Howard Steven Friedman is a leading statistician and health economist. His latest book, Ultimate Price: The Value We Place on Life, is a timely and shocking account of the judgements made in reducing human life to a data point.
Your book demonstrates that price tags are placed on human lives every day. How does this affect ordinary people?
Price tags are being put on our life “from the day we are born to the day we die,” yet we are often unaware of their existence or impact. This real world of price tags is derived from business analysts making cost-benefit calculations on auto safety, jurors awarding damages for a wrongful death, and regulators determining acceptable levels of water contaminants and what drugs and medical procedures are covered by the National Health Service.
For example, regulators in the United Kingdom routinely perform cost benefit analysis to assess the impact of regulations where a value of the human lives saved is included in the benefits. The National Institute for Health and Care Excellence (NICE) Guideline Development Group considers both clinical impact and cost effectiveness, a calculation that involves an upper limit on how much should be spent on a treatment that will add, on average, a few additional months or years of life.
What motivated you to write the book?
Every day we see more evidence that some people’s lives are highly valued and well-protected by companies and our legal system, while other people are left far more susceptible to injuries and death. Trusting technical experts, government agencies, and corporations to always make equitable decisions can lead to disastrously inequitable and sometimes dangerous results. Readers can readily understand the assumptions involved in how their lives are valued and need to make sure that their lives, and the lives of others, are valued fairly.
How are lives being valued in relation to the Covid-19 outbreak?
Initially, there were very few tests available and the media was flooded with reports of sports stars, politicians and celebrities like Tom Hanks testing positive. As some health systems became overwhelmed, directives were issued about whose life to prioritise higher. For example, Massachusetts health officials issued voluntary guidelines on rationing ventilators that prioritise medical personnel, pregnant women, and healthier individuals with longer life expectancies. In case of a tie, younger patients would be favoured.
Calculations related to the tradeoff of opening different aspects of the economy and the corresponding risks to health and safety are similar, in principle, to how regulatory agencies often perform cost-benefit analysis. But with the COVID crisis, these calculations are vastly more challenging.
Shockingly, a court can determine that a death does not merit any damages at all, since the death “saved money”.
An egregious example involves Cheryl Thurston. Cheryl was an inpatient at a state mental health institution in New York. She was severely disabled and required one-on-one supervision while bathing. While left unsupervised in the bath, she had a seizure and was found unconscious. She died within a day. Cheryl had no lost earnings. New York law allows for compensation for the victim’s pain and suffering, but since Cheryl never regained consciousness it was assumed that she had neither felt pain nor suffered. The case was dismissed with no damages awarded.
In such a glaring instance, the sense of unfairness was palpable enough for the judge to comment, “The ultimate scandalous irony is that, had Cheryl been chattel rather than a human being, Claimant could recover the lost value of her property. It is repugnant to the Court to have to enforce this law which places no intrinsic value on human life.”
The decision sent a clear message to New York care facilities that even if their negligence causes someone’s untimely death, they may not have to pay any penalties. Not surprisingly, in New York State, nursing homes are now shielded from many lawsuits over their failure to protect residents from death or sickness caused by the coronavirus where the confirmed COVID-19 death toll in New York State nursing homes alone is over 5,000.
How can the public resist this unfairness?
There are many examples where the public became aware of a bias or injustice and then became motivated to drive change. For example, under President George W. Bush, the Environmental Protection Agency (EPA) introduced the idea of two price tags on life, $3.7 million for people under the age of seventy and $2.3 million for people older than seventy. Criticism was immediate and scathing. The public reacted furiously to what advocates for the elderly labeled the “senior death discount.” The EPA soon backed off and reverted to using a single price tag for every life rather than assuming that some people are worth more than others. To this day, all US regulatory agencies apply the rule that all lives are valued equally regardless of age, sex, income or any other factors.
Public outcry has also influenced civil court cases. Eric Garner was choked to death by police officer Daniel Pantaleo after being accused of selling untaxed cigarettes. The $5.9 million settlement in the Eric Garner case bears no relation to the expected earnings of the forty-three-year-old man, who was out of jail on bail, but was influenced by strong public interest in the case.
How do we build a fairer system?
Gender, race and age discrimination appear most prominently in two situations: when income is a factor in valuing life and in criminal justice cases when there is the potential for bias.
When income is used as an input in valuing life, such as in civil court cases, then adjustments to the income should be made to reflect known race, age and gender-based income biases. In criminal justice cases, analysis must be vigilant to ensure that justice is blind and that factors such as race, gender and age do not unduly bias each stage of justice from evidence gathering to the process of being charged, tried, convicted, and ultimately punished by the court.
