This week opened with the distressing news that Lord Sumption, supposedly someone whose judgement is entirely sound, having been a Supreme Court justice, had told a cancer sufferer live on air that her life was less valuable than others. Pretty disgusting stuff that, to me, seems to show a type of thinking that is similar to eugenics; valuing life more or less based on a person’s illnesses and so on.
I have had my own run ins with the mapping of health and care onto economics – which is what this is about. When I was a member of Arthritis Research UK’s USER stakeholder committee – a panel of lay members who appraised whether research proposals were in line with the charity’s objects – we often had to make difficult calls on whether to fund research into extremely low-prevalence/rare conditions. These conditions were often not the main focus of the charity’s research, but there were no other funders who would fund this work. The arguments that we had were often economic in character: we have £x to spend on Y number of projects. Which projects should we fund? In my contributions I tried to balance funding the charity’s “core” conditions – rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, lupus – suffered by millions of people, against funding extremely rare, but extremely debilitating conditions. I usually argued that we should fund at least one of the very very rare conditions every round. It was a horrible choice to have to make.
In the case of coronavirus, though, there is such a differential outcome in what is being proposed that the decision is very different. At Arthritis Research UK, we were dealing with conditions, in every case, that caused people extreme daily pain and threats to their lives. It wasn’t as though we prioritised minor conditions over things that would kill people; it was the prevalence that led to the difficult decisions about scarcity. In the case of Covid, it is the asymmetry of how the virus affects people vs. restrictions of liberty that seems, to me, to make it unacceptable. I like a party as much as the next person. Do I like parties so much that I would be willing to kill everyone over 80 – or make it so that the world is so unsafe that they cannot go out? I do not.