This scenario is made up of two parts. Bioterrorism

Please write your answer for Part A before you answer Part B and when you comment, please break up your answer into Part A and Part B.

PART A:

You are the head of a public health clinic in the urban core. An hour ago a toxic biological agent was seeded across the city by a low-flying crop-duster airplane.

The bio-agent is fast-acting and severely incapacitates in 90 minutes and kills in three hours. Everyone in the city is infected. Most are already dying in the streets as they choke to breathe in their mission to find help. 

You are infected as well and your staff are either dead or missing.

A supply of antidote from the national government is due to be dropped into the city via parachute in five hours that will heal those who are not dead yet, but who have also swallowed a Magic Pill to keep them alive.

These Magic Pills are strategically scattered across the city in certain public health clinics. Magic Pills are expensive and brand new so they are in the initial delivery phase and are in short supply.

To stave off death until the antidote arrives, you have a supply of only three Magic Pills that will stop the advance of the toxic agent. If a person does not swallow a Magic Pill, death is guaranteed.

Your decision today is to pick which of the following seven people waiting outside your door — don’t forget to include yourself — will get a Magic Pill and who will die in front of you. You have 60 seconds to make your decision so those you choose to live will have the best chance for survival:

An Old Woman

A Fireman

The Chief of Police

A Mother and Her Young Child

The Homeless Man You Feed Every Day

The High School Basketball Star

Who gets your three Magic Pills? Don’t forget to include yourself in your calculation. You must assign all the Magic Pills right now. After you have made your decision and cemented it as Part A of your comment, please scroll 2,000 pixels down this page and answer Part B.

One Grey Pixel!

PART B: In your mind you have privately assigned the three Magic Pills and the moment you are ready to announce your decision and distribute the pills —

Your Mother Your Spouse Your Child
— burst into the clinic!

They are all infected as well.

They each need a Magic Pill to live — without one they will die. Now who do you pick? Does your previous decision change or not? Which three of the 10 people now before you get the Magic Pill? Don’t forget to include yourself in the decision process.

What do you say to those you did not pick?

Please make your answer to Part B of this scenario separate from your Part A answer in your comment so we can see the logic and the emotion of your thought process. Don’t forget to explain why you made your decisions for each person in both Parts A and B.

95 Comments

  1. If I was really in a situation like that, I’d probably die before I could swallow the miracle pill because I’ve always had trouble with swallowing meds regardless of the size of the pill.
    That aside, is there anyone working with me at the clinic? If so I would take one pill and give it to two staff members. And I would not announce that there were 3 miracle pills so there would be no riot until the government meds arrived.
    PART A
    1. Me (because no other clinic members were mentioned and if I don’t survive, who would administer the cure?)
    2. The Homeless Man You Feed Every Day (because he is more likely to be loyal and help me.)
    3. A Fireman (I had considered the Chief of Police to help fend off the rioting but I anticipate a riot would ensue and people would fight for the pills. But then again, they may be too weak to do anything.)
    PART B
    1. The Homeless Man You Feed Every Day (because he is more likely to be loyal and help me.)
    2. A Fireman (fight the fires once the riots begin because people would fight to get to their families to the front once they regain their health.)
    3. The Chief of Police (to help contain the rioting.)
    It is my understanding that firemen and policemen have some training for emergency situation. I could show them the proper way to administer the meds and then standby my family but I would also try to assure we would be the first people to whom the meds were administered once they arrived by air.
    Question: Wouldn’t the Mother and Young Child each need a pill?

  2. A S —
    Yes, you are working alone. After I published the article I went back to add that to make certain it was clear you are the only one in the clinic. You read the piece and responded so quickly that you didn’t get a chance to see my almost-immediate update.
    😀
    Yes, the mother and child each need a pill. That’s why there are seven people to consider in Part A and not six — adding you makes 8 people who want 3 pills.
    So you would choose to die with your family as part of Part B?
    I didn’t tell you the age of the old woman — how old did you determine her to be?
    Does the promise of a young and strong basketball player not interest you?
    Did you consider giving the child in Part A the Magic Pill and not the mother? Or did you consider them inseparable and, therefore, not candidates for living because their family benefits twice as much as the others if they both get a pill?
    It’s interesting in Part B you still chose the Homeless man — you’re dead — but you still want his loyalty and help?
    You’re right about the riots! The entire city will likely be quarantined and people will want to get in or get out!

