Several papers in this issue of the Journal of Medical Ethics focus on dilemmas of various sorts. Our feature article and accompanying commentaries discuss the dilemma facing Japanese citizens in implementing tsunami-tendenko, a highly effective, life-saving strategy for responding to tsunamis which nevertheless requires people to act contrary to certain powerful moral intuitions. Two papers—one by Bram Wispelwey and one by Robert Torrance—reflect on what considerations should prevail in deciding how to proceed when the requirement to ensure treatments are safe and effective conflicts against patient autonomy. And Charles Foster speculates about how the law is likely to weigh people's freedom to disclose genetic information about themselves against the privacy of others to whom the information also applies.

Conflict between consequentialist and deontological intuitions: a real-life case study

Philosophers are fond of constructing elaborate thought experiments to test our moral intuitions. ‘Trolley problems’, an increasingly elaborate mainstay of moral philosophy since Philippa Foot first described them in the 1960s, are designed to weigh consequentialist moral intuitions against conflicting deontological ones. Trolley problems have attracted the attention of psychologists—notably Joshua Greene and colleagues1—wishing to gauge the interaction between, and influence of, reason and emotion on moral judgment. Some argue that moral judgment is made on the basis of emotion alone, with reason providing merely post-hoc rationalisations of decisions already made.2 Emotion, these researchers hold, leads us to make deontological moral judgments, whilst reason leads us to make consequentialist ones. This claim gains support from more recent research that finds a correlation between a tendency towards consequentialist moral judgments and antisocial personality traits, including psychopathy.3 Psychopathy, of course, is characterised by stunted emotional response.

The conflict between consequentialist and deontological moral intuitions that is highlighted by hypothetical trolley problems also arises in a far more pressing, real-life context that is the focus of this issue's feature article. …