It's more important to prevent the deaths of young people

In which I argue with the majority of U.S.-based bioethicists

Photo by Nathan Dumlao

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A recent article in the American Journal of Bioethics reports the findings of a survey of bioethicists based in the United States. There were 515 respondents, two-thirds of whom have a PhD or DPhil, a quarter have an MD or nursing degree, and an eighth have a JD. The survey asked the respondents their views on a bunch of different bioethics topics, including abortion and assisted dying. 

This is really helpful. Although there’s a vibe that bioethicists agree on certain things, it’s surprisingly hard to figure out which things. Someone should run a similar study of Canadian-based bioethicists.

I found some of the agreement surprising, and I’ll write about that in another post. Naturally, I first want to discuss some stuff I think the majority get wrong. Here’s one that stands out:

Asked about the age at which it is most important to prevent someone from dying, most bioethicists responded that “preventing a death is equally important irrespective of age” (254, 63%). In order of frequency, other respondents indicated it was most important to prevent someone from dying at 10 years of age (65, 16%), 1 year of age (53, 13%), or 25 years of age (32, 8%). No respondents selected either 50 or 