I recently had a debate with my roommate about a very significant issue: how do we as a society decide whether and for how long individuals in a “permanent vegetative state” (deliberate scare quotes) are kept on life support. Who decides the matter of the prolongation of their lives? There are a few possibilities:
The Person Himself/Herself?
Yes, if they clearly indicated while they were conscious that they would prefer not to be kept on life support in such a situation. Living wills? Perhaps every person applying to get a driver’s license could be required to declare their position officially for future reference?
Are parents normally permitted to cause the death of their child by neglecting their needs such as food and water? Will parents always act in the child’s interest? What if they were tired of taking care of the kid? Do they always know what their child would have done? If you have children, do you know what they would want? Are you willing to pass that information on even if it contradicts with your views?
The state (bureaucrat, judge, legislators, governor)?
–Cue Orwellian Doomsday Prophecies–
It seems like government making such decisions would be a situation to avoid, but that is the status quo in many cases. In most situations I would prefer the parents making the decision over the county judge, a Health Department case worker, the state legislature, the Govern[at]or, the Senate, the President… the U.N. Secretary General….
The Benthamite Radical Equation
Scenario: X number of dollars are spent each year to preserve/prolong (fill in the blank depending on your ideology) the life of Individual A on life support. X dollars could alternately be used to invest in AIDS research, inoculation campaigns, prevention programs, or sleep apnea education that would — by prevention or intervention — save the lives of 10 people. This is classic opportunity-cost that leads us to the inevitable conclusion: Individual A has got to go to make room for Individuals B through K. Right?
If the situation was so simple then the choice would be clear. However, it isn’t so simple. For one thing, there are a ridiculous number of alternatives that X dollars could be used for. More importantly, though, there are many more sources of X dollars than diverting funds from the care of Individual A. Please, take a look at the federal budget for the United States and tell me that there isn’t somewhere else we could pull resources from, something that isn’t a matter of life or death.
Assuming that the value of each human life is equal, let W be the value of one human life. Given that Individual A is supported for one year by an expenditure of X dollars, the support of Individual A yields value per dollar V = W / X = W/X by unit definition.
Another value-yielding activity is fire ant research. Assuming that Fire Ant Research is less valuable than an individual human being, let us suppose that the value of one year of fire ant research at Tennessee State University is Y = W / 100 (implying that a single human being is exactly 100 times more valuable than TSU fire ant research) and the cost of said research is also X dollars. TSU fire ant research yields value per dollar Z = Y / X = W / 100X. Thus the value per dollar of maintaining Individual A on life support is 100 times the value per dollar of TSU researchers investigating fire ants.
Supposing that Preventative Measure M can preserve the life of 10 individuals (Individuals B-K) over the same time period with an expenditure of $X, the value per dollar yield of engaging in Preventative Measure M is N = 10W / X. Thus engaging in prevention produces 10 times the value yield of maintaining life support for Individual A.
After further investigation, we again conclude that Individual A should be removed from life support and allowed to die, and funding should be redirected to Preventative Measure M, thereby increasing the value yield captured by X dollars. Q.E.D.
In the above decision we exchanged the W value received by keeping Individual A alive for the 10W received as reward for carrying out Prevention Measure M for a net gain of ?value = 9W. However, if we instead divert funding from fire ant research to Preventative Measure M, which gave a value of W/100, we would have a higher net gain in value: ?value = 10W – W/100 = 9.99 W > 9W. Therefore, funding Preventative Measure M by diverting funding from fire ant research causes greater overall wellbeing doing so using Individual A’s life support money, and we conclude that the best course of action is to continue supporting Individual A and to discontinue TSU’s fire ant program. Q.E.D.
Oh, Be Wise
In the scenario presented, we have only considered one other opportunity by which to calculate the opportunity cost of preserving A’s life. In reality, there are many, many more opportunities, thus complicating the decision. Given perfect information about the value of each option in terms of resultant wellbeing, the fire ant program would not be eliminated until all other programs, policies, decisions, etc. in support of less effective value sources were eliminated first. Along the same lines, Individual A would not be removed from life support until all other options resulting in less net gain in wellbeing were eliminated. In other words, there is much to consider before we start pulling plugs. As King Benjamin in the Book of Mormon taught, “see that all … things are done in wisdom and order…” [Mosiah 4:27]. I wholeheartedly agree.