Other factors which have at various points been used...
Very clever and powerful argumentation.
So how would YOU proposwe to allocate a scarce resource like “saving a life” when you have 1 available and have to choose between a few people to do it?
I don’t think I can be swayed by arguments against my proposal unless they propose an alternative, or somehow make the strong argument that the necessity to choose how to allocate resources doesn’t apply in the case of medical care.
It has been said abou democracy that it is a horrible system that perpetrates all osrts of injustices and generates all sorts of stupid policy choices, with the only thing in its favor being that it is better than all (currently known) alternative systems.
Maybe one of the things that makes policical “argumentation” so difficult is that the most emotionally compelling arguments are those against something which do not bear the burden of coming up with a workable alternative.
So how would YOU proposwe to allocate a scarce resource like “saving a life” when you have 1 available and have to choose between a few people to do it?
First: I don’t know; but the fact that I don’t have a perfect answer doesn’t mean that I can’t see things wrong with the “disabled people are worth less than able-bodied people” answer — beginning by pointing out that it can’t readily be distinguished from the “men are worth less than women” answer or the “poor people are worth less than rich people” answer.
Second: Saving a life isn’t a resource. Food, drugs, or a doctor’s time are resources. We don’t have 1-up mushrooms in our world.
Third: We don’t have to stack-rank every two possible scenes in order to have a consequentialist ethical system. By “possible scene” I mean something much smaller than a “possible world”, something deliberately disregarding consequences outside of an artificially-defined neighborhood. “Save Alice’s life and let Bob die” is a possible scene, not a possible world.
(A possible world in which some life-saving agency prefers to save 901 able-bodied people and allows 1000 disabled people to die might also might include significant consequences such as, oh, disabled veterans firebombing that agency’s offices; or (perhaps more realistically) the social status of the life-saving agency being docked for its immorality, leading to fewer people entering the life-saving business, leading to fewer lives being saved.)
Fourth: “Hard cases make bad law” — which is to say, even if one has to make a choice between saving Alice’s or Bob’s life, you probably can’t generalize much from it. The fact that in one particular case, a person might choose to save the life of a person with traits X, Y, and Z instead of a person with traits A, B, and C does not mean that you can safely extrapolate that person thinks that anyone with trait X is more worth saving than anyone with trait B.
Fifth: I’d really suggest thinking about the assumptions that led you to think that “disabled people are worth less than everyone else” was a reasonable solution? Where did you get that idea? What makes you think it’s even morally permissible (to say nothing of morally required) to consider someone’s leg count as an indicator of their life’s value — especially if you wouldn’t consider someone’s sex or race as such an indicator?
“Hard cases make bad law” — which is to say, even if one has to make a choice between saving Alice’s or Bob’s life,
What if I have to choose between putting $100 million dollars into specially training gerontologists to extend the lives of institutionalized triple amputees vs putting $100 million dollars into training doctors to use stem cell thearpies to regenerate limbs? These choices get made all the time in society. I just propose we make the consciously and that we at least analyze our results quantitatively, since quantitative analysis is, in my opinion, a significant factor in the success of so many other human endeavors.
(A possible world in which some life-saving agency prefers to save 901 able-bodied people and allows 1000 disabled people to die might also might include significant consequences
You didn’t really propose the counterfactual. But beyond that, the essence of my metric is that a world which adds 2 years to the lives of 1000 triple amputees compared to a world which regenerates the limbs of 500 of those triple amputees, but fails to extend their lifespans by two years. I don’t pretend to know at exactly what numbers preference becomes confusing for most people, but I know for darn sure that most people will risk death in operations to improve or preserve their functioning. How do you include that fact in a metric other than by showing a positive value for positive outcomes?
How do you include that fact in a metric other than by showing a positive value for positive outcomes?
By extrapolating from the choices of the people involved? It seems to me that people with no legs have just as much interest in staying alive as people with two legs. That doesn’t mean they have an interest in staying no-legged rather than becoming two-legged; but I don’t consider “give Bob his legs back” equivalent to “kill Bob and save Alice, who has legs”, either.
Second: Saving a life isn’t a resource. Food, drugs, or a doctor’s time are resources. We don’t have 1-up mushrooms in our world.
