How do you measure the value of a life?

Easily... cost benefit analysis...
End of life care decisions are often influenced by the political and economic atmosphere in which they are made. Canada is a capitalist country and as such values individualism and productive capacity of its citizens. Some scholars have taken a political economy perspective in theorizing on end of life policies in the West. It is no surprise that the political and economic agenda of the state is hidden under rhetoric proposing to support an individual’s right to autonomy in controlling the circumstances of their death this simply serves to justify the current ‘policy of inaction’. Political economists explores the interplay between ethics on end of life and the economic environment, which determine why some lives are believed to be worth saving and others are not. It is interesting to note that the advancements made on the front of medical technology have given rise to a unique phenomenon- in that our ability to save lives exceeds our resources (alloted to health care). This creates a dilemma in which lives must be assessed and subsequently prioritized. This very sentiment is expressed by Robin Dubos at a bioethics conference in the United States, who asked:

To what extent can we afford to prolong biological life in individuals who cannot derive either profit or pleasure from existence, and whose survival creates painful burdens for the community? (Epstien, 2007)

To quantify the benefit of medical intervention the measure of Quality adjusted life years was created. This is a tool that is used to weigh the cost and benefits of medical interventions. Essentially, lives are given a quantitative value, are prioritized and resources are distributed accordingly. This flies in the face of equitable and universal health care. Supporters of this method of resource allocation argue that because health resources are limited, this method ensures that resources are allocated in such a way that best benefits society. It is significant to point out that according to this perspective ‘society’s benefit’ is defined by economic return on lives. This approach to resource allocation serves to devalue the lives of elderly and does not ensure them the quality services. Taken to the extreme, it suggests that lives can be judged on a spectrum of age and ableism. QALY has been implicated to justify underfunding of resource-intensive services with low yield of Quality adjusted life years including intensive care, geriatric care and psychiatric care. These practices are highly discriminatory against the aged and chronically ill and disabled.

In the current situation there is a need for social action. The next few blogs will put forth end-of-life care policy recommendations to attempt to create a system that is more equitable. Currently, capitalist ideology pervades Canadian culture and is reflected in policy. However, it must be recognized that the plight of the elderly will eventually become everybody’s plight as we all age and/or will struggle to support aging loved ones. The unequal distribution of resources ensures that aging with dignity will be a luxury rather than a right. Furthermore, Canada needs to revamp the current approach to end-of-life care in a way that addresses the unequal distribution of caring labor between genders. It is deeply sinister that lives are appraised by their position within the capitalist system, although this sentiment is often hidden behind rhetoric of independence measures such as the QOYB make this sentiment more apparent. Elders who may otherwise be satisfied in their old age are constantly reminded that they are a burden on their family, community and society at large. If it is the case that there is a real scarcity in resources which cannot support end of life care for all Canadian citizens than this is a tragic state. However, if it is simply the unequal distribution of these resources that has created the current condition, which I am apt to believe, than Canada must reevaluate their current practices and place them in line with the ideals in which they purport to uphold. As Karen Bass famously wrote, “You judge a society by how it treats its most vulnerable citizens”
.... we invite you to read further to our policy recommendations and give us your input.