Wednesday, July 29, 2009

1 Quadriplegic = Half a Human Life, 1 Teen = Fourteen 85 Year Olds

That is the assumption behind a benchmark some, including Peter Singer, are urging for inclusion in any overhaul of the U.S. health system. It's called QALY or Quality of Life Years and the U.S. government has already endorsed it by including substantial funds for research on the concept in the "stimulus" bill. Here's how Peter Singer explained it in the New York Times:
As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.

The principle for Singer applies not only to age, but disability as well:
One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar. . .

. . .Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics.

In its most recent issue, OSV provides a rebuttal to this kind of thinking from my old Philosophy Prof. and friend, Dr. Ray Dennehy of the University of San Francisco. I'll give you the bottom line, but you should read the whole thing:
The kind of contrast that Singer draws between lives with disabilities and lives without them collides with the doctrine of natural rights that forms the bedrock of our democracy. The basis of life, liberty and the pursuit of happiness is human nature, and a disabled person has not lost that nature. To borrow from the philosopher, Yves R. Simon, it is just as much an act of murder to kill a sickly man as a healthy one; it is just as much an act of murder to kill a colored man as a white man; it is just as much an act of murder to kill a poor man as a rich man; it is just as much an act of murder to kill a child in its mother's womb as a human adult.

The value of the human person and his right to life do not depend on features that make men different, but rather on the essential features of personhood that are common to all human beings.
Read on. There's a lot of valuable stuff here. The possibility of such proposals entering the health care overhaul is another good reason for congressmen to actually read and deliberate bills before them.