Juicebox Podcast: Type 1 Diabetes
Episode #1661: The Trolley Problem
Date: October 24, 2025
Host: Scott Benner
Guest: Erica (returning co-host and parent of a child with Type 1 Diabetes)
Overview
In this reflective episode, Scott Benner and Erica use the classic moral thought experiment known as "The Trolley Problem" as a metaphor for the everyday decision-making challenges faced by people living with Type 1 Diabetes and other chronic illnesses. They explore themes of action versus inaction, taking personal responsibility, blame, shame, and the psychological processes that influence management of a lifelong medical condition. Their candid, relatable discussion offers validation, insight, and encouragement for listeners navigating similar complexities.
Key Discussion Points and Insights
1. Personal Updates and Softball as a Precursor
- The episode opens with a light-hearted check-in about Erica’s busy summer, spent supporting her daughter’s All Star softball team (02:17–03:32), segueing into a reflection on childhood self-image, competition, and parental pressures.
- Scott draws a parallel between external pressures in sports and managing chronic illness—emphasizing the theme that life presents us with challenges and choices that are often outside our control.
2. Introducing the Trolley Problem
- Scott explains the Trolley Problem as a tool for exploring moral dilemmas and trade-offs (04:35–06:52).
- He asks Erica: Would she pull the lever herself to save five people by sacrificing one, or do nothing?
- Erica’s response: She would like to think she’d pull the lever, but acknowledges real-time panic and indecision (06:52–07:48).
- Scott expands: The choice between responsibility for inaction versus responsibility for direct action (07:48–08:41).
"If you do nothing, the trolley kills those people and you take on no responsibility other than inaction. But your inaction would have been you deciding to kill a person who was not going to be killed if you didn't do anything, right?"
— Scott (07:48)
3. Variables in Moral Decisions
- Scott adds layers:
- What if the one person is someone you know?
- What if age is a factor?
- How do we justify or rationalize choices by adding context?
- They note how emotions and relationships complicate otherwise logical decisions (10:33–11:26).
4. Linking to Chronic Illness: Action vs. Inaction
- Scott connects the trolley problem to diabetes management:
- Taking action (bolusing, pre-bolusing, routine management) is like “pulling the lever”—you shoulder the responsibility for the outcome.
- Inaction (ignoring diabetes management) lets "the disease" bear the blame, but may lead to worse outcomes (15:23–18:36).
"If you are doing that with your care, then I just think you'd be better off pulling the lever if you have diabetes ... I think it would be better for you to be in the fight, be part of the decision making process than it would be for you to just say, hey, I didn't do this."
— Scott (17:46)
- Erica adds: Not engaging with management makes it easier to blame the illness rather than oneself; action requires accepting possible blame for imperfect results (18:36–20:52).
5. Blame, Shame, and the Search for Control
- Both discuss the human tendency to assign blame:
- Some blame genetics, God, or their bodies when a chronic illness strikes (20:52–22:23).
- Erica references Jane Mattingly’s concept of “body betrayal” and the difficulty of regaining “body trust” (22:23–28:11).
- Scott describes the ongoing parental struggle—trying to support a child’s independence while wrestling with worry and powerlessness.
“There are days that like, you know, Arden's 21 years old, she's in college. And I'll look some days and see she hasn't taken her thyroid meds in three days. And I'm upset. I'm not upset at her because I get it ... I'm here. And it's not my fault, but I'm here. And I just think once you're here, that's it. You're part of it now. It doesn't matter how you got there, right?”
— Scott (31:58)
6. Decisions Driven by Fear and Past Experiences
- Erica highlights several psychological phenomena:
- Fight, flight, freeze, or fawn responses in high-stakes choices (14:29–15:23).
- How past lows or fears of hypoglycemia can drive everyday management choices (33:16–38:48).
- The reality that people may over-bolus or under-bolus based on the setting (home vs. class), comfort, and fear of acute events.
