Can We Measure the Value of Saving Human Lives in Dollars? Somber Calculations in a Time of Plague

This essay is part of a series concerning the Coronavirus pandemic. Read more from the collection here.

Texas Lt. Governor Dan Patrick has been widely excoriated for suggesting that he, as a senior citizen, would be willing to “take a chance on [his] survival, in exchange for keeping the America that all America loves for [his] children and grandchildren.” A great deal of cant has resulted, suggesting that any tradeoff of human life for economic value is unconscionable—in effect, accusing Patrick and others of sacrificing Grandma to prop up the Dow Jones average.

In Patrick’s defense, I would point out that the federal government and the World Health Organization have long recognized the inevitability of such tradeoffs. The Department of Transportation, for example, estimates the value of saving a single human life at just over $9 million. There is, however, a profound paradox here. We all accept that every human life is priceless, beyond all monetary measure. If so, it seems that we must affirm that every day of every human life is beyond price.

[Read: Pandemics and the Agency of Citizens]

However, it seems to be impossible to put such sentiments into practice. If the Department of Transportation, for example, put an infinite value on all human life, we would all be driving at below twenty miles per hour in vehicles stuffed with hundreds of thousands of dollars of safety equipment. A nationwide commitment to the infinite value of human survival would require that virtually all of our GDP be devoted to health, safety, and the bare necessities. No homes beyond meager shelter, no vacations, no arts and music, etc.

On further reflection, the paradoxes only seem to multiply. If we ask how the U.S. government or the WHO estimates the value of human life, we discover the appeal to social-science research in which people are asked to make hypothetical choices, sacrificing some life expectancy for other goods and services. This seems, for an economic point of view, to be a sensible procedure, but it leads quickly to apparent contradictions.

Suppose you had a choice of earning $1 million by taking an extraordinarily lucrative job, but accepting it would require re-locating your family to a place, like Denver, where they would be exposed to more solar radiation. This might reduce the life expectancy of each of your six children by a month. It is easy to imagine a good and virtuous parent making such a choice, given the great good for the children and others that the additional income could do. Yet, it is also easy to imagine the same parent being willing to spend over $1 million to obtain for an ill child another six months of life. How can six months of life be worth less than $1 million in one case, and much more than $1 million in the other?

The paradoxes become even sharper if we follow the WHO in using disability-adjusted years of life as our measure. It seems quite reasonable for someone to prefer fewer years of life without some disability (like blindness or deafness) to a greater number of years with that disability. But do we want to concede that the lives of able-bodied people are of greater intrinsic worth than those of the disabled? We begin to run the risk of being forced to embrace the Nazi notion of lebensunwertes Leben, life unworthy of life. Yet, we can imagine some blind people preferring fewer years without deafness, and some deaf people preferring fewer years without blindness, without either group conceding that their years of life are more valuable than the years of their being both blind and deaf.

The Economic versus the Thomistic Model of Rationality

These paradoxes have a root cause. They all depend on a certain kind of economic model of practical rationality. They assume that the value of a human action can be identified with the expected value of the consequences of that action. To determine the value of an action, we compare two sorts of “possible worlds”: those likely to result if the action is taken, and those likely to result if the action is not taken. We then put a value on each world, looking at that world from a detached point of view (the point of view of the “ideal observer” or “ideal spectator” of Adam Smith or David Hume). Following this model, we would find ourselves trapped in self-contradiction. To restore consistency, we would have to say either that it is irrational to take into account the quality (as opposed to the quantity) of life, or we would have to say that the lives and years of some human beings are of intrinsically more value than others.

But what is the alternative to this Smith-Hume model? It is a view of agency crafted by Plato, Aristotle, and Cicero, which finds its fullest development in the philosophical anthropology of Thomas Aquinas. I’ll call it the Thomistic model. According to the Thomistic model, the value of a human action depends on three factors, only one of which (the intended consequences) is included in any fashion in the Smith-Hume model. The three factors are (i) the value of all human actions as human, (ii) the essential nature of the specific action (in itself), and (iii) the circumstances of the action. I will focus on the two variable factors, (ii) and (iii).

The essential nature of a specific action points us to the question of whether what is done is intrinsically evil in itself. Morally evil things are not to be done. An action of intentionally applying lethal force to an innocent human being is always a bad action, regardless of its actual or intended consequences. This factor doesn’t dissolve the paradoxes I set out above, since none of them involved killing. Instead, we are simply concerned with the relative goodness or value of saving or not saving human lives. The unintended consequences of a course of action (like resuming normal activity), even when they include foreseeable human deaths, do not make the action one of intentional killing.

[Read: Cooperation, Coercion, and the Coronavirus]

The factor that is most relevant is the factor of circumstance—the relation between the actor and the action. These include what the Cambridge philosopher Bernard Williams described as agent-relative considerations. They are considerations that are relevant to the measurement of an action’s value but would be invisible to the ideal observer, who takes “the view from nowhere” (in the philosopher Thomas Nagel’s phrase).

The circumstances of action include what Aquinas called the order of charity. Failing to save the life of one’s spouse, parent, or child is worse than failing to save the life of a stranger. A community’s failing to save the life of one of its members is worse than its failing to save the life of one belonging to a different community. Another application of the order of charity is this: the primary aim of any political community must be its own common good. The common good is not the aggregate of the individual welfare of a society’s members, but rather the flourishing of the whole community as such. The deaths of even large numbers of members of a community always comes at some cost to the common good, but they would not represent a catastrophic loss, so long as the community were able to sustain its social existence.

