Putting a value on a human life

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As Victoria locked down in response to its spike in infections, people whose economic interests or individual liberties were threatened protested strongly. As infections diminished they demanded an immediate and extensive easing of restrictions. The debate between those who wanted an immediate opening to business and those more cautious has been fuelled by discordant opinions among those with expertise in public health.

Main image: Grandmother and granddaughter hugging. (Ekaterina Shakharova/Unsplash)

Underlying their differences, however, is a more fundamental judgment about whether the virus itself or the economic effects of the response to it have caused more damage to human lives. That question, in turn, has invited reflection about the relative value of one human death (and so of one human life) as compared with another. This is a radical question because it makes us ask whether the value of a human life is defined by economic wellbeing and by potential contribution to the economy, or by deeper qualities.

Duncan Maskell, the Vice-Chancellor of Melbourne University which has been severely affected economically by the loss of overseas students and the interruption of face to face teaching, has raised this question in interviews and speeches. He sees it as one that society must address. In his reflections he has referred to the Quality of Life Adjusted Year (QALY), a tool used by economists to put some price on the lives of different people. The measure can take into account the contribution that people can make to society, their health, their gifts and potentially all other aspects of their lives. Maskell sees some variant of QALY to have an important part to play in establishing priorities in the response to coronavirus.

The authority we give to QALY and similar economic measures will depend on how we define the value of human life. I would argue that their authority lies in assessing economic relationships, but does not extend beyond them. They help meet the occasional demand to put a figure on the economic value of relationships that transcend economics. When assessing the financial compensation due to people killed or maimed in a plane accident, for example, it is proper to take into account their position in life, their health, their family and their personal gifts and other factors. QALY can provide a useful guide to economic transactions.

QALY and similar tools, however, are of limited authority because the figure they put on personal values that lie beyond the economic is purely symbolic. It does not express the value of the person but names an agreed price to be paid in some economic transactions. Because it enables non-economic human values to be translated into economic currency for economic transactions, QALY has a place within economic discourse. Its place is limited to economic discourse because the process of translation is non-reversible: it does not license the agreed currency of economic transactions to determine the value of a human life.

To assess the value of a human life we need to look more broadly. The starting point is that human beings are not interchangeable and each person has an inalienable value. They are each their own centre and agents of their own lives, and may not be used as a means to others’ ends. This view of human value is reflected within most societies in their insistence on the rule of law, for example, and on the right to hold personal religious or political views. It holds that the value of each human being is inherent and unquantifiable, and that all human beings command respect independent of their economic contribution, their gifts, their personality or their standing in society.

In assessing what respect for each human life entails in society, we need to set it within a network of relationships with other persons and with the wider environment. To be born, raised, educated, loved, and be able to travel, use technology and be safe, we depend on others. The value of each human life is inalienable, but it is properly expressed through relationships of mutual respect, of mutual gift, and concern for the common good, not through an exclusive focus on one’s individual interest. Economic relationships are only one set of relationships through which the value of a human life finds expression.

 

'The inadequacy of a neo-liberal mindset that values human beings by their individual economic contribution is also revealed in the predictable consequences of giving priority to economic growth at the cost of not keeping the virus suppressed.'

 

Although these principles may seem idealistic and dogmatic, they were embodied in the initial response to the coronavirus. It sought to safeguard both public health and the conditions for future economic development. In doing so it emphasised the value of all Australians, and particularly of people who were most vulnerable. It did not trade the interests of one group against others, nor value some Australians’ needs over others. It recognised, too, that the good of all Australians could be secured only by sacrificing individual and sectional interests in order to respond to COVID. To deal with its effects and curtail its spread required a degree of self-sacrifice by all, which was for the most part cheerfully accepted. Medical staff, aged care workers and deliverers whose work brought them closest to the virus and so put their own health at risk were celebrated by the community.

At the same time respect was paid to people whose lives were particularly placed at risk through the disruption to economic relationships. Homeless people found temporary housing, unemployed renters were given temporary security, many people who would have been laid off kept their work through Jobkeeper and other support for businesses. People already unemployed received more support.

The emphasis in the COVID response on respect for the human life of the most precarious, the readiness to disrupt economic relationships while offsetting the human consequences of doing so, and the call to self-sacrifice in order to benefit the whole community all embody the rich understanding of the value of human life described above.

More recently, however, that sense of solidarity has weakened, and another deeply rooted but thinner understanding of the value of human life associated with neo-liberal ideology has reasserted itself. It sets the value of human life within the quest for economic prosperity that is gained by individuals competing economically and so contributing to society. Other relationships that shape a person are recognised, but are subordinated to the economic ones. From this perspective it may seem reasonable to use economic measures such as QALY to compare the value of the life of the young and the old, or of the strong and the frail, and to determine public policy accordingly. Anger at restrictions on economic activity, whose effects fall inequitably on people with greater prospective contribution to make to the economy, may also seem justified.

