Why Saving Five is Not Always Right: A Christian Perspective on the Trolley Problem and Surgeon Case
Framing the Moral Dilemma
This essay addresses the question: Is there any compelling way to explain why it seems morally permissible to pull the lever redirecting the trolley in Thomson’s famous Bystander case, yet impermissible to kill one healthy patient in order to harvest their organs to save five dying people needing transplants in the also renowned Surgery case? I will argue that the Doctrine of Double Effect (DDE) provides an intuitively satisfying explanation that captures the morally relevant distinctions between these two tragic scenarios.
As a Christian, my primary framework for evaluating complex moral issues comes from biblical revelation emphasizing the unconditional sanctity of human life as made in God’s image. Genesis 1:27 reads, “So God created mankind in his own image, in the image of God he created them.” This principle forms the basis for all people's innate worth and dignity regardless of utility. Therefore, I approach this analysis guided by the supreme value Scripture places on human life across contexts. By articulating DDE’s underlying principle and applying it judiciously to test cases, I will show that the doctrine can be a nuanced guide for complex situations involving harm.
The Trolley Problem vs. Surgeon Case
Careful examination of the key details surrounding the Bystander and Surgery cases is essential for precise comparative moral analysis.
In Bystander, a runaway trolley is barreling uncontrollably towards a track section where five people are trapped and will be killed if it continues unchecked. A bystander happens to be standing near a switch that can divert the trolley to a side track, where just one person is trapped and who would die as a result. The bystander faces a choice — do nothing and allow the trolley to stay on the main track, killing five people, or pull the switch, diverting the trolley to the side track, resulting in only one death instead of five.
It is important to note that, in opting for diverting the trolley, the single resulting death on the side track is a foreseen but completely unintended consequence of redirecting the trolley with the goal of saving the greater number on the main track. The bystander’s intention is preventing the trolley from killing the five, not terminating the life of one; the single additional death is neither aimed as a means to saving more lives nor willed as an end goal in itself. Nonetheless, the bystander remains fully aware that pulling the switch will regrettably result directly in someone’s death and must gravely incorporate accounting for that harm potential in their urgent moral calculation. So, some moral agency contributing towards the single death does exist in the choice to divert the trolley. However, the specific fatal outcome remains neither the bystander’s purpose nor the expressed desire. Instead, it merely represents tragic collateral damage of an attempt to avoid greater harm by deflecting preexisting forces beyond the agent’s control.
The Surgery case involves an organ transplant surgeon presented with five terminally ill patients who will face imminent demise soon without organ transplants. Fortunately, the surgeon has one completely healthy patient currently under their care who could provide the necessary organs to save the lives of the other five through lethal surgery harvesting the healthy patient’s vital organs. Carrying out such organ harvesting surgery would directly intentionally end the life of one innocent patient as an essential step to gather organs for the five others. So unlike Bystander, where death results as an incidental side-effect of redirecting threat without eliminating it entirely, here the surgeon must forcibly kill the healthy patient precisely to generate organs, intentionally destroying a life that otherwise would have continued. Death becomes a necessary means to save more lives, not just an unwanted consequence but the exact goal. The surgeon intentionally chooses death because of its results.
On basic moral intuition and emotional reaction, redirecting the trolley to save more lives seems tragic but understandable given the extreme emergency context, whereas intentionally slaughtering the helpless patient for organs seems an outrageous assault on medical ethics and human dignity offensive to core values. Most reasonable observers sense a meaningful moral distinction exists that renders the redirection substantially less objectionable than utilitarian execution in the minds of all but the most fanatical act utilitarians. But can this common reaction be rationally vindicated beyond sentimentality and gut reactions? Does a coherent principled explanation exist capable of justifying widely-shared assessments about the appropriateness of intervention present in these two difficult cases? I believe so, rooted in the Doctrine of Double Effect (DDE) that can be formalized as follows:
It is sometimes permissible to X. Foreseeing it would cause bad thing Y; even though it would not be permissible to X intending to cause bad thing Y.
In essence, the doctrine of double effect offers guidance for assessing actions that generate both harmful and helpful results.
Evaluating Moral Intuitions: The Doctrine of Double Effect
I will now argue that the DDE framework arguably captures key moral intuitions distinguishing the Bystander and Surgery cases.
DDE’s essential insight, integrating seamlessly with the biblical principle outlined above regarding human worth, is that utilizing harm as a weaponized means is impermissible since it violates inherent human dignity. Intentionally ending a life to leverage resulting cadavers for further ends fundamentally instrumentalizes victims in more reprehensible ways than tolerating the regrettable loss of life as a side effect when pursuing morally legitimate goals through permissible tactics. This means/side-effect distinction rationally explains firmer objections against Surgery’s premeditated medicalized murder compared to Bystander’s heavy-hearted trolley redirection.
My argument can be formalized as follows:
P1: In Bystander, the one death is a foreseen but unintended side effect.
P2: In Surgery, the one death is an intended means to saving more lives.
P3: According to the doctrine of double effect (DDE), it is harder to justify intending harm as a means versus unintended harm as a side effect.
P4: General moral intuition agrees that Bystander obviously involves unintended harm as a side effect while Surgery involves intended harm as a means, making the trolley redirection substantially more acceptable.
