Efficient Ethical Principles for Making Fatal Choices

Abstract

Resource allocations of all kinds inevitably encounter financial constraints, making it infeasible to make financially unbounded commitments. Such resource constraints arise in almost all health and safety risk contexts, which has led to a regulatory oversight process to ascertain whether the expected benefits of major regulations outweigh the costs. The economic approach to monetizing health and safety risks is well-established and is based on the value of a statistical life (VSL). Government agencies use these values reflecting attitudes toward small changes in risk to monetize the largest benefit component of regulations—that dealing with mortality risks. This procedure consequently bases the benefit value on the individual’s own rate of tradeoff between risk and money and in effect creates a quasi-market approach to public policy assessment. Whereas tort liability awards are personalized to reflect the particular circumstances of the case, government policies generally rely on average valuations of mortality risk across broad worker groups. The COVID-19 pandemic has highlighted the potential role of resource constraints in the distribution of medical resources, particularly with respect to the provision of ventilators. The age-based allocation of treatment advocated by some medical ethicists violates age discrimination laws, is based on their own ethical judgments, and is divorced from consideration of private willingness-to-pay values or other possible economic efficiency criteria. A more constructive approach than the lifeboat and triage scenarios that are often discussed by medical ethicists is to consider ex ante how people would choose to provide for treatments when facing a prospective risk, making the task equivalent to that of valuing and saving statistical lives. Continued high valuations of risk reductions even by those who are old provides a rationale for more protective practices and more forward-thinking medical decisions than those advocated by some bioethicists.