The argument for opening up the economy, which is based on defining human value by privileging economically competitive individuals, short changes the richness of human life. Its flaws are also revealed in its track record. As Australia faced the pandemic it was already living with gross and growing inequality, high personal debt associated with a reluctance to spend on goods and services, a grossly underfunded public health system unequipped for emergencies such as COVID, underfunded universities, lack of social housing, and very high underemployment and casual employment, particularly among young people. These conditions threatened the response to the pandemic, contributed to its massive effects on unemployment, and encouraged the spread of the virus through nursing homes and quarantine centres. The results of an economic framework that privileged competitive individuals and neglected the common good magnified the economic impact of the virus, and could be remedied only by cooperation and massive public expenditure for the good of all Australians.

The inadequacy of a neo-liberal mindset that values human beings by their individual economic contribution is also revealed in the predictable consequences of giving priority to economic growth at the cost of not keeping the virus suppressed. Overseas evidence suggests that such a policy leads to a massive second wave of infection that affects public confidence and lowers economic growth even more than in societies that emphasise suppression.

It seems that the more deeply the influence of competitive economic individualism has seeped into national culture, the greater is the resistance to restrictions on individual freedom in the name of the common good, and the higher cost in illness, death and national prosperity. Nations in which there are a relatively small infection and death rate and steadier economic performance are those that have a culture of cooperation and an understanding that the economy serves the common good.

Any society that allows QUAL and similar economic measures to determine the relative value of different human lives will have settled for a diminished understanding of human life and its riches. And that always leads to loss, even in economic terms.

 

 

Andrew HamiltonAndrew Hamilton is consulting editor of Eureka Street, and writer at Jesuit Social Services.

Main image: Grandmother and granddaughter hugging. (Ekaterina Shakharova/Unsplash)

Topic tags: Andrew Hamilton, COVID-19, human life, dignity, value, QALY, economics

 

 

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Existing comments

The virus we are currently grappling with, and its effects, has led to many larger questions such as those posed by Andy in this article. Thankfully, despite some glaring mishaps in the level of vigilance required in controlling the spread of the virus and its infectious strength, our State and Federal governments have attempted to put the common good as first priority. The value of each human life is inestimable. We rightly laud people who are talented and share their gifts. However, by valuing the least in our society (which would include the incarcerated) maybe we can increase the chances of not relying so much on our monetary worth.
Pam | 01 October 2020


Thanks for the article but I think it is written with the luxury of timing and favorable outcomes becoming evident here at home. Cast the mind back just a few short months ago when PPE was being sold to the highest bidder and local ventilator manufacturing awry, medical staff becoming victims and hospitals overwhelmed internationally. One would hope that QALY would not find its use in medical Triage but it already does, to a degree. "..triage is a medical determination, not an ideological one. It treats all patients as equals and bases hard decisions on the same objective criteria of assessing survivability regardless of the personal characteristics of each person."(Smith). We (Australia) are finding ourselves in the situation where we now can be confident of emergency and critical medical capacity - everybody gets a gurney/guernsey here... but who would trade places with those overwhelmed medics in Spain or Italy making those life-critical triage decisions on who gets the ventilator? Would you choose the 30 year old diabetic or the 55 year old cardiac patient, both with inalienable, inherent value... who can know the survivability outcome? I'd caution on condemning "any society" to having diminished understanding of human life.
ray | 01 October 2020


I am so glad Andy writes this and agree 100 per cent . I am no biblical scholar but New Testament is full of this moral reasoning: Jesus and Mary M, Jesus and the leper, the criminals being crucified with him , the parable of the prodigal son etc. economic rationalism is so utterly unChristian! Tony Kevin
Tony Kevin | 02 October 2020


How welcome is any reference to being human! To people having and making their lives alongside other people! May we dare to dream of our 7.5b lives being lived with the best of our shared intelligences to meet human need rather than for profit. And may we hurry up about it.
Catarina Neve | 03 October 2020


Thank you so much for this contribution, Andy. I was appalled at Duncan Maskell's easy reference to QALY as the criterion for judging human values for several reasons. Although he speaks with the authority of Vice Chancellor, this is not his area of expertise. His specialty field is education -- please heaven teachers don't stoop to using something akin to QALY in the assessment and support of their students. Melbourne University is beset by problems both economic and academic. Students feel singularly unsupported. Professor Maskell would serve society better by tackling his own problems first.
Sandy | 05 October 2020


Difficult equation. Some people "worth" billions of dollars are worth bugger all as human beings.
john frawley | 07 October 2020


the left loves lockdowns and the right wants a free for all but one can have hospitals which look after everything and people die of all sorts of diseases. One should be carefull but not careless. Our political leaders should also listen not just to medical evidence but climate change evidence.
stuart lawrence | 07 October 2020


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