I don’t know what a 1-up mushroom is, but for the life of me I can’t extract any meaning from this other than that you deny a connection between doctor’s time, drugs, and food and saving a life?
A 1-up mushroom is an object in the popular “Super Mario Bros.” video games, which gives the player an extra life (and does nothing else). My point here was that consequences such as “saving a life” are not resources. You can’t buy a life-saving; you can buy various things that have a good chance of having life-saving among their many consequences.
Third: We don’t have to stack-rank every two possible scenes in order to have a consequentialist ethical system. By “possible scene” I mean something much smaller than a “possible world”, something deliberately disregarding consequences outside of an artificially-defined neighborhood. “Save Alice’s life and let Bob die” is a possible scene, not a possible world.
That is not at all what I did. I proposed a metric for evaluating a health care system. For all intents and purposes, I said a health care system where the population lives 80 years and 10% of them are disabled was better than one where the health care system cost the same and the population lives 80 years but 20% of them are disabled.
For all intents and purposes, I said a health care system where the population lives 80 years and 10% of them are disabled was better than one where the health care system cost the same and the population lives 80 years but 20% of them are disabled.
Well, what you said was:
lifespan metric is weighted by degree of full functionality, that is various deficits [...] would all and each reduce the weighting of years of life in the metric.
That’s a weighting applied to individuals, implied to be used when making individual decisions. And you clarified:
But all other things being equal, and in the highly artificial situation that only one of Bob and Alice would be saved, it seems more reasoanble to pick the more functional than the less functional.
And my point was to investigate the value-system behind that claim. Why value “functionality” in terms of physical disabilities — and not in terms of any of the other things that people have made this decision on — such as social status, reproductive potential, earned income, skin color, belovedness by others, moral virtue, or purity of soul?
And my point was to investigate the value-system behind that claim. Why value “functionality” in terms of physical disabilities — and not in terms of any of the other things that people have made this decision on — such as social status, reproductive potential, earned income, skin color, belovedness by others, moral virtue, or purity of soul?
First, I never based it on PHYSICAL disability. For me, the paradigm disability is reduced mental status, with vegetative state being worth nothing in terms of keeping alive. But why limit myself to mental disability?
Second, I never stated, and would not agree, to make it illegal for people to spend their own resources on keeping alive anybody who wanted to be kept alive. Perhaps I am a billionaire willing to spend $1 million to keep my extremely sick 95 year old mother from dying from her cancer for another 3 months. Whoop de do for me. All I’m saying is that when totting up the value of the medical system, more accomplishment is measured from keeping a healthy 20 year old alive for an extra 3 months.
Third, it seems that underlying your case is something like, “all human life is equally valuable.” My problem with this is it denies the value of taking a risk of dying in order to improve a life. If I have someone who is willing to risk a shorter life in order to cure paralysis (maybe some sort of stem-cell spinal cord treatment that has an 80% chance of improving things and a 5% chance of killing you), then I want the improved functionality to show up in my plus column, which they don’t if “all human life is equally valuable.”
Fourth, In my opinion, it is not intellectually honest to say “all human life is equally valuable, even disabled” and “it is a great improvement in life to cure a disability.” Either disability is not as valuable an outcome as ability, or it is. To pretend it is both it seems to me can only lead to suboptimal policy and mistaken conclusions.
hings wrong with the “disabled people are worth less than able-bodied people” answer — beginning by pointing out that it can’t readily be distinguished from the “men are worth less than women” answer or the “poor people are worth less than rich people” answer.
I wouldn’t propose a healthcare system which set about curing femaleness by converting them to males, but I’d be pretty pleased with a health care system that made the lame to walk, the blind to see, and the diabetic to regulate blood sugar. So that is one rather important way to “readily distinguish” disability from gender.
“poor people are worth less than rich people,” I would imagine you would value a system (but not necessarily a healthcare system) which turned poor people in to rich people and did not turn rich people in to poor people. So in this sense, I’d imagine you and I would both find important similarities between “rich and poor” and “abled and disabled.” But I don’t think the health care system is the best place to address that social issue, so I didn’t propose “making the population richer” as part of the health care metric.
Please correct me where I either 1) imagine you would agree with something , but you actually disagree with it or 2) follow a chain or reasoning you would not agree with.
