"but, the lone trolley walker was healthy, too. there's no reason to think that person would have died if you didn't pull that switch. so, it's just like killing the healthy organ donor."

maybe i didn't articulated that as well as i'd like. 

so, with the trolley problem, there's a train coming and the train is going to kill five people or one person. you really have a choice between whether the train is going to kill one or five, and you have to make that choice. 

with the hospital problem, you have five sick people dying of presumably different ailments, and one healthy person that has nothing to do with any of this. you don't have to make a choice between one outcome or the other.

so, am i reducing it to the cause? well, i'm pointing out that it's not equivalent. you may try to force me into seeing the lone trolley walker as being sacrificed, like the organ donor would be, but i'm going to push back against that. 

so, let's flip the question over - which scenario is more active and which is more passive? in the trolley problem, you're explicitly deciding who dies and who doesn't, and i'm saying you should decide on the option of least disruption. in the hospital problem, you don't have to explicitly decide, and i'm claiming you consequently shouldn't, you should take a more passive approach.

but, i'm also pointing out that you can alter the scenario so it's more equivalent.

"but, nobody is going to disagree that you should take somebody off life support to donate their organs, except maybe certain religious groups. it's not much of a dilemma."

well, nobody really disagrees that you should flip the switch so the trolley hits the loner, either, except perhaps extreme calvinists that are going to argue those five weren't in the elect, or something - that's really not much of a dilemma, either.

i suspect that the hospital problem was probably introduced as equivalent to the trolley problem by some christian that wanted to confuse people, and has succeeded in doing so. but, these things should be decoupled; conflating them just confuses the logic.