It feels like the odds a drug is perfect and a few years too late for you unless you skip the tests is exceedingly low compared to the odds that a drug will not pan out or might even be unsafe.

The perverse incentives is also a very real issue.

You can have a class of drugs allowed if you're going to die anyway.

People in that state are highly vulnerable to fraud. See https://en.wikipedia.org/wiki/Amygdalin

They are also vulnerable to dying. They should be able to try whatever drug they need and the government shouldn't be allowed to stand in their way.

The pharma companies are not clamoring for a huge surge in compassionate use (emergency use of unapproved drugs) either.

Who is going to pay? Early stage drugs are still figuring out their manufacturing process, and quantities can be extremely limited. Say you give drug X to a sick patient and they die, what then? Was it because of the novel drug? Not a favorable position to have more deaths associated with your treatment. Can you draw any data from these patients to inform further trials? Also complicated because end stage patients have already exhausted other options and the interaction with other compounds can make disentangling this harder.

Death is certain, getting ripped off less so.

Sure, that's why it should still be regulated, just less than drugs for everyone else.

In particular drugs should still be checked for efficacy before getting on that list.

But requirements for long term safety and side effects when people die in a year should be relaxed.

With drugs there is also the option that something is not harmful, but also not effective and thus lead to something effective not be taken...

How is this the trolley problem for someone with a terminal disease? I assume the sick population are the people in the trolley and the experimental patient is the person on the track? In this scenario, by not pulling the lever you just extend the life of the people on the trolley to the end of the ride for a dangerous drug. Where as, pulling the level could save the life of the person on the track and the people in the trolley if the drug is successful.

What am I missing? For non-terminal diseases, it's a bit murkier, but still I don't follow the analogy.

Some people do go into remission from a terminal cancer diagnosis, either because the diagnosis was wrong or because they live long enough for an approved treatment to come on the market. Also, that you have terminal cancer doesn’t say anything about how long you’re going to live. You can live for many years with terminal cancer.

I do think we’re overly cautious with drug approvals and I think we should be more open to leaving the decision to patients and their medical teams, but it’s not as simple as saying someone’s terminally ill, so just do whatever. Reducing it down to the trolley problem makes it seem much more black and white and immediate than it really is.