I wouldn’t propose a healthcare system which set about curing femaleness by converting them to males, but I’d be pretty pleased with a health care system that made the lame to walk, the blind to see, and the diabetic to regulate blood sugar. So that is one rather important way to “readily distinguish” disability from gender.
Understood. I agree with you here. But I do not think that is the same question as whether to consider physical disability in saving lives.
(Please don’t respond to this comment, since the substance is elsewhere.)
I’d really suggest thinking about the assumptions that led you to think that “disabled people are worth less than everyone else” was a reasonable solution?
I’d like to make it clear that this discussion is about how to determine the performance of a health care system. Not the metaphysical value of human life in its various combinations and permutations.
Some of the assumptions behind my proposal is that 1) lower disfunction in the served population is a positive outcome from a health care system, and 2) lengthening lifespan in the served population is a positive outcome from a health care system.
Do you agree with either or both of these?
If you do agree with both, can you imagine a metric which reflects additional credit on a system which reduces or effectively treats disability which simultaneously does not distinguish between the value of the disabled and the abled?
The reason I need a counterproposal from you, at least a partial one, is that so far what you have said amounts to “boo on not valuing disabled people, but I can’t go as far as to say that your proposal isn’t the best one possible.” If this is what you are saying, let me know. If this is not what you are saying then show me a proposal that is better than mine, it doesn’t have to be comprehensive or perfect, merely better than mine.
I’d like to make it clear that this discussion is about how to determine the performance of a health care system. Not the metaphysical value of human life in its various combinations and permutations.
That’s odd, it seems to me that you introduced the idea back here, as noted elsethread.
Some of the assumptions behind my proposal is that 1) lower disfunction in the served population is a positive outcome from a health care system, and 2) lengthening lifespan in the served population is a positive outcome from a health care system.
Sure. It does not follow that these are the only things that matter, though. Taken alone, these would authorize killing people to use their organs to save others. We recognize that’s a bad idea not just deontologically (“murder is wrong”) but consequentially also (“it wouldn’t work out well, doing that would cause problems beyond the immediate neighborhood being contemplated”) and, for that matter, categorically (“if you murder person A, this implies you don’t value individual life, so why are you saving persons B through F?”) and acausally (“if we lived in a world where we did things like that, other people would do stuff to us that we wouldn’t like”).
The reason I need a counterproposal from you, at least a partial one, is that so far what you have said amounts to “boo on not valuing disabled people, but I can’t go as far as to say that your proposal isn’t the best one possible.”
Okay, here ya go: “Instead of trying to decide whose life is more valuable, when you possess a life-saving resource and encounter a life that (to the best of your knowledge) is in need of saving, you save that life.”
In business terms, “first come, first served.”
In hippie terms, “love the one you’re with.”
In timeless terms, “if you don’t save a life when you have the chance, then what makes you think that future-you would ever choose to save a life?”
In progressive terms, “if not now, when?”
Take the Schelling point. Discard the assumption that you know (or should know) how to value one life over another. In the (statistically impossible) case of simultaneous arrivals, pick arbitrarily. This avoids setting yourself as judge over other people, and thus avoids all the problems mentioned above, including the acausal ones; and it thereby avoids licensing ableism or killing one to save five.
Very clever and powerful argumentation.
So how would YOU proposwe to allocate a scarce resource like “saving a life” when you have 1 available and have to choose between a few people to do it?
I don’t think I can be swayed by arguments against my proposal unless they propose an alternative, or somehow make the strong argument that the necessity to choose how to allocate resources doesn’t apply in the case of medical care.
It has been said abou democracy that it is a horrible system that perpetrates all osrts of injustices and generates all sorts of stupid policy choices, with the only thing in its favor being that it is better than all (currently known) alternative systems.
Maybe one of the things that makes policical “argumentation” so difficult is that the most emotionally compelling arguments are those against something which do not bear the burden of coming up with a workable alternative.
First: I don’t know; but the fact that I don’t have a perfect answer doesn’t mean that I can’t see things wrong with the “disabled people are worth less than able-bodied people” answer — beginning by pointing out that it can’t readily be distinguished from the “men are worth less than women” answer or the “poor people are worth less than rich people” answer.