  3. Now I know why I went Xmas Shopping!
    If I was a public health employee I would follow the issued guidelines for such a situation which would be a case of assessing most useful skills /knowledge/experience to ensure the survival of the greatest mumber in the long term.
    I suspect it would be
    Me, A Fireman, The Chief of Police basically for our combined knowledge in such a situation and the levels of experience and training. It would depend on the health, age and qualifications of the others involved.
    Case B – Should be the same as A – although if any of the others had similar skills to mine I would probably chose to go with my family.
    My quirky head asks would splitting each pill into three – or in the case of the scenario B four work?

  4. Hi Nicola!
    Thanks for your analysis and I hope your shopping was great fun!
    No, splitting a Magic pill makes it disappear and then no one gets one. I can’t believe I have to tell you that!
    😀
    So you would choose to live over your family? Duty over honor?
    What do you say to the others about why you didn’t pick them?

  5. “It’s interesting in Part B you still chose the Homeless man — you’re dead — but you still want his loyalty and help?”
    I’m not necessarily dead. I’m on the top of the list when the meds arrive along with my family. I may be weakened but I want him to make sure we get the cure if still half living.

  6. Worth a try !
    “So you would choose to live over your family? Duty over honor?”
    Yes if I was the most useful in the outlined scenario – however if my child was a bio-chemist and also worked in public health they would get the pill !
    I would explain that I have been doing the job for X years and been paid by the authorities to do so and that there are procedures to follow.
    I am not saying I would feel comfortable with the decisions I would be making but would at least understand why they were being made.
    Maybe I should make them vote ( and not allow them to vote for themselves? )
    Seriously I would follow the book and the rules – that is what they are there for.

  7. Hi Nicola!
    Don’t “the book and the rules” assume a fruitful and predictable circumstance?
    Do you think those you condemn to die will listen to your “by the book” rationale? Do you think your strangling is in their future? What to they have to lose? You’ve already condemned them to death.
    Do you anticipate the need to protect those who get the pills? There are more assigned death than living.
    Do you think those pills would actually be administered? Wouldn’t the dead do everything in their power to steal the pill, destroy the pill or kill those who swallow the pill?

  8. The original message said that it incapacitates in 90 minutes and kills in 3 hrs. but he cure is suppose to arrive in 2 hrs. It didn’t say I would be dead for certain. Being the head of a health clinic in the senario given, I would hope I would be able to prolong my life and the lives of my family with the medication already in the clinic. I would also find out from the government agency what chemicals are in the cure and the exact nature of bio-terror used to make sure that the meds to prolong live would not react with the cure.
    The Old Woman (regardless of age) has lived her life when compared to the lives of the other people not called “old”.
    The Mother and Young Child are paired up.
    The Highschool Basketball Star would be of little help if the meds actually arrived and teenagers (even ones used to pressure of state finals etc.) are prone to be more emotional / psychologically unstable in crisis situations.
    I would only let those who received the pill know what to do next. I feel no obligation to worry the crowd with excessive information that would only serve to increase panic and kill or be killed mentality.
    We must also note that it is highly probable that the shipment would take much longer than that (see Hurricane Katrina reaction time). So yes, very probable that the only survivers would be the 3 people who got the miracle pill but I still stand by my original comments.

  9. A S —
    Right. The three hour clock started ticking an hour before the scenario begins. If you don’t have the Magic Pill you have no hope of getting to the third hour.
    I’ll go make that clearer for future generations who read this.
    😀

  10. Hmm… if the 3 hrs. started 1 hr. before the scenario, then the people would be well on their way to being incapacitated as we speak. Likely already weak from the infection, it is plausible that neither the fireman and the police chief would not be as necessary as previously imagined.
    If only members of my own family survived, it would be likely that my life thereafter would be horrid as revocation of the medical license and the trials etc. which would ensue along with the guilt of not saving others would likely tear apart the hypothetical marriage and cause psychological damage. So I may still choose to die with the family.
    Assuming everyone who didn’t receive the pill would die and that the people are already severely weakened, the basketball star and the mother & young child may have the best possible chance to bounce back and have the best potential.
    But the Homeless Man, the Fireman, and the Police Chief have probably been through more so they may be more resiliant so they would still be my pick.

