In Kantian moral theory, the difference between the two situations is that in the surgeon's problem, a patient is used as a means, which in Kantian ethics is not morally permissible. In the trolley problem it is argued that the primary act of flipping the switch to change the path of the tracks, if done independently, is not intended to cause harm to another person. However, the death of that person on the alternate track is a consequence of the switch being triggered, so that person is not used as a means to save the five people on the other track. Kant devised the formula of the end in itself which encourages us to act in such a way as to always treat humanity, whether in one's own person or in that of another, never simply as a means but, always at the same time as an end . In the surgeon's problem, one patient would be killed solely to save the other five needy patients. That patient is then used as a means, which should never be allowed in Kantian moral ethics. The utilitarian approach on the other hand would conflict with the Kantian perspective of this situation. Utilitarianism, also called the greatest happiness principle, holds that actions are right because they end up promoting happiness, and are wrong because they tend to produce the opposite. A utilitarian would argue that killing five is worse than killing one, because utilitarianism promotes the maximization of happiness, and the greatest happiness would come from saving five people, even if that meant one would have to be killed to achieve this outcome. In terms of the difference between killing and letting die, utilitarianism holds that there is no difference between the two, because they both result in the same consequences: death.** “For