Second: Saving a life isn’t a resource. Food, drugs, or a doctor’s time are resources. We don’t have 1-up mushrooms in our world.
Third: We don’t have to stack-rank every two possible scenes in order to have a consequentialist ethical system. By “possible scene” I mean something much smaller than a “possible world”, something deliberately disregarding consequences outside of an artificially-defined neighborhood. “Save Alice’s life and let Bob die” is a possible scene, not a possible world.
(A possible world in which some life-saving agency prefers to save 901 able-bodied people and allows 1000 disabled people to die might also might include significant consequences such as, oh, disabled veterans firebombing that agency’s offices; or (perhaps more realistically) the social status of the life-saving agency being docked for its immorality, leading to fewer people entering the life-saving business, leading to fewer lives being saved.)
Fourth: “Hard cases make bad law” — which is to say, even if one has to make a choice between saving Alice’s or Bob’s life, you probably can’t generalize much from it. The fact that in one particular case, a person might choose to save the life of a person with traits X, Y, and Z instead of a person with traits A, B, and C does not mean that you can safely extrapolate that person thinks that anyone with trait X is more worth saving than anyone with trait B.
Fifth: I’d really suggest thinking about the assumptions that led you to think that “disabled people are worth less than everyone else” was a reasonable solution? Where did you get that idea? What makes you think it’s even morally permissible (to say nothing of morally required) to consider someone’s leg count as an indicator of their life’s value — especially if you wouldn’t consider someone’s sex or race as such an indicator?
What if I have to choose between putting $100 million dollars into specially training gerontologists to extend the lives of institutionalized triple amputees vs putting $100 million dollars into training doctors to use stem cell thearpies to regenerate limbs? These choices get made all the time in society. I just propose we make the consciously and that we at least analyze our results quantitatively, since quantitative analysis is, in my opinion, a significant factor in the success of so many other human endeavors.
Umm … I’m not challenging your quantitative analysis — I’m challenging your claimed values.
(Please don’t respond to this comment, since the substance is elsewhere.)
You didn’t really propose the counterfactual. But beyond that, the essence of my metric is that a world which adds 2 years to the lives of 1000 triple amputees compared to a world which regenerates the limbs of 500 of those triple amputees, but fails to extend their lifespans by two years. I don’t pretend to know at exactly what numbers preference becomes confusing for most people, but I know for darn sure that most people will risk death in operations to improve or preserve their functioning. How do you include that fact in a metric other than by showing a positive value for positive outcomes?
By extrapolating from the choices of the people involved? It seems to me that people with no legs have just as much interest in staying alive as people with two legs. That doesn’t mean they have an interest in staying no-legged rather than becoming two-legged; but I don’t consider “give Bob his legs back” equivalent to “kill Bob and save Alice, who has legs”, either.
I don’t know what a 1-up mushroom is, but for the life of me I can’t extract any meaning from this other than that you deny a connection between doctor’s time, drugs, and food and saving a life?
A 1-up mushroom is an object in the popular “Super Mario Bros.” video games, which gives the player an extra life (and does nothing else). My point here was that consequences such as “saving a life” are not resources. You can’t buy a life-saving; you can buy various things that have a good chance of having life-saving among their many consequences.
That is not at all what I did. I proposed a metric for evaluating a health care system. For all intents and purposes, I said a health care system where the population lives 80 years and 10% of them are disabled was better than one where the health care system cost the same and the population lives 80 years but 20% of them are disabled.
Is that a rank ordering you would agree with?
Well, what you said was:
That’s a weighting applied to individuals, implied to be used when making individual decisions. And you clarified:
And my point was to investigate the value-system behind that claim. Why value “functionality” in terms of physical disabilities — and not in terms of any of the other things that people have made this decision on — such as social status, reproductive potential, earned income, skin color, belovedness by others, moral virtue, or purity of soul?
First, I never based it on PHYSICAL disability. For me, the paradigm disability is reduced mental status, with vegetative state being worth nothing in terms of keeping alive. But why limit myself to mental disability?