  11. A S!
    Yes, I agree! Incapacitation has already started!
    Youth and strength may be more important now.
    As well, there may not be any unlawful disorder because most of the people are already dead or dying.
    The entire city will likely become a tomb by the end of the day and remain like that forever.
    Is it possible to decontaminate an entire city?

  12. I suppose it would depend on the nature of the bio-hazard. Some dissipate others linger. I would suspect one would also have to monitor the neighboring communities as well to see if their health declines. There is also the possiblity that the contamination becomes airborne again come the next rain.

  13. Excellent comment, Dave, and brutally honest. Do you feel any sort of duty to hand out the pills via a blind lottery or something: “There are 3 Magic Pills in this Bag and the rest are sugar pills. Close your eyes and pick your fate.” Or do you like the power of being in charge?
    I ran a similar scenario in one of the Public Health classes I taught and we used a name brand pill and they all got wound up over the efficacy of the pill and not the ethical heart of the decision-making process — and that’s how “The Magic Pill” was born!
    One of my most brilliant MD students parsed Part A down to an inch of its life and gave a 30 minute presentation on her rationale as she decided to save herself, the Police Chief and the Fireman. We all clapped for her.
    Then I gave them all Part B.
    None of them wanted to consider Part B.
    I told them these are precisely the sorts of life and death conundrums they will deal with in the real world after their training is done and it’s better to consider these questions now and not when lives are really on the line.
    My beloved MD then changed her answers for Part B to save her mother and her child and herself. She cried afterward. We all wept with her.

  14. “Hi Nicola!
    Don’t “the book and the rules” assume a fruitful and predictable circumstance?
    Do you think those you condemn to die will listen to your “by the book” rationale? Do you think your strangling is in their future? What to they have to lose? You’ve already condemned them to death.
    Do you anticipate the need to protect those who get the pills? There are more assigned death than living.
    Do you think those pills would actually be administered? Wouldn’t the dead do everything in their power to steal the pill, destroy the pill or kill those who swallow the pill? ”
    I know there is a book – I know someone who has access to the book – I know the way the book is supposed to work. ( this will make another interesting conversation at the dinner table at New Year.)
    As to resistance – your updated scenario means they will already be incapacitated to some extent. The police Chief of course will be aware of the book, will be onside and know the book and the plan.
    I am sure they could ALL be given a pill – magic or not

  15. Nicola!
    I fear for you! I predict a bludgeoning may be in your future with this book of rules! I’m sure it’s giant and really heavy!
    Yes, they are getting weaker by the moment, but I have no doubt together the dead would be able to heft your book and drop it on your delightful head!
    :mrgreen:
    Right! A “Pill Lottery” might be the fairest way out of it – if, however, everyone agreed to go along with it — but that assumes people will be civil in death as they are in life and that, in this scenario anyway, is bloody unlikely!

  16. …hmm… a few more questions for you (even though my original 60 secs are up)
    Since this is a hypothetical question I would like to know more of the particulars:
    1. Is everyone there someone I recognize in the community?
    2. Are they my patients whereby I know their medical history?
    3. Are my mother & child my biological relations? Was my mother a physical presence during my upbringing? Do I resent her for anything?
    4. Do I have a happy marriage? Did my spouse cheat on me? Did we have a recent argument?
    5. How much life insurance do I have? Would it guaruntee that my spouse and offspring are taken care of should the survive (including lingering health issues as a result of this senario)?
    6. Is anyone one in this senario so desperate for survival at this point that he has a gun to my head to insist he/she gets a magic pill?

  17. Hi David,
    PART A
    My priority in a situation where not everyone can be helped is to try to help the greatest number of people that I can help.
    Therefore, I choose the Police Chief and the fireman. The Police Chief is the C3 of the police department — the command, control, and communication. If the Police Chief isn’t available, then valuable time could be lost finding a replacement for her or him.
    I also choose the fireman because he or she can be useful in helping other people. In an event like this, it is likely that fires will start. Also, the firefighter might be crossed trained to be a paramedic or at least have some basic medical skills.
    It’s a tough decision to make, but it needs to be made. I don’t think I would tell the others — unless they knew about the pills. It wouldn’t do any good to say who would be saved when others would eventually fall to the disease.
    PART B
    The firefighter loses in this situation.
    I’d have to give a pill to my wife if she showed up and the other to my child. If my wife didn’t want it, then we’d give our pills to the fireman to distribute as the sickness overtook us.

