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  • Reverend James Squire

Skin in the Game


Photo by Claudio Poggio


One of the difficult ethical decisions that I covered in my Ethics class has many ethical ramifications from it. It is called many names. I prefer to call it “The Trolley Dilemma: Would You Kill One Person to Save Five?” It is a refutation of the Utilitarian Ethic which is “the greatest good for the greatest number of my group” and is also the reason that surgeons don’t operate on family members. It is often used in bioethics as well.


Here is the dilemma: There is a trolley coming down the tracks. You notice that it is on course to kill five people who are working on the tracks but are obvious to the ongoing trolley. You notice that there is a lever on the tracks that if you pull it, the train will switch to another track where one person would be killed. What would you do?


Let’s say that you are standing on a bridge over the trolley tracks and see the track with the five men working and also the track where one man is working. There is a fat man standing next to you on the bridge. You look down and there is no lever on the track. If you push him so that he falls on the track where the five men are working as well as the one man on the other track, only the fat man will die. Thus, you are still saving five, and the man on the other track. Could you push him off?


How does the Trolley Dilemma inform our everyday decision making? In the case where you can pull a lever and be somewhat removed from the situation, you are deciding on a more passive solution. If you push the man off the bridge, you are actively doing something that is active and more personal for you. To use the phrase, “you have skin in the game.” Pushing the man off the bridge makes it more personal with a higher level of involvement. Could you do it?


That is all the information that you have to make a decision. Everyone is different but does the same end result make the decision easier? Most people, but not all, opt for pulling the lever and kill the one and not the five because it is easier to do so remotely or from a distance.


The Trolley Dilemma affects us in ways that we may have never thought about. It is about how the active and the passive are in tension in our decisions. No, you know the man to be pushed off the bridge is a serial killer. That is not knowledge that is available to you to make the context easier for you to do.


It is one of the reasons that surgeons don’t operate on family members. They have active “skin in the game.”


It happens to be the core issue in our political life. Joe Manchin and Krysten Sinema cast votes about the extension of the child support bill. They have no idea how that directly affects a family who is struggling to make ends meet. One mother wrote Manchin to say what it was like to be her and her children in an attempt to make his decision active and not passive.


When Congress has the best medical care in the nation along with a given monthly paycheck and a lot of time off, it has an effect on the average working-class person or underserved family who feel that Congress “has no skin in the game.” Congress thinks their decisions are active, but in reality, they are passive. It is cognitive dissonance between active and passive decision making. Self – interest is the opposite of “skin in the game.” Even Nancy Pelosi, ever the paragon of virtue, wavered on whether you could be in Congress and be involved in the market. Her husband has a financial services firm which values her wealth at 150 million.


When we are actively involved with someone, it is harder to do something that may harm them or not be in their best interests.


Think of the issues in your daily life where active versus passive affects what you do! When I was chaplain at the Episcopal Academy, I would receive a rude call from a parent that was over the top. I would always say, “You are really angry me with me. Let’s meet and discuss it further.” When we are face to face, the nature of the exchange is very different. It is active and not passive as in a phone call where one is one step removed. I NEVER found a face-to-face meeting filled with rancor if I met face to face with the people. Like the guy who has to decided on actively pushing the fat person off the bridge, it is harder to do in person- to- person rude exchanges. If the person on the other end of the phone call wouldn’t meet, I knew that they just wanted to express anger and not try to reach a solution. Because of my background, I am not good at being someone’s punching bag.


I sometimes got in the office early like at 6 in the morning. I received a call from someone who wanted to leave strong a message regarding a complaint that this person had. When I picked up the phone and answered, she was startled. She said that she didn’t expect to get me. She was stumbling over the issue and then said, “I will call you later.” She never did. We have all heard the admonishment that if you want to write someone about something that they did that you didn’t like (passive decision), you should write the letter and sleep on it. I would just suggest that if you have a complaint and can’t speak directly, face to face, with the alleged offender, then forget it or it may be something that you may come to regret.


This active and passive dilemma comes up in many situations in bioethics particularly with end- of-life decisions. Sometimes treatment is withheld which is a passive way of proceeding while others may increase the level of morphine to such a level that would bring a more peaceful, less painful departure from this life. This is seen as a more active gesture.


The origin of the phrase “skin in the game” is derived from derby horse races. The owners of the horse have “skin in the game.” They have the most at stake! Although we don’t think of Warren Buffett as a horse person, he first used the phrase before buying his first investment saying “now I have skin in the game.”


Think of various relationships you have and various decisions you have made. Are they active or passive? If you were on the bridge over the trolley tracks, would you push the person next to you off to save six lives killing just one? Would you pull the lever from a safer position or not?


The answers may tell you a great deal about how your ethical self operates.

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