Consent and pricing life Notes for November 13

Main points

A good part of our discussion was about Menzel’s two earlier presentations: on Tuesday and Wednesday.

We also talked about some of the issues surrounding pricing life in the reading from the syllabus for this session.

Questions about the earlier presentations

These revolved around the following observation. When we ask people to assess the quality of lives when improvements are at issue, they give one sort of answer. When we ask people to assess the quality of lives when saving lives is at issue, they give another.

Thus, if you asked me whether people who can’t walk have a lower quality of life than people who can, I would say “yes.” They can’t walk, after all. If you asked me whether I think we should spend our health budget efficiently, to get the best health results for our resources, I would say yes. Then if you asked me whether I think that we should save the lives of people who can walk before those who cannot, I would say no.

Those three answers appear inconsistent. But it’s hard to reject any one of them. I certainly don’t want to do so and neither does Menzel.

You can get the same results by looking just at quantity. We could replace the first question with another. Is a longer life better than a shorter one, other things equal? You betcha! Then replace the third question with: should we favor those who will live longer (like the young or those who do not have an additional, fatal condition) over those who will live shorter lives? Nope. The same kind of apparent inconsistency shows up.

Menzel’s presentations aimed at showing how the inconsistency is merely apparent and can be resolved.

Pricing life

Professor Brown thought that chapter three could have been boiled down to a statement of the question and the last sentence on page forty-seven. The question is whether limits to what insurance will cover involve putting an objectionable price on life. The answer is that they involve putting a price on safety or avoiding risk rather than a price on life. I agree.

This was a very controversial chapter last year. A good chunk of the group agreed with Broome’s objection on page 46: the only time when we can sensibly put a value of avoiding risks to our lives is at the point of death. I came up with what I thought was a clever argument in response: it’s on the handout.

What was the chapter about?

Menzel’s project is to try to figure out how to give us what we want out of a health system. It seems evident to me that some of the obvious-seeming ways of doing this would be miserable failures. If you asked us what we want, you would get gibberish: we can’t say. If you relied on what our elected representatives say, you’ll get something slightly better, but not much. Basically, we don’t think much about this, when we do think about it, we’re pulled by all sorts of irrelevant considerations, we lack understanding of what it would be like to live with a chronic health problem, and we lack the specialized knowledge to understand what’s at stake.

So we need a more sophisticated method of discovering our attitudes towards the value of life, risk, the quality of life, and where protection against risks to our health fits in among our priorities. That’s what the surveys and Quality Adjusted Life Years are about discovering.

What Menzel is doing is pointing out various problems and inconsistencies that crop up in the course of doing these surveys. Then he offers solutions that avoid inconsistency whenever doing so seems plausible.

Actually, his project in Strong Medicine is more specific than this. It is to gather this information and show that it supports something stronger than conclusions about what we want. It is to show that this information supports conclusions about what we would consent to, specifically, what we would consent not to have, even when having it might be beneficial.

This page was written by Michael Green for Freedom, Markets, and Well-Being, PPE 160, Fall 2008. It was posted November 14, 2008.
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