The value of a human life

One of the most enduring points of tension during the COVID-19 pandemic has concerned whether the national ‘lockdown’ has done more harm than good.

This issue was squarely on the agenda during a recent edition of ABC TV’s Q+A. The most significant point of contention arose out of comments made by UNSW economist, Associate Professor Gigi Foster. Much of the public response was critical of Dr. Foster’s position – in part because people mistakenly concluded she was arguing that ‘economics’ should trump ‘compassion’.

That is not what Gigi Foster was arguing. Instead, she was trying to draw attention to the fact that the ‘lockdown’ was at risk of causing as much harm to people (including being a threat to their lives) as was the disease, COVID-19, itself.

In making her case, Dr. Foster invoked the idea of Quality Adjusted Life Years (QALYs). As she pointed out, this concept has been employed by health economists for many decades – most often in trying to decide what is the most efficient and effective allocation of limited funds for healthcare. In essence, the perceived benefit of a QALY is that it allows options to be assessed on a comparable basis – as all human life is made measurable against a common scale.

In essence, the perceived benefit of a QALY is that it allows options to be assessed on a comparable basis – as all human life is made measurable against a common scale.

So, Gigi Foster was not lacking in compassion. Rather, I think she wanted to promote a debate based on the rational assessment of options based on calculation, rather than evaluation. In doing so, she drew attention to the costs (including significant mental health burdens) being borne by sections of the community who are less visible than the aged or infirm (those at highest risk of dying if infected by this coronavirus).

I would argue that there are two major problems with Gigi Foster’s argument. First, I think it is based on an understandable – but questionable – assumption that her way of thinking about such problems is either the only or the best approach. Second, I think that she has failed to spot a basic asymmetry in the two options she was wanting to weigh in the balance. I will outline both objections below.

In invoking the idea of QALYs, Foster’s argument begins with the proposition that, for the purpose of making policy decisions, human lives can be stripped of their individuality and instead, be defined in terms of standard units. In turn, this allows those units to be the objects of calculation. Although Gigi Foster did not explicitly say so, I am fairly certain that she starts from a position that ethical questions should be decided according to outcomes and that the best (most ethical) outcome is that which produces the greatest good (QALYs) for the greatest number.

Many people will agree with this approach – which is a limited example of the kind of Utilitarianism promoted by Bentham, the Mills, Peter Singer, etc. However, there will have been large sections of the Q+A audience who think this approach to be deeply unethical – on a number of levels. First, they would reject the idea that their aged or frail mother, father, etc. be treated as an expression of an undifferentiated unit of life. Second, they would have been unnerved by the idea that any human being should be reduced to a unit of calculation.

…they would have been unnerved by the idea that any human being should be reduced to a unit of calculation.

To do so, they might think, is to violate the ethical precept that every human being possesses an intrinsic dignity. Gigi Foster’s argument sits squarely in a tradition of thinking (calculative rationality) that stems from developments in philosophy in the late 16^th and 17^th Centuries. It is a form of thinking that is firmly attached to Enlightenment attempts to make sense of existence through the lens of reason – and which sought to end uncertainty through the understanding and control of all variables. It is this tendency that can be found echoing in terms like ‘human resources’.

Although few might express a concern about this in explicit terms, there is a growing rejection of the core idea – especially as its underlying logic is so closely linked to the development of machines (and other systems) that people fear will subordinate rather than serve humanity. This is an issue that Dr Matthew Beard and I have addressed in the broader arena of technological design in our publication, Ethical By Design: Principles for Good Technology.

The second problem with Dr. Foster’s position is that it failed to recognise a fundamental asymmetry between the risks, to life, posed by COVID-19 and the risks posed by the ‘lockdown’. In the case of the former: there is no cure, there is no vaccine, we do not even know if there is lasting immunity for those who survive infection.

We do not yet know why the disease kills more men than women, we do not know its rate of mutation – or its capacity to jump species, etc. In other words, there is only one way to preserve life and to prevent the health system from being overwhelmed by cases of infection leading to otherwise avoidable deaths – and that is to ‘lockdown’.

…there is only one way to preserve life and to prevent the health system from being overwhelmed by cases of infection leading to otherwise avoidable deaths – and that is to ‘lockdown’.

On the other hand, we have available to us a significant number of options for preventing or minimising the harms caused by the lockdown. For example, in advance of implementing the ‘lockdown’, governments could have anticipated the increased risks to mental health leading to a massive investment in its prevention and treatment.

Governments have the policy tools to ensure that there is intergenerational equity and that the burdens of the ‘lockdown’ do not fall disproportionately on the young while the benefits were enjoyed disproportionately by the elderly.

Governments could have ensured that every person in Australia received basic income support – if only in recognition of the fact that every person in Australia has had to play a role in bringing the disease under control. Is it just that all should bear the burden and only some receive relief – even when their needs are as great as others?

Whether or not governments will take up the options that address these issues is, of course, a different question. The point here is that the options are available – in a way that other options for controlling COVID-19 are not. That is the fundamental asymmetry mentioned above.

I think that Gigi Foster was correct to draw attention to the potential harm to life, etc. caused by the ‘lockdown’. However, she was mistaken not to explore the many options that could be taken up to prevent the harm she and many others foresee. Instead, she went straight to her argument about QALYs and allowed the impression to form that the old and the frail might be ‘sacrificed’ for the greater good.

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