Second, I never stated, and would not agree, to make it illegal for people to spend their own resources on keeping alive anybody who wanted to be kept alive. Perhaps I am a billionaire willing to spend $1 million to keep my extremely sick 95 year old mother from dying from her cancer for another 3 months. Whoop de do for me. All I’m saying is that when totting up the value of the medical system, more accomplishment is measured from keeping a healthy 20 year old alive for an extra 3 months.
Third, it seems that underlying your case is something like, “all human life is equally valuable.” My problem with this is it denies the value of taking a risk of dying in order to improve a life. If I have someone who is willing to risk a shorter life in order to cure paralysis (maybe some sort of stem-cell spinal cord treatment that has an 80% chance of improving things and a 5% chance of killing you), then I want the improved functionality to show up in my plus column, which they don’t if “all human life is equally valuable.”
Fourth, In my opinion, it is not intellectually honest to say “all human life is equally valuable, even disabled” and “it is a great improvement in life to cure a disability.” Either disability is not as valuable an outcome as ability, or it is. To pretend it is both it seems to me can only lead to suboptimal policy and mistaken conclusions.
I wouldn’t propose a healthcare system which set about curing femaleness by converting them to males, but I’d be pretty pleased with a health care system that made the lame to walk, the blind to see, and the diabetic to regulate blood sugar. So that is one rather important way to “readily distinguish” disability from gender.
“poor people are worth less than rich people,” I would imagine you would value a system (but not necessarily a healthcare system) which turned poor people in to rich people and did not turn rich people in to poor people. So in this sense, I’d imagine you and I would both find important similarities between “rich and poor” and “abled and disabled.” But I don’t think the health care system is the best place to address that social issue, so I didn’t propose “making the population richer” as part of the health care metric.
Please correct me where I either 1) imagine you would agree with something , but you actually disagree with it or 2) follow a chain or reasoning you would not agree with.
Understood. I agree with you here. But I do not think that is the same question as whether to consider physical disability in saving lives.
(Please don’t respond to this comment, since the substance is elsewhere.)
I’d like to make it clear that this discussion is about how to determine the performance of a health care system. Not the metaphysical value of human life in its various combinations and permutations.
Some of the assumptions behind my proposal is that 1) lower disfunction in the served population is a positive outcome from a health care system, and 2) lengthening lifespan in the served population is a positive outcome from a health care system.
Do you agree with either or both of these?
If you do agree with both, can you imagine a metric which reflects additional credit on a system which reduces or effectively treats disability which simultaneously does not distinguish between the value of the disabled and the abled?
The reason I need a counterproposal from you, at least a partial one, is that so far what you have said amounts to “boo on not valuing disabled people, but I can’t go as far as to say that your proposal isn’t the best one possible.” If this is what you are saying, let me know. If this is not what you are saying then show me a proposal that is better than mine, it doesn’t have to be comprehensive or perfect, merely better than mine.
Cheers, Mike
That’s odd, it seems to me that you introduced the idea back here, as noted elsethread.
Sure. It does not follow that these are the only things that matter, though. Taken alone, these would authorize killing people to use their organs to save others. We recognize that’s a bad idea not just deontologically (“murder is wrong”) but consequentially also (“it wouldn’t work out well, doing that would cause problems beyond the immediate neighborhood being contemplated”) and, for that matter, categorically (“if you murder person A, this implies you don’t value individual life, so why are you saving persons B through F?”) and acausally (“if we lived in a world where we did things like that, other people would do stuff to us that we wouldn’t like”).
Okay, here ya go: “Instead of trying to decide whose life is more valuable, when you possess a life-saving resource and encounter a life that (to the best of your knowledge) is in need of saving, you save that life.”
In business terms, “first come, first served.”
In hippie terms, “love the one you’re with.”
In timeless terms, “if you don’t save a life when you have the chance, then what makes you think that future-you would ever choose to save a life?”
In progressive terms, “if not now, when?”
Take the Schelling point. Discard the assumption that you know (or should know) how to value one life over another. In the (statistically impossible) case of simultaneous arrivals, pick arbitrarily. This avoids setting yourself as judge over other people, and thus avoids all the problems mentioned above, including the acausal ones; and it thereby avoids licensing ableism or killing one to save five.
Suggested reading on argumentation:
Privileging the Hypothesis
You’re Entitled to Arguments, But Not (That Particular) Proof