Have you ever sat at the deathbed of a statistical life? "Statistical lives" are what politicians save, or let die, or kill, when they decide on resource allocations for health care.
Health care is not the only area where political decisions are matters of life and death. Environmental programs to reduce air pollution, educational efforts to publicize the adverse effects of smoking, traffic measures that lower the risk of car accidents:
Many policies save lives -- and omit other lives that would have been saved if the money had been spent otherwise.
So, if you have ever sat at somebody's deathbed, the answer may very well be yes: You sat at the deathbed of a statistical life.
Even so, we say that John died from cancer, not that he died from a policy decision to stop payment for cancer screening. We say that Mary died in a car accident, not that she was a casualty of the Road Traffic Act.
In short, we do not usually identify policy decisions as the causes of individual deaths.
This would be quite different if the identities of future victims were known at the time such decisions are taken.
Imagine that they were known, and that the individual victims of policy decisions would somehow stare into the faces of decision makers just as if they were being held at gunpoint. Policy making, I am sure, would suddenly halt.
In fact, the analogy of holding victims at gunpoint is misleading, because in public decision-making we can hardly claim that everything is all right as long as we don't pull the trigger.
Given that everything that happens is somehow a consequence of decision-making, the distinction between killing someone and letting her die is unconvincing.
So perhaps decision makers, faced with the victims of previous policies and the future victims of current ones, would simply be happy that at last they could allocate resources in an optimally efficient way.
That seems unlikely. Indeed, the thought experiment of turning statistical lives into identifiable lives highlights an important point about policy-making.
Anonymity
Much, if not all, of the appeal of "efficient" resource allocation depends on the anonymity of the victims.
Full anonymity explains why efficiency rules -- say, leaving the most "expensive" patients untreated when resources are scarce -- meet with no protest. Such anonymity also holds for those who are left untreated in "triage" -- the sorting of casualties when natural or man-made disasters strike.
But, for the same reason, efficiency rules often do meet with protest when they are used or proposed for rationing medical services in everyday medicine.
It is part of the everyday life of many citizens -- even part of their identities -- that they suffer from an expensive health problem. Under an efficiency regime, they might as well bear a target on their foreheads.
What about young and healthy citizens? Many will develop expensive health problems in the future. But their future is unknown, as is the fate of future disaster victims. Why should they not fully embrace efficient resource allocation?
Funds reallocation
Many statistical lives -- your own, perhaps -- could be saved by excluding future payment for some expensive medical treatment (say, hemodialysis) for those who are now healthy and reallocating the funds to cheap but effective prevention programs.
Since there is no fairness problem here, would it not simply be irrational to reject efficiency? After all, saving statistical lives does save individuals.
Whether or not you see a distinction between statistical lives and individual lives depends on whether you accord value not only to when you die, but also to how you die.
Dying is hard. But it is our fate as humans, and it is usually accepted with dignity when the hour comes. Nevertheless, as long as we see a chance to escape death, we run from it, and we expect those who take care of us to look for the escape routes.
So here is a difference: When you die from lack of medical care, there is an escape route. It is clearly marked, but nobody helps you get to it. They stand idly by, abandoning you to death.
By contrast, when you die from the absence of prevention policies, you may be dying sooner than you otherwise would, but you are not being left to die.
This is why sitting beside, and even lying on, the deathbed of a statistical life may be more tolerable after all.
Perhaps a maximally extended life expectancy is of higher value to you than living in a society where doctors do not leave curable patients to die if they cannot pay for the required treatment out of their own pockets.
But there is nothing irrational in deciding otherwise. It all depends on a value judgment -- one of the many value judgments societies must make with respect to modern medicine.
The higher the technical capabilities, and the costs, of modern medicine become, the more contested this particular value judgment will be.
Weyma Luebbe is chairwoman of the department of philosophy at Leipzig University.
Copyright: Project Syndicate
Recently, China launched another diplomatic offensive against Taiwan, improperly linking its “one China principle” with UN General Assembly Resolution 2758 to constrain Taiwan’s diplomatic space. After Taiwan’s presidential election on Jan. 13, China persuaded Nauru to sever diplomatic ties with Taiwan. Nauru cited Resolution 2758 in its declaration of the diplomatic break. Subsequently, during the WHO Executive Board meeting that month, Beijing rallied countries including Venezuela, Zimbabwe, Belarus, Egypt, Nicaragua, Sri Lanka, Laos, Russia, Syria and Pakistan to reiterate the “one China principle” in their statements, and assert that “Resolution 2758 has settled the status of Taiwan” to hinder Taiwan’s
Can US dialogue and cooperation with the communist dictatorship in Beijing help avert a Taiwan Strait crisis? Or is US President Joe Biden playing into Chinese President Xi Jinping’s (習近平) hands? With America preoccupied with the wars in Europe and the Middle East, Biden is seeking better relations with Xi’s regime. The goal is to responsibly manage US-China competition and prevent unintended conflict, thereby hoping to create greater space for the two countries to work together in areas where their interests align. The existing wars have already stretched US military resources thin, and the last thing Biden wants is yet another war.
As Maldivian President Mohamed Muizzu’s party won by a landslide in Sunday’s parliamentary election, it is a good time to take another look at recent developments in the Maldivian foreign policy. While Muizzu has been promoting his “Maldives First” policy, the agenda seems to have lost sight of a number of factors. Contemporary Maldivian policy serves as a stark illustration of how a blend of missteps in public posturing, populist agendas and inattentive leadership can lead to diplomatic setbacks and damage a country’s long-term foreign policy priorities. Over the past few months, Maldivian foreign policy has entangled itself in playing
A group of Chinese Nationalist Party (KMT) lawmakers led by the party’s legislative caucus whip Fu Kun-chi (?) are to visit Beijing for four days this week, but some have questioned the timing and purpose of the visit, which demonstrates the KMT caucus’ increasing arrogance. Fu on Wednesday last week confirmed that following an invitation by Beijing, he would lead a group of lawmakers to China from Thursday to Sunday to discuss tourism and agricultural exports, but he refused to say whether they would meet with Chinese officials. That the visit is taking place during the legislative session and in the aftermath