C: Therefore, the conclusions derived from systematically applying DDE align with and offer a rationally defensible explanation for the general moral instinct that Bystander’s trolley redirection is comparatively far more justified than Surgery’s.
The argument is valid because if the premises are true, it would be logically impossible for the conclusion to be false. Specifically, premise 1 establishes that Bystander involves unintended harm, premise 2 shows that Surgery involves intended harm, premise 3 says intended harm is harder to justify than unintended harm, and premise 4 notes that people see Bystander as more acceptable than Surgery. If all those premises are true, then it directly follows and cannot be false that the way DDE distinguishes intended versus unintended harm matches up with and explains the common intuition that Bystander is more justified than Surgery (the conclusion). There is a direct logical connection from premises establishing those key distinctions to the conclusionary statement that DDE aligns with and elucidates moral intuitions, so if the premises are true, the conclusion must also be true.
Additionally, there’s a biblical basis for thinking DDE captures ideals about valuing human life that develop over time in Scripture. Jesus condemned anger and insults as being like murder because they depend on intention, not just actions — involuntary harm isn’t a major sin (Matthew 5:21). This shows continuity between avoiding harm-intentioned malice and respecting human dignity. Though situational factors sometimes require tough choices, casually stripping all factors down to utility would be regressing to barbarism. We must consider not only potential ends but also actual means.
Some strict consequentialists will predictably argue that only the overall outcome of more benefit versus harm determines whether an act is permissible, regardless of psychological factors like intention. They’ll say:
The different judgments about whether it’s okay to redirect the trolley versus harvest organs seem contradictory and random since in both cases it results in one death exchanged for five lives saved. If only raw consequences dictate moral choices, why give any weight to vague ideas about ‘intended means’ that are irrelevant to the actual effects produced in the end?
I get why that argument seems compelling on one level. Surely morality has to focus on real impacts on well-being, not thought crimes! However, this objection goes too far by ignoring DDE’s important realization about how intended harm has uniquely destructive consequences related to corrupt intent — real consequences that persistently degrade the world, not just fleeting mental states.
While aiming for the best overall outcomes matters greatly, how those outcomes happen also affects moral reasoning since means influence ends. Beyond immediate obvious effects, deliberately seeking to harm innocents grievously is far more sinful because it stains the moral reality of the world in tangible ways that reverberate forward in time, not just a momentary lapse. We have stronger grounds to condemn harm-intending choices because they exhibit greater moral deficiency and degrading conditions moving forward.
Intended harms show this unique disorder in interconnected ways, including:
Establishing dangerous precedents and social patterns that chip away at human worth.
Displaying vicious character and blameworthy motives contrary to love.
Deafening moral conscience and making people more likely to do further bad things by decreasing sensitivity.
In Scripture, Christ redeems sinners through sacrificial love, enacting deeper truths about righteousness, not through clever but corrupt shortcuts. This shows how God’s mercy avoids superficial wickedness to channel suffering toward moral perfection in ways compatible with free will. Similarly, DDE condemns easy but wrong solutions to hard dilemmas involving harm. While consequences matter, the real means we pick carry moral significance with tangible spiritual fallout.
Final Remarks
In this essay, I’ve shown how the Doctrine of Double Effect gives a convincing explanation for why most people see a moral distinction between Bystander’s acceptable trolley redirection versus Surgery’s awful organ harvesting — it highlights the unique disorder created by intentionally using harm as a means toward good ends. Though outcomes substantially impact evaluating actions when facing dilemmas, ideas from deontology and revelation dictate that respect for life’s sanctity means we should pursue rescue through permissible means upholding human dignity, not through profane sacrifice, treating lives like numbers on a ledger. Intent shapes means and ends, imparting a moral tone to consequences beyond raw calculations. Through DDE, we can acknowledge harm while forbidding the weaponization of harm, preventing an `ends justify means’ slide. By emphasizing universal human worth, this view gestures toward divine love.
Through analysis of themes like dehumanization, corruption, and real harms spawned by transgressive intent, I’ve demonstrated there are substantive rational grounds for nuanced ethical appraisals that capture the deeply wrongful facets inherent to deliberately harm-aiming choice, which critics dismissing DDE’s intent/side effect differences fail to grasp. Sadly, preventable harm may happen — but it must never be our goal or choice. Side effects may be mourned; murder cannot be condoned. This coheres with and progresses beyond legalistic `thou shalt not kill’ rules toward Christ’s sacred vision of creation, prioritizing human worth over selfishness.
DDE thoughtfully moves through moral complexity beyond legalism toward wisdom fitting our imperfect but perfectible state by offering a compelling values-aligned explanation integrating easily with common intuition and conscience. This doctrine nurtures collective growth based on mutual restraint and respect instead of mere power relations, encouraging understanding between persons, not detached number-crunching. Deliberate harm must remain unthinkable despite rationalistic objections. The taste of ill-gotten “greater goods” corrupts because choice itself conveys meaning. Through the Doctrine of Double Effect, we can acknowledge harm while banning its weaponization, preventing the dilution of means into ends. By spotlighting universal worth, this ethic gestures toward love itself.
