Wednesday, February 18, 2009

MMR & responsibilty

Danny Finkelstein told, in his Saturday column, of experiments involving a version of the old ethical dilemma about the 5 railway workers & a runaway train



“The first had the respondents as the driver of a runaway train about to kill five maintenance workers. But they could flick a switch, go down a different path and kill only one worker. What would they do: flick or not flick?


Ninety five per cent said flick. It's simple arithmetic


Then there was a second dilemma. This time the respondents were told that they were on a bridge and watching the runaway train head towards the five maintenance workers. They happened to be standing next to a large man. By pushing him off, the respondent would kill him. On the other hand his bulk would stop the train and save the other five. To push or not to push? Almost everybody chose not to push"


The change from ‘driver’ to ‘observer’ is interesting; previous versions I have heard involve in both cases an observer who, in the first dilemma, can throw the points to divert the runaway train


“Mathematically, these two options are the same. Five die and one is saved
because of the action of the respondent. But emotionally they felt quite
different. Greene and his colleagues noted that, while solving these dilemmas,
different parts of the brain lit up. The second dilemma brought into play not
only the logical circuits of the brain but also an area associated with interpreting the feelings of other people.”







One problem with these hypotheticals is that you are told what WILL be the outcome of your action. This one is definitely peculiar in that way – how can you know that the large man has enough bulk to stop a train which left to its own devices could kill 5 men? And if he is that big, how on earth could you push him off the bridge?

Leaving that aside, does it not seem more likely that the different experimental outcomes of these two examples are due not to empathy with the victim but with the decision maker – with the degree of agency or responsibility, & therefore guilt which he might feel for having sacrificed the sole victim?

In the first case the driver can reduce the damage of something which is happening anyway; he is powerless to halt the runaway train (this applies even if the train is running away because of some earlier mistake he made). And all the potential victims are maintenance workers, with the implication that they have accepted the risks of working on a railway line. Even the victim might, if given the opportunity, choose to sacrifice himself for his mates

In the second case, the observer on the bridge is contemplating the sacrifice of someone who (like him) is just a spectator on the scene, a hapless passer by. In what sense is the observer qualified to sit in judgement in this way – unless questions of life & death are always to be decided by crude arithmetic?

Some will argue that this is in fact the utilitarian argument – the greatest good of the greatest number. Some might argue that life is sacred, you should never take one by your own deliberate act

The lines of discussion opened up fill whole books & libraries & lifetimes, but I found myself thinking specifically about what light might be thrown on the current ‘debate’ about MMR

Taking your baby to be vaccinated or inoculated is not something you do lightly – after all if a random stranger tried to stick a needle in your child’s arm you would do everything possible to stop them. You do it to protect your child, for the avoidance of disease which could lead to death, life long disability, disfigurement or even just a week in bed feeling poorly. Altruism – the protection of other people’s children through the immunity of the herd - is an added bonus

Nevertheless vaccination has always been controversial, the subject of political battles in the C19th, & generally speaking has never been compulsory in this country. My best friend at school had a mother who refused on principle to have any of her 4 children vaccinated against anything. And now we have the refusal of some parents to go for MMR

When I first heard about this I got the impression that the medical establishment was (not for the first time) objecting simply to the publication of a hypothesis

Funnily enough the idea of a link between the measles virus & autism gained a certain plausibility for me when I heard a doctor on the radio trying to explain why measles was not an unproblematic, simple childhood illness, but one worth vaccinating against. It was the mention of lesions on the lining of the colon which did it

For me there seemed to be an analogy with PKU. I am obviously not a scientist or a medic, & my understanding of PKU is based almost entirely on the explanation given to me by my mother when I was about 10

She was explaining why we had been saying special prayers for a member of our congregation, who had just, at long last, managed to finalise the adoption of a 4 year old boy she had been fostering since birth. I do not know whether the problem was with the natural mother’s consent or with doubts by the adoption authorities, because the little boy had been diagnosed with PKU (it was not automatically tested for at birth in those days). My mother explained that this meant that there was something wrong with his digestion so that protein, instead of building him up, turned into poison in his bowel & poisoned his brain. Fortunately it had been found in time & provided his mother was very careful about what he ate all should be well, though he might be a bit slow

That had a very profound effect on me, especially as he was such a beautiful, solemn little boy with glossy black hair, big eyes & long, long eyelashes

But, the fatal but, is that this analogy provides no basis at all for linking autism to MMR but not to the single vaccine or to the measles virus itself. And so the campaign against MMR seems irrational to me


HOWEVER – and this is where the guilt of the agent comes in – the fact that a doctor could come up with the idea of a link is itself a kind of evidence, sufficient to raise a doubt in some peoples mind


If my unvaccinated child suffered great harm from measles that would be a cruel
act of random fate, or God’s mysterious purpose

If my child were vaccinated & then developed autism I should be unable to forgive myself

Statistics apply to populations, not to individuals. If there is any risk – even if that risk is vanishingly close to zero, because many other doctors have searched long & hard & can find no evidence that it exists – it is not something I can do to my child

A public health doctor has no right to decide that the benefits of herd immunity which I confer on other people’s children justify the risk to my precious baby


In such circumstances lectures & threats do not seem either humane or productive

The beautiful words of the Anglican confession do more to help people think differently about how they think about responsibility for the sins of both omission & commission:


"We have left undone those things which we ought to have done, and we have done those things which we ought not to have done, and there is no health in us."




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