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A quadrilemma is a seldom–used and unconventional term describing a problem requiring a choice among four alternatives. It is in contrast to the standard term dilemma, which is between two opposing alternatives in which a person can only choose one. A less common term trilemma involves choosing either one or two choices among three possibilities.[1]

An essay on the subject of health care options suggested that choosing among technological change, insurance, quality of care, and containing costs was a quadrilemma since it required choosing among four alternatives.[2][3] In another instance, the term appeared in 1861 in The New York Times in an essay regarding the secession of the southern states of the United States, referring to choices available to the south.[4] It was used in 2004 to describe choices available to the nation of Bhutan regarding a decision of whether or not to join the World Trade Organization.[5] The term has been used to describe the premises for arguments concerning the existence of God referring to thinking by the mathematician Blaise Pascal.[6]


  1. NIALL FERGUSON AND TED FORSTMANN. Back to Basics on Financial Reform: The case for limiting leverage and regulating derivatives is overwhelming, but that doesn't require a new 1,300-page law., The Wall Street Journal, APRIL 23, 2010. Retrieved on 2010-04-25. “A "trilemma" is like a dilemma, only there are three things to choose from and you can have just two. The current debate over post-crisis financial regulation suggests we face such a trilemma: We can choose any two of the following, but not all three: 1) efficient capital markets 2) no bailouts to big banks and 3) a depression-free economy. From the 1980s until 2007, we essentially opted for one and two.”
  2. Weisbrod, Burton A. The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment, American Economic Association, 1991-06-02. Retrieved on 2010-04-25. “523-52”
  3. George W. Pasdirtz. Technology and the health care quadrilemma: a test, Health care quadrilemma (HCQ) theory describes the reciprocal relationship between health care technology, health care insurance, quality of care and cost containment. State-space, time series models were developed to investigate these relationships for the US health care system over the period 1950--1999., 2008. Retrieved on 2010-04-25. “17th annual international conference on health sciences simulation (ICHSS'08): Health policy table of contents Pages: 491-496”
  4. QUADRILEMMA, The New York Times, 1861-07-24. Retrieved on 2010-04-25. “The Confederate States," says the Charleston Mercury, "have had four instrumentalities to win them peace, and the acknowledgment of their independence: 1. Negotiation. 2. Fighting on the sea or privateering. S. Fighting on land. 4. Cotton. Two of these instrumentalities have failed." Such is the "Quadrilateral" on which the rebel States relied for success in their treason, and such the confession of the failure of two of them”
  5. Mancall, Mark (author); Karma Ura & Karma Galay (editors). Bhutan's Quadrilemma: To Join or Not To Join the WTO, That is the Question, Gross National Happiness and Development - Proceedings of the First International Conference on Operationalization of Gross National Happiness, 2004. Retrieved on 2010-04-25.
  6. Chris Schroeder. The Abortion Quadrilemma, Chris Schroeder, June 21, 2009. Retrieved on 2010-04-25. “Pascal's Wager: 1) God exists and I believe in Him, 2) God exists and I don't believe in Him 3) God doesn't exist and I believe that he does, 4) God doesn't exist and I don't believe that He does.”