COVID-19: A trolley without brakes

Alejandra Rivera Quintero

At this very moment, we might be unable to measure the reach of this pandemic: our generation does not have a direct reference point allowing us to know what it is like to have a health care system with limited resources. Of course, anyone in this country knows what it is like to find that our medicines are out-of-stock, or what a nightmare it can be to wait in a waiting room, for hours, in order to be cared for in a Family Medicine Unit. However, this is not even close to what will happen when our hospitals won’t be able to look after the people presenting severe symptoms of an infection with COVID-19. 

When this moment comes to our country, as it has already happened in other countries, we will see how mortality rates increase, and not only because of the very lethality of the virus or because of the potential comorbidities that the patients can experience. Mortality rates will increase because there won’t be enough beds or breathing machines anywhere. The moment will come when hospitals will be completely saturated and when health-care workers will be scarce: even though their profession seems heroic to us, they also get tired, and yes, they also expose themselves to a great risk of getting infected and dying. The moment will come when public hospitals, private hospitals and military hospitals will need to accommodate improvised spaces in order to be able to receive a growing number of sick people. Worse: even in the morgues, places will start lacking. Anyone suffering from an accident or any other sort of medical emergency that does not have anything to do with the virus (anything from giving birth, to a strong trauma, to a simple allergic reaction) won’t be looked after with promptness either.

A part of the problem has to do with the fact that, in Mexico, our public health care system has been dismantled for decades and this is clearly going to become evident in our country. However, the thing is that not a single country in the world –not even the most developed countries- possesses a health care system able to treat, simultaneously, so many different medical emergencies. 

When we get to this point, our health-care institutions will need to decide on which patients should be given the priority, and they will need to decide this quickly. When we get to this point, it will become clearer to us what kinds of lives are considered dispensable and we will finally know who can be sacrificed so that others can live. 

The trolley problem is a classic example to represent the principles of utilitarianism. In this example, there is a runaway trolley barreling down railway tracks, without brakes. Ahead on the tracks, five people are tied up, unable to move. The driver has the option to pull a lever that would switch the trolley to a different set of tracks, but on those tracks, a person is also tied up, unable to move. The utilitarianist perspective supports the idea that it is preferable to make a decision that would save the greater amount of people, even if it implies the suffering of a few people. For this reason, it is usually morally justified that, confronted with the trolley problem, people usually opt for switching the trolley to a different set of tracks. However, the decision cannot always be based on pure arithmetic. If the trolley problem takes into account that, on one side of the tracks there is a group of young people with a privileged socioeconomic status, in their most productive age and without any previous illness, and on the other side there is another group of pauperized people,  aged 60 and over, indigenous, migrants, without access to health care services, handicapped, suffering from chronic illnesses, etcetera: then the decision will be based on the greater benefit, or even more precisely, on a power exercise that would determine which lives are worthy of being lived and which lives are, on the contrary, dispensable.


Maybe that explains why, in the United States, the effects of this pandemic have been felt with so much intensity by the Afro-American population and the Hispanic community, or why Italy decided to prioritize young people over elderly people. What remains to be seen is which lives will be abandoned to their death in our context. Even though we have the intuition of the populations who could be disadvantaged the most, what remains true is that we now find ourselves at a very decisive moment, as we are simultaneously tied to railway tracks as well as being the ones with our hand on the lever; bad news is, we are on the brink of finding out that our trolley does not have brakes.  

Mexico City, April 13th 2020. 


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