Deciding who to save is always an uncomfortable decision because it positions us in front of someone who will die because of our choice. But not taking the decision at all is even worse because then both will die. Therefore, we have triage systems that help us to take the decision consistently to our moral principles.
Whenever we can increase the number of QALYs using the same resources the decision is simple. Whenever we can get the same amount of QALYs with less resources the decision is also simple. Things get complicated when the ratio QALY/$ is the same. I don’t know what the next criteria are to be used then. To me it also seems very problematic to use the economic position of the affected persons. One could argue that the better positioned person will (potentially) get more welfare and therefore choosing her/him to maximize the absolute welfare, but one could alternatively argue that the person who will (potentially) do the most efficient transformation of our common resources into personal welfare is the right choice. I develop the example in the rest of the reply, without taking a stance on which choice is best.
[Update: I edited this reply to include the introduction above this line, as it provides more context]
What is the cost of saving a life? In my view the resources to be counted are the sum of:
Resources needed to save the life in a given point of time
Resources needed to keep the person alive with the expected level of welfare during the rest of her/his life
Even in a hypothetic scenario where saving a life (1) of a rich person costs the same as saving the life of a poor person, we would still have to consider how much resources will the rich person consume (2) compared to the poor.
The life of the average person in Luxembourg takes 15 times more resources than the life of the average person in Gambia [1], therefore the life expectancy should be almost 15 times longer in order to generate a similar level of welfare per resources used. But it is not.
Taking finite resources such as fossil fuels or easily accessible minerals will reduce the resources available for future beings’ welfare, so we as humanity should make an effective use of them to generate effectively welfare and HQALYs. In this respect, an alternative uncomfortable conclusion seems to favor increasing the number of lives with a low ecological footprint compared to the number of lives with higher impact.
Whether somebody is aligned with this alternative uncomfortable conclusion will depend heavily on how she/he sees the availability of resources. Let’s take these two extremes:
If you believe we still have a lot of room forgrowth and human ingenuity will find ways to make more people richer before overshooting Earth’s ecosystems’ capacity, and this is very positive for welfare creation as described in “Growth and the case against randomista development” by Hauke Hillebrandt and John G. Halstead
In case of (A—planet limits coming soon) then the uncomfortable conclusion is that it is way much better to let the richest people die instead of the poor one in your uncomfortable example. A less uncomfortable conclusion would be to heavily limit their capacity to exhaust resources and impact ecosystems by setting limits on personal ecological footprint and/or huge taxes, but in case someone needs to die the choice seems evident.
In case of (B—room for positive growth) then the smart thing to do might be to open the borders completely. As it is described in the post “Global economic inequality” the life expectancy and many other welfare factors depend almost completely on where are you from. If we could for example increase 15 years the life expectancy of 100 million of sub-Saharan Africans by letting them come into Europe this would mean 1.500 millions HQALYs generated within a generation time. If we don’t think it is possible to extend the European way of life to so many additional people, then (B) is not completely true and we should go back to (A) and reduce the consumption per capita of the rich people to let more room for the poor people to develop their welfare.
Deciding who to save is always an uncomfortable decision because it positions us in front of someone who will die because of our choice. But not taking the decision at all is even worse because then both will die. Therefore, we have triage systems that help us to take the decision consistently to our moral principles.
Whenever we can increase the number of QALYs using the same resources the decision is simple. Whenever we can get the same amount of QALYs with less resources the decision is also simple. Things get complicated when the ratio QALY/$ is the same. I don’t know what the next criteria are to be used then. To me it also seems very problematic to use the economic position of the affected persons. One could argue that the better positioned person will (potentially) get more welfare and therefore choosing her/him to maximize the absolute welfare, but one could alternatively argue that the person who will (potentially) do the most efficient transformation of our common resources into personal welfare is the right choice. I develop the example in the rest of the reply, without taking a stance on which choice is best.
[Update: I edited this reply to include the introduction above this line, as it provides more context]
What is the cost of saving a life? In my view the resources to be counted are the sum of:
Resources needed to save the life in a given point of time
Resources needed to keep the person alive with the expected level of welfare during the rest of her/his life
Even in a hypothetic scenario where saving a life (1) of a rich person costs the same as saving the life of a poor person, we would still have to consider how much resources will the rich person consume (2) compared to the poor.
The life of the average person in Luxembourg takes 15 times more resources than the life of the average person in Gambia [1], therefore the life expectancy should be almost 15 times longer in order to generate a similar level of welfare per resources used. But it is not.
Taking finite resources such as fossil fuels or easily accessible minerals will reduce the resources available for future beings’ welfare, so we as humanity should make an effective use of them to generate effectively welfare and HQALYs. In this respect, an alternative uncomfortable conclusion seems to favor increasing the number of lives with a low ecological footprint compared to the number of lives with higher impact.
Whether somebody is aligned with this alternative uncomfortable conclusion will depend heavily on how she/he sees the availability of resources. Let’s take these two extremes:
If you believe we will soon overcome our planet limits and face significant difficulties as described by Corentin Biteau in “The great energy descent (short version) - An important thing EA might have missed”
If you believe we still have a lot of room for growth and human ingenuity will find ways to make more people richer before overshooting Earth’s ecosystems’ capacity, and this is very positive for welfare creation as described in “Growth and the case against randomista development” by Hauke Hillebrandt and John G. Halstead
In case of (A—planet limits coming soon) then the uncomfortable conclusion is that it is way much better to let the richest people die instead of the poor one in your uncomfortable example. A less uncomfortable conclusion would be to heavily limit their capacity to exhaust resources and impact ecosystems by setting limits on personal ecological footprint and/or huge taxes, but in case someone needs to die the choice seems evident.
In case of (B—room for positive growth) then the smart thing to do might be to open the borders completely. As it is described in the post “Global economic inequality” the life expectancy and many other welfare factors depend almost completely on where are you from. If we could for example increase 15 years the life expectancy of 100 million of sub-Saharan Africans by letting them come into Europe this would mean 1.500 millions HQALYs generated within a generation time. If we don’t think it is possible to extend the European way of life to so many additional people, then (B) is not completely true and we should go back to (A) and reduce the consumption per capita of the rich people to let more room for the poor people to develop their welfare.