By Rebecca Epstein-Levi: For More Info, Go Here…
A social ethics expert weighs in on the devaluation of disabled lives during epidemics.
How much your life is worth?
In an emergency, is your life worth saving? Or are you already too broken?
These sorts of questions are bioethicists’ bread and butter, and they are about to become increasingly acute as the wave of the COVID-19 pandemic breaks in full force across the United States, and we face the kinds of crises, such as ventilator shortages, that have contributed to killing thousands in Italy.
I’m an expert on social ethics and health risks, so let me be clear: the ways our social and medical systems currently pose these questions have immediate and deadly consequences. This is especially true for disabled people, whose lives are often deprioritized even more than usual when life-sustaining resources become scarce. We’re trained to see disabled and elderly people as acceptable casualties of disasters so that we can accept the use of scarce resources to ensure the survival of the young, the abled, and the healthy. We make these judgments even in non-crisis situations — consider, for example, the “Quality-Adjusted Life Year,” or QALY, which assigns a monetary value to a year of life and deducts value for illness or disability and is widely used to determine the allocation of medical funding. The COVID-19 pandemic will only exacerbate matters.
What I’ve said isn’t speculation. Recent ventilator allocation guidelines from the University of Washington medical system define the “greatest good” as “maximizing…healthy, long-term survival…weighting the survival of young otherwise healthy patients more heavily than that of older, chronically debilitated patients.” These guidelines have explicitly and unambiguously judged the lives of young, able-bodied people to be worth more and to contribute more to the “greatest good” than those of disabled, ill, and elderly people.
Nor is this stance on ventilator allocation new to the time of COVID-19. As Ari Ne’eman has pointed out, these sorts of ventilator allocation guidelines have existed for years: New York State’s 2015 guidelines, for example, permitted withdrawing ventilators from chronic users if the users were admitted to a hospital during a ventilator shortage.
But think about the ethics of such guidelines: most of us would be, rightly, appalled if we killed people to give their internal organs to others. Why does it become less appalling to take away the life-sustaining breathing apparatus of a living person just because it’s outside their body?