“Usually because of a fear of a low blood sugar later, they have this mindset: it'll be safer, I'll feel safer if I'm a little bit higher later than being low when I'm in a meeting ... if you're thinking about the future, saying, ‘well, I'm going to feel safer later if I'm just a little bit higher…’”
— Erica (34:24)
7. Data and Psychological Study Results
- Scott notes that in actual studies, 80–90% of participants say they would pull the lever, but a much smaller percent would physically push someone—suggesting people distinguish between direct and indirect harm (39:32–41:18).
8. Practical Encouragement: Take Action, Be Kind to Yourself
- Erica and Scott agree the metaphor only goes so far—real life isn’t as black and white, and there’s no single “right” answer (41:18–42:03).
“We just get to be kind and compassionate to ourselves and make the best decision possible and then be kind to ourselves after the decision.”
— Erica (41:56)
- Scott closes by reaffirming his core message:
- Be in the fight for your care.
- Take responsibility for action, but extend yourself grace if things don’t go perfectly—learn and continue.
“I think that means that 80 or 90% of you out there have the ability to, you know, grab the bull by the horns and make some decisions for yourself and live with the outcomes, learn from your experiences and make better decisions next time. Yeah, I think you should do that. That's what I think you should do. I think you should try.”
— Scott (43:31)
Notable Quotes & Memorable Moments
-
On the true core of the episode:
“To me, that's the core of this, right? … And then you apply it to living with a chronic illness …”
— Scott (15:23) -
On the ‘body betrayal’ concept: “Is this my body failed me mindset ... but we can't get stuck there, because that's when we get, we get stuck in kind of more of a self pity, victim mentality ... we want to trust. In order to trust our bodies, our body has to trust us to take care of it.”
— Erica (26:53) -
On self-compassion:
“And oftentimes you just land at—We just get to be kind and compassionate to ourselves and make the best decision possible and then be kind to ourselves after the decision.”
— Erica (41:56) -
On what listeners should strive for:
“I think you should do that. That's what I think you should do. I think you should try, I guess, is my point. Good enough?”
— Scott (43:31)
Timestamps for Important Segments
| Timestamp | Topic | |-----------|---------------------------------------------------------| | 02:17 | Erica’s summer, softball update | | 06:52 | The Trolley Problem explained; Erica’s first answer | | 09:32 | Scott’s answer and variations to the problem | | 15:23 | Bridging trolley problem to chronic illness management | | 20:52 | Discussion on blame: body, genetics, “dastardly” diabetes| | 26:53 | Body betrayal, “body trust,” and psychological impact | | 33:16 | Applying concepts: fear-driven decisions in diabetes | | 39:32 | Research: Most people would pull the lever, not push | | 41:56 | Compassion and learning from experience |
Tone & Language
- Conversational and empathetic: Both hosts share honest, personal stories, modeling vulnerability and self-reflection.
- Humorous and light at times: Scott often jokes to keep difficult topics approachable.
- Validating, non-judgmental: Erica urges listeners to “be kind and compassionate to ourselves” when living with chronic illness.
- Directly addresses listener concerns: Frequent use of “you” puts the audience in the center of the discussion.
Summary Takeaways
- Action vs. Inaction: Managing diabetes (or any chronic illness) is a series of choices—avoiding action may feel easier, but taking responsibility, even imperfectly, leads to better outcomes and growth.
- Self-Compassion is Critical: No one does this perfectly; shame and blame are common—offer yourself the same empathy you’d offer others.
- Real-Life Complexity: Like the trolley problem, diabetes management is rarely black-and-white; factors such as fear, past trauma, relationships, and context shape our decisions.
- Encouragement: Most people do have the capacity to engage, learn, and improve their health management over time. Start where you are.
This summary captures the thoughtful, meandering conversation between Scott and Erica—grounding the existential challenges of diabetes in philosophy, psychology, and personal experience, and encouraging listeners to take action, learn, and most importantly, be gentle with themselves along the way.