Emergency Medicine is a specialty that you may not think involves a lot of ethical dilemmas. The obvious issues like abortion, euthanasia and reproductive ethics affect other people. However, ethics is actually really central to our practice. We might not realise it, but there are ethical implications for every single decision we make. The Ethical Dilemmas in Emergency Medicine series at St. Emlyn’s is going to explore that and will hopefully get you asking questions about your practice that you hadn’t realised need answering.
In this blog post, I’m going to present a hypothetical scenario to get us started. It’s a bit fantastical and this particular scenario itself doesn’t relate to anyone’s everyday practice because it’s so extreme. However, the choices we make here have huge implications for all of the more mundane decisions that we make in practice. In the posts that follow, we’ll start to see why.
We really want your input on this. Have a think about the scenario and please post your comments below. I’m sure there’s going to be a huge range of opinions on this so please don’t be afraid to share your tuppence worth with us. It will help us to take our subsequent posts in the best direction to explore some of the issues that might be raised.
So here’s the hypothetical scenario…
You’re called to the scene of a road traffic collision on a bridge. When you arrive, you find an elderly man trapped underneath a car, which is hanging over the edge of the bridge. You triage this man and find that he’s stable – but you’re going to need the fire crew to get him out, and that will take time.
In the car that’s hanging over the edge of the bridge is a family of 5 people. They are all fully conscious and have no apparent serious injuries. As you’re making your initial assessments, the car starts to sway. You realise that it’s going to fall off the edge of the bridge. If it does fall, it will land on the road below, 50 feet down, which will kill the 5 people in the car. Your judgement tells you that if you and your colleague push down on the back of the car, you’ll tip the balance and the car will stay on the bridge, saving the 5 people in the car. However, you can also see that this will crush the elderly man beneath the car and you feel sure that this will kill him.
What are you going to do? Will you watch and let the car fall, in which case the family of 5 will die but the elderly man will survive? Or will you act to stop the car from falling, in which case the family will survive but the elderly man will die? Remember, though, that if you choose to act and save the family, the elderly man won’t just die. You’ll have killed him. If you let the car fall, the family will have died – but you won’t have killed them – they just died.
I hope this is some food for thought for you. It’s a little abstract but your answers do have implications for our everyday practice. Please let us know what you think. In part 2 we’re going to move things on and explore the implications of the decision either way!