  18. A S —
    1. You don’t know any of them.
    2. You don’t have any medical histories.
    3. Your mother almost died giving birth to you. Your child is biologically yours. You love your mother more than yourself.
    4. You have been happily married. Your husband almost died after he married you but your mother nursed him back to life. The only argument you had was the day before when you ran this scenario by him and told him then he wouldn’t be getting a Magic Pill from you. He has been seething ever since.
    5. You have no life insurance. You are running a community clinic. There are no guarantees anyone will survive without your modest income.
    6. There are no guns, but your gut tells you there are several folding knives in the room but you won’t know in which pockets they loom until after you render your decision.

  19. Chris!
    Fine analysis! Are you giving a pill to yourself in Part A? It’s interesting how your choices give preference in restoring the human infrastructure of a city that will soon have very few people alive.
    It’s fascinating you can deny your mother but not your wife. Amazing!
    When my MD student chose family over duty in Part B she realized she was “a hypocrite and a fraud” because she didn’t follow her training. She could not believe she made a personal decision to save herself and her family over others. It really got to her. I told her that’s the job of being human in a job when the stakes are living and dying.

  20. “There are no guns, but your gut tells you there are several folding knives in the room but you won’t know in which pockets they loom until after you render your decision.”
    Well this actually helps. I’d have a fake lottery whereby the magic pills are mushed up in applesauce. I’d still pick the 3 most likely to survive (although it would be impossible to tell for certain as they would all be in a weakened state). So this would exclude me, my mother, my spouse, or child since we would not have the means to survive once healed. I would call the 3 “chosen ones” aside and give them the pills in a separate manner.
    If the remaining persons killed one another for the applesauce those that die just suffer 1 1/2 hrs. less than their killers. The expenditure of energy used to battle it out could accelerate the ill affects of the bio-hazard thereby causing the attackers to become incapacitated at an earlier rate.

  21. If knives are used against me, who would be left to figure out which pills are the Magic Pills? They’d have to take all the pills which could mean a possible O.D. in which case they too would die. And even if they survived, they would not know how to administer the antidote that the government is planning to send. They would at best prolong the inevitable.
    “Are you aware that mixing Magic Pills with applesauce creates military-grade Anthrax?”
    Applesauce shouldn’t have this affect but since we are using your hypotheticals let’s suppose that it does. I never said that the real magic pills were mixed in only the fakes used for the phony lottery. This would help keep the attackers away from the 3 survivors.
    Additionally, I the fake pills used could be mild sedatives used in order to calm the crowd.

  22. Dave!
    The reporters only report Magic Pills exist. They don’t know exactly where they are located. The people are coming to you hoping you have one and will give one to them. They’ve heard rumors in the street you had a delivery and they aren’t leaving until they get a decision. You could try to turn them all away into death if you wish.
    They’re holding their attack until after your decision about the pills. Then they’ll come after you…
    You can run, but you cannot hide from an angry mob, Dave!

  23. A S!
    I cannot believe you have so quickly forgotten all your Magic Pill training! Magic Pills are the size of baseballs, but easily edible, and they glow orange and purple and have a green aura. You can’t hide them in your pocket!
    Ah! You might be on target with knocking EVERYONE out with a sedative “as part of the Magic Pill” process and then reviving those you chose to live and leaving the rest to fall forever into a Golden Slumber… or are you then dealing in euthanasia?

  24. “or are you then dealing in euthanasia?” It is not the sedatives which are the causality of death but the threat unleashed by the crop duster. Even if it is considered euthanasia, you must remember, I’m dead along with my family so no one would be left to prosecute.

  25. In this hypothetical scenario, is the town’s genetic material also contaminated? If not, I may store samples of everyone’s genetic code before I too am incapacitated so any loved one may be able to clone said person if they so chose.

