Who Says You’re Dead? Medical and Ethical Dilemmas for the Curious & Concerned by Jacob M. Appel, MD

The trolley problem is a hypothetical thought exercise meant to test where you stand on an ethical dilemma. If you have not heard of the trolley problem, this is the description via Wikipedia:

There is a runaway trolley barreling down the railway tracks. Ahead, on the tracks, there are five people tied up and unable to move. The trolley is headed straight for them. You are standing some distance off in the train yard, next to a lever. If you pull this lever, the trolley will switch to a different set of tracks. However, you notice that there is one person on the side track. You have two options:

  1. Do nothing and allow the trolley to kill the five people on the main track.
  2. Pull the lever, diverting the trolley onto the side track where it will kill one person.

What is the right thing to do in this situation? Is there even a right answer?

This situation is not particularly relevant to most of us, but Who Says You’re Dead?: Medical & Ethical Dilemmas for the Curious & Concerned brings perhaps more realistic scenarios to the table and asks, what would you do?

Each chapter deals with a certain topic (such as body parts, the mind of a doctor, and end of life issues) and presents a brief dilemma related to it. According to the author, some of these are from news headlines, some are completely made up, and some are from his own personal encounters from working at various clinical institutions, just disguised well to remain confidential to the parties involved.

Going on a first date? Maybe the best way to get to know them is to ask where they stand on a person’s choice of having a fiberglass horn implanted in their skull to resemble a dinosaur. In a serious relationship and thinking about kids? Maybe discuss whether you would want to try an experimental heart transplant that involves a chimp being euthanized to save your 5-year old, which might not even work. You might learn a thing or two about your spouse. Okay, maybe don’t do quite that, but you get the point. These are sensitive topics and require more than just a quick on-the-spot answer. Luckily, after each question, there is a brief reflection that looks at the topic from a medical/ethical standpoint. The purpose is more about discussion, rather than to try and sway the reader one way or the other. Supreme Court cases are referenced, as well as research done by the CDC and other medical entities.

While reading this book, the first thing that came to mind was a recent grisly, yet fascinating, news story. A man donated his mother’s body to the Biological Resource Center (BRC) for alzheimer’s research, and later found out that she was sold to the military and used in an IED blast test. Clearly the parties involved needed a lesson in ethics, because they received some 5,000 bodies donated to them for scientific purposes and instead harvested their organs to sell them. A lawsuit was filed by the man and 19 others who experienced similar situations. In court BRC’s attorney claimed that the plaintiffs signed consent agreements that said bodies could be dis articulated. The Biological Resource Center was ordered to pay $58 million to donors’ families and they are now permanently closed. What led BRC to believe that their actions were justified?  The topic of ethics is complex and there are plenty of factors that go into decision making. Hopefully this book can help add to your arsenal of thinking practically and with empathy.

I would recommend you take your time with this book. All in all, there are 79 dilemmas, and each deserves their fair share of introspection. Do some research before coming to a conclusion, as should be done with other topics. In the back of the book there is a “sources and further reading” section that may help if you get stuck and cannot make a decision either way. It is not a bad thing to be hesitant in these situations. It is a good exercise and you may learn a thing or two about yourself.

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