If I remember/understand correctly, the normal instruments fail to deliver useful answers for very bad conditions. For example, if you administer a survey asking how many years of healthy life the survey-taker thinks a year where they suffer X is worth, very bad situations generate incredibly broad answers.
Some people say those years are valueless (so just at 0), some say they have huge disvalue (so they’d rather die now than face one year with the condition and then the rest of their life in good health), and some say that it’s close to the value of a year of healthy life (not so sure about this one; I think I remember someone saying it, but it was just in conversation).
future studies should calibrate SWB ratings against an explicit lower anchor of death (I really do not see any need to estimate values for states worse than dead)
I didn’t read around enough to see if he offers a justification for it.
One small note for DALYs as they currently are: if the major impacts of impairment are essentially flow-through effects of economic value (so if I’m bed-bound my whole life, that’s bad for me, but the economic slowdown has overall worse effects), then it may be plausible that DALYs shouldn’t go below zero. Your post mentions the case of the child, where it seems to go below zero. But it could be a practical point that keeping the measure at zero results in better estimations of the scale of economic impact than it going below zero.
I’m working with Paul Dolan on a report related to this topic, and the need to value states worse than dead (SWD) is our only major point of disagreement. He gives some kind of justification for his views on p26 of this report, but I find it extremely unconvincing.
But to be fair, nobody has proposed a particularly good method for dealing with SWD. Most attempts have used versions of the time trade-off, with limited success – for a slightly outdated review, see Tilling et al., 2012.
In this Facebook post I’ve listed a few options for achieving the related but more modest objective of determining the point in happiness scales that is equivalent to death.
Thanks for the additional readings. I think Paul Dolan is asking the right questions. I am disappointed that after a promising initial discussion eight years ago, Holden doesn’t seem to have spoken again on the subject and to the best of my knowledge there is still no way on GiveWell to put different weights on “impact” to give different results.
I don’t understand your last paragraph though. DALYs don’t seem to measure economic effects on others at all, so if you do start to consider them wouldn’t that be a big argument to make some DALYs negative?
Sorry, I didn’t communicate what I meant well there.
It might be the case that DALYs somewhat faithfully track both (a) the impact of conditions on subjective wellbeing and (b) the impact of conditions on economic contribution, even if they’re not explicitly intended to track (b). It might also be the case that efforts to extend DALYs to more faithfully track (a) for things that are worse than death would mean that they tracked (b) less well in those cases.
Then, it could be the case that it’s better to stick with the current way of doing things.
I don’t actually think the above is particularly likely (and yet less so after writing it out) and even in the case that it captures something correct for some moral frameworks, it probably looks different under others.
I agree that this seems important.
If I remember/understand correctly, the normal instruments fail to deliver useful answers for very bad conditions. For example, if you administer a survey asking how many years of healthy life the survey-taker thinks a year where they suffer X is worth, very bad situations generate incredibly broad answers.
Some people say those years are valueless (so just at 0), some say they have huge disvalue (so they’d rather die now than face one year with the condition and then the rest of their life in good health), and some say that it’s close to the value of a year of healthy life (not so sure about this one; I think I remember someone saying it, but it was just in conversation).
As far as discussion on it, I found this GiveWell post that glances on it, and health economist Paul Dolan saying
I didn’t read around enough to see if he offers a justification for it.
One small note for DALYs as they currently are: if the major impacts of impairment are essentially flow-through effects of economic value (so if I’m bed-bound my whole life, that’s bad for me, but the economic slowdown has overall worse effects), then it may be plausible that DALYs shouldn’t go below zero. Your post mentions the case of the child, where it seems to go below zero. But it could be a practical point that keeping the measure at zero results in better estimations of the scale of economic impact than it going below zero.
I’m working with Paul Dolan on a report related to this topic, and the need to value states worse than dead (SWD) is our only major point of disagreement. He gives some kind of justification for his views on p26 of this report, but I find it extremely unconvincing.
But to be fair, nobody has proposed a particularly good method for dealing with SWD. Most attempts have used versions of the time trade-off, with limited success – for a slightly outdated review, see Tilling et al., 2012.
In this Facebook post I’ve listed a few options for achieving the related but more modest objective of determining the point in happiness scales that is equivalent to death.
Thanks for the additional readings. I think Paul Dolan is asking the right questions. I am disappointed that after a promising initial discussion eight years ago, Holden doesn’t seem to have spoken again on the subject and to the best of my knowledge there is still no way on GiveWell to put different weights on “impact” to give different results.
I don’t understand your last paragraph though. DALYs don’t seem to measure economic effects on others at all, so if you do start to consider them wouldn’t that be a big argument to make some DALYs negative?
Sorry, I didn’t communicate what I meant well there.
It might be the case that DALYs somewhat faithfully track both (a) the impact of conditions on subjective wellbeing and (b) the impact of conditions on economic contribution, even if they’re not explicitly intended to track (b). It might also be the case that efforts to extend DALYs to more faithfully track (a) for things that are worse than death would mean that they tracked (b) less well in those cases.
Then, it could be the case that it’s better to stick with the current way of doing things.
I don’t actually think the above is particularly likely (and yet less so after writing it out) and even in the case that it captures something correct for some moral frameworks, it probably looks different under others.