  26. In this hypothetical scenario, is the town’s genetic material also contaminated? If not, I may store samples of everyone’s genetic code before I too am incapacitated so any loved one may be able to clone said person if they so chose.

  27. I will enquire about the book and directives!
    Maybe keep a pill for me and the police chief and throw the other on the floor and remove myself and police cheif to place of safety !
    And one of course has to ask what you would do?

  28. I will enquire about the book and directives!
    Maybe keep a pill for me and the police chief and throw the other on the floor and remove myself and police cheif to place of safety !
    And one of course has to ask what you would do?

  29. I cannot wait to see that book, Nicola! Take a photo of it when you find it!
    😉
    I like your idea to take a pill, give one to the Chief and then use his gun to protect you both as you toss the last Magic Pill in the street in the opposite direction of your escape as in Chris’ “Michigan Roll” from a few days ago!

  30. I cannot wait to see that book, Nicola! Take a photo of it when you find it!
    😉
    I like your idea to take a pill, give one to the Chief and then use his gun to protect you both as you toss the last Magic Pill in the street in the opposite direction of your escape as in Chris’ “Michigan Roll” from a few days ago!

  31. Part A:
    The Mother and the child – there go two pills
    The chief of police
    Rationale:
    Though technically/theoretically I don’t have emergency situation training but I think saving a child is the first priority in any extreme case. A kid of today is the future citizen of tomorrow.
    The mother needs the pill to take care of the child.
    At this point it is not important who is administering/distributing the antidote once it arrives as long as it is getting distributed. As I will have a couple of minutes before I die, I will chalk out a plan how the antidote can be distributed and will hand over the responsibility to the mother of the child and ask the chief of police to protect her from any vandalism that might occur.
    The notion of a mother to be responsible is cross cultural and she has to perform this duty successfully to ensure a relatively better future for her child.
    Part B:
    As it will be impossible for me to be neutral with my family around, I think a ‘magic pill lottery’ or the ‘first come first served’ will be the best solution for this case.

  32. “We don’t know if the genetic material is contaminated or not, so collect it and save it! Love the idea!” I not sure about the ethics of collecting genetic material without the consent of the individual. But since I’ll be dead anyway, why not.

  33. Here’s what I would do:
    Part A:
    I get a pill because I can: I’m the Decider!
    I offer a pill to the young child but only if the mother agrees not to take one, too. If the mother refuses to die and let her child live, then they both die and I will make that clear to her. In this case, the mother accepts the offer to die in her child’s arms. The young child gets a pill.
    The Fireman and Police Chief are part of a system that no longer has a function. They may be good people, but they’ve found success in their lives, and so they end in duty and their families will reap the benefits of death in service.
    The Homeless Man doesn’t get a pill and neither does the old woman. Their stakes in life are already set. They need to play out the hand the best they can alone.
    The High School Star gets a pill. There is youth and vigor and promise there that gets another a shot at living.
    Part B:
    Forget Part A!
    This is, Survival of the Fittest, after all, in the most pure form of evolution imaginable — and I have the power of the Magic Pills in my hand: I’m the Decider!
    So… my mother dies. My wife and child live along with me as we eat our Magic pills together as a family.

  34. A S!
    Ah! But if you collected the genetic material to “aid in future identification of the presumed dead” you’d be okay legally and ethically, right?
    If others choose to clone that material that’s beyond your involvement, right?

  35. I don’t want to marry a ‘decider’ who ‘decides’ to keep his spouse and child alive…
    What if one fine morning he ‘decides’ not to…???
    ooops!!! 🙁

  36. “To aid in future identification of the presumed dead”, to clone, to prevent future outbreak… not sure about the legality of it all.
    But I and my family would be dead so they couldn’t sue us and the entire town / city would be dead (except 3 people who would likely move elsewhere) so really no one I can think of left to sue.

  37. “This is, Survival of the Fittest, after all, in the most pure form of evolution imaginable — and I have the power of the Magic Pills in my hand: I’m the Decider!”
    I hope for your sake you and your family have your knives handy while administering the pills. With the survival of the fittest mentality, who’s to say someone else with a knife won’t cut it out of your throats so they / their family can survive especially if they are “the size of baseballs… and they glow orange and purple and have a green aura”.

