilemma universe has decreed that either one person or five people will die as a result of an energetic trolley car and a track switch position that only you control. Leave the switch in place and five people are run over by the trolley. Pulling the switch veers the trolley onto an alternate track, successfully saving the original five people but causing the death of a different lone person on the alternate track. Your action or inaction in this horrific Rube Goldberg contraption contributes to the death of either one or five people. Most people I know feel some sort of angst at making their decision. MIT has a website that allows you to pull the switch, so to speak, on several different variations of this dilemma and see how you compare with others who have played this game, if you enjoy that sort of thing.

Kris Hammond, Professor of Computer Science and Journalism at Northwestern, believes a robot would handle the trolley car problem far better than a human since they can just “run the numbers and do the right thing”. Moreover, says Professor Hammond, though we “will need them to be able to explain themselves in all aspects of their reasoning and action…[,his] guess is that they will be able to explain themselves better than we do.” Later in the article he claims that it is the very lack of angst regarding the decision-making process that makes the robot superior, not to mention the fact that the robot, as in the case of self-driving cars, would avoid placing us in the dilemma in the first place by collectively being better drivers.

For the sake of today’s blog, I am willing to grant that second claim to focus on the first: Is there really lack of angst and, if so, does that lack contribute to making the robot’s decision right and therefore superior?

Currently, no robot has sufficient artificial intelligence that might allow for self-awareness sufficient to create angst. Essentially, a robot lacks independent agency and as such cannot be held morally accountable for any actions resulting from its programming. The robot’s programmer certainly does and can. Presumably (hopefully) the programmer would feel some angst, at least eventually, when he or she reviews the results of the robot’s behavior that resulted directly from his or her program. Is the displaced decision-making really advantageous? Is the calculus inherent in the encoded binary utilitarian logic really that simple?

Watson, IBM’s artificial intelligence system, can finally best some human chess grand masters. Chess is a rule-based game with a large but not infinite set of possible moves. Could a robot really be programmed to handle every single variation of the trolley car dilemma? Are the five individuals on the first track or the single individual on the second track pastors, thieves, or some weird combination of both, one of whom recently saved your life? Should any of that matter? Who gets to decide?

Trolley car dilemmas seem to demand utilitarian reasoning. Robots are arguably great at making fast binary decisions so if the utilitarian reasoning can be broken down into binary logic, a robot can make utilitarian decisions faster than humans, and certainly without experiencing human angst. Prof Hammond claims the robots will simply “run the numbers and do the right thing”. But the decisions are only right or superior if we say they are.

Utilitarian decision-making is great if everyone agrees on the utility assigned to every decision.  But this is clearly not the case, as the summary results on the MIT website clearly show.  Further, I think that most normal people have angst over their own decisions in situations like these, even inconsequential decisions offered on MIT’s harmless website.  So in the case of the robot, the angst doesn’t occur when the robot is actualizing its program – it occurred months or years ago when the programmer assigned values to his or her utilitarian decision matrix.

Were those the right values? (hint: there is angst here)
Who gets to decide? (hint: even more angst here)