The ethics of who lives and dies is one of the most sensitive and important problems raised by the current crisisby Julian Baggini / March 20, 2020 / Leave a comment
The idea of anyone deciding which of their fellow human beings will live or die is a viscerally repugnant one. Who wants a society in which “bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care”? The person who said this added “Such a system is downright evil.”
But wait. These words come from a tweet by the Tea Party conservative Sarah Palin, former governor of Alaska. She used them in the context of opposition to the Affordable Care Act, popularly known as Obamacare. In the same tweet she coined the phrase “death panels” to describe committees that made life and death decisions. Republicans successfully associated these with European-style health care.
In a sense, Palin was right. Any government that provides healthcare has to make decisions of who to prioritise and this will make a difference to who lives and dies. But the alternative is to leave it to insurers to decide who among the assured is covered and to let those who can’t afford insurance to proceed unimpeded to their graves.
There can be no avoiding cost-benefit analysis in healthcare, which means there is no avoiding the horrible tasks of selecting who lives, directly or indirectly. With the Covid-19 epidemic heading towards its peak, it’s essential that we get clear about the ethics of how we do this in extreme circumstances.
In general, cost-benefit analysis works very well when the costs and benefits being compared are of the same kind and are clearly measurable. If there is a choice between two equally safe and effective drugs and one is twice the price of the other, of course you choose the cheapest.
Matters soon complicate, however, when you compare different types of costs and benefits, especially when there is no clear metric. Should the government spend £1.6bn on culture (which is the budget of the Department for Digital, Culture, Media and Sport) or on hospitals? The question asks us to compare apples and pears. The benefits of the arts are not (mostly) concerned with health and they can only be measured by pseudo-scientific metrics devised to please bean…