  38. I like that answer. Who knows, the Magic Pill or the damage done by the bio-terror may negatively impact child-bearing capabilities and there would not be enough time to figure it out. And even if it hadn’t, there would be no guaruntee of future progeny.

  39. Wow. What a horrible scenerio.
    Who would raise the children? How would they get to the next state etc to avoid the residues?
    I’m glad you didn’t say 4+ kids because then one of them would have to die.

  40. Wow. What a horrible scenerio.
    Who would raise the children? How would they get to the next state etc to avoid the residues?
    I’m glad you didn’t say 4+ kids because then one of them would have to die.

  41. A S —
    The kids would have to fend for themselves and hope help came soon.
    Four kids are tough. It would depend a lot of variables: health, age, intelligence, etc. If everything were equal, you’d have to choose the oldest to take care of the youngest and then you’d have to decide between the two children in the middle and it might just come down to letting them fight it out or you deciding which one you think will survive best alone in the world and if that is equal… well… then… the one you like better even though you love them both.

  42. A S —
    The kids would have to fend for themselves and hope help came soon.
    Four kids are tough. It would depend a lot of variables: health, age, intelligence, etc. If everything were equal, you’d have to choose the oldest to take care of the youngest and then you’d have to decide between the two children in the middle and it might just come down to letting them fight it out or you deciding which one you think will survive best alone in the world and if that is equal… well… then… the one you like better even though you love them both.

  43. I read this post on Thursday, and had no problem with Part A (myself, the chief of police, the high school athlete); however, when I got to Part B I just wanted to run for cover. I simply could not answer. Why? Because the answer that sprang to mind felt like it was the ‘wrong’ answer. So I went away without commenting. But the question just kept nagging at me. In all honesty, what would I do? Given the power to save them, I simply could not let my spouse and child die. And I’m not selfless enough to give my pill to someone else. It’s a hard truth to face, but there it is. I can only hope none of us will ever be confronted by such a cruel scenario.

  44. Hi icedmocha!
    I admire your willingness to come back here and reveal yourself — and I did — to be a fraud and a hypocrite when it comes to saving yourself and your family from evolutionary extinction.
    The Ice Age wiped out life in large sweeps and, so too, will Terrorism wipe out large masses of us in the future.
    These questions are telling and painful because we are forced to reckon with not only who we are but also who we thought we’ve been all along.
    For many of us, being selfish and self-interested goes against our better wishes and that is a hard truth to take.
    When my students revolted and initially refused to answer Part B — I told them they were wasting their money and the training their minds and spirits in Public Health and Medicine if they thought these sorts of hard, impossible, questions were not part of the job description.
    If they didn’t want to make choices between living and dying for the benefit and detriment of lots of other people then they should teach or run a dog grooming business or answer phones — because Public Health is, at its core, dealing with death.

  45. Part A: I’d pick the three people who together have the biggest chance of helping the population outside the room survive.
    (1) Me – I know where the other Magic Pills are located, and I see no indication that anyone else does. I will be able to ease the suffering of those who must die, and I can help the survivors recover after the magic antidote is sprayed over the city.
    (2) and (3) are the Fireman and Chief of Police. Someone will need to help control the doomed and survivable crowd until the antidote arrives. We don’t want the doomed killing all the survivors; we don’t want the survivors killing each other.
    Part B:
    On paper I am able to say that I should do the exact same as before. I would not have picked this job if it weren’t my whole life, and my family would know this. They would not want me to do otherwise.
    Faced with this choice in real life, I have no clue what I would actually do.

  46. The man that knows has one word for us
    “Echelon” – more details can be obtained in this country from Divisional Police Authorities – however asking about it may attract a lot of attention.

  47. The details that I have are very limited.
    I asked the question in general terms – as in
    “is there a plan outlining planning, instructions and priorities for procedures in case of a chemical or biological attack ?” – and then went on to outline your scenario.
    Of course there is. Was first response.
    “Including who gets to live and die ?” Was my next prompt – same response.
    I then got the “word” and was told who are the guardians are of the plans.
    I have to say I went and googled and was a tad wary about the results I got …….. however the international communications interception network of that name could well be dual purpose and work in both situations.
    I have no reason to doubt what I have been told – knowing the source as well as I do – and knowing what his job is and what it has entailed over the last ten years.