On a more speculative note, I will suggest that we can supplement Aquinas’s order of charity with some additional orders:

(2) The order of scarcity: it is more important to prevent imminent death than to extend life by the same number of years for someone with many years to live.

(3) The order of certainty: it is more important to increase the probability of continued life for those almost certain to die than to increase the probability of survival by the same amount of time for people with a good chance of surviving in any case.

(4) The order of causality: it is more important to save a life when the death would be the inadvertent effect of one’s own actions than to save a life when the death would be entirely due to unrelated causes.

(5) The order of normality: it is more important to save a life when you can do so by simply choosing not to make a significant change (for whatever reason) in one one’s normal course of action than to save a life when doing so involves making such a change.

(6) The order of proximity: it is more important to save a life when one is among those who could most easily do so than when one is not.

(7) The order of alteration for the worse: it is more important to extend the life of one who is permanently blind (for example) by a year than to extend the life of a seeing person with a year lived in blindness.

All of these are controversial (especially among professional ethicists), but they seem to be well supported by moral common sense.

What can we say about the quality of life? Other things being equal, it is of equal value to save the life of a disabled person as to save the life of an able-bodied person. It is also, other things being equal, of greater value to add a year of able-bodied living to someone’s life than to add a year of disabled living. These are consistent, because the relevant circumstances of action are different. If someone is permanently blind, adding a further year of blind life for that person is of equal value to adding a further year of seeing life to a seeing person, even if adding a further year of blind life for the seeing person would be of less value (as would adding a year of further-disabled life to the blind person).

So, what we are concerned with in these hard choices is the value of saving or extending human life, i.e., the value of certain human actions. And this latter value can in many cases be given an approximate monetary measure, since we can compare the value of such actions with the value of obtaining or retaining a degree of wealth. This monetary measure of actions is sensitive to differences in circumstances. Saving a human life in one context might be worth billions of dollars and worth almost nothing in other circumstances, even if the quality and quantity of life are exactly the same in both cases.

Priceless Life and Coronavirus

What then does it mean to say that human life is priceless? It means this: there is no absolute upper bound on the monetary value of saving any particular human life, pertaining to all possible circumstances. We are never in a situation in which we can say, “$X million is intrinsically of greater worth than an additional year of this human being’s life.” Nonetheless, once the circumstances are fully given, we can and in some cases must assign a monetary value to saving any given human life, or to extending a human life by a predictable period of time. The monetary value of saving a life is also dependent on the total wealth of a community, since a dollar of wealth is more precious to a poor community than to a wealthy one. This is not because saving human life is worth less in a poor community, but because wealth is worth more.

Is a total lockdown a reasonable response to the threat to life posed by the coronavirus? To answer that question, we have to estimate both the economic cost (per month) of the lockdown (as compared to less costly measures, like targeted isolation, contact tracing, and hospital expansion) and the expected monetary value of the action of saving the lives that would otherwise be lost, which depends on the probability of various death rates, and of the life expectancy of likely victims, as well as on the relevant circumstances.

How do current circumstances affect the value of life-saving measures as measured by the value of each added year? Among the factors increasing the value of saving lives in a lockdown: we would be preventing imminent deaths (scarcity), the deaths are to members of our own community (charity), and the deaths would result from our own actions of social comingling (causality). Among the factors reducing the value: none of the potential victims is certain to catch the virus and die (certainty), and the deaths would result without any deviation from our normal way of life (normality). In addition (and this is something the Hume-Smith model gets right), since the likelihood of death increases significantly with greater age and with other life-threatening maladies, the number of life-years lost is proportionately lower, when compared to a disease like the flu that strikes mostly people who are young and otherwise healthy. Finally, a total shutdown, at least in the long run, threaten the very existence of our shared social order, a catastrophic loss to the common good (charity).

These are not easy decisions, and we should not impose on ourselves any snap judgments of others who come to different conclusions. The issue is further complicated by the fact that we are dealing with uncertainty and not risk: we will not even know what the objective probabilities are until we collect more data. Because of the potential exponential growth, and the fact that each death makes additional deaths statistically much more likely (the fat tails phenomenon described by Nassim Nicholas Taleb), we need to err on the side of caution. The precautionary principle is reasonable here: we need to act so as to bring as close to zero the probability of the most extreme results.

However, the precautionary principle does not point in only one direction. Closing down an entire society for a prolonged period of time is uncharted territory, with many perils. We don’t know if the lockdown is socially or politically sustainable in the long run. We don’t know what will happen to our practices and institutions, including the rule of law. Economic depression can also cause millions of deaths through suicide and drug abuse, as well as civil unrest, all of which would divert resources from fighting the virus. In light of the preeminent importance of the common good, the precautionary principle should guide us, above all else, to avoid such a catastrophic social collapse.

I’m no expert on either public health or economics, but it seems clear that a middle course will prove optimal. In due time we should pivot away from a systemic lockdown to a much more targeted approach, relying on testing and contact tracing, quarantining of carriers, and intelligent physical distancing where possible. The lockdown that began in March and will continue in April was probably necessary to buy us the time we needed to produce sufficient numbers of test kits, protective gear, and ventilators, but relaxation of the restrictions in due course will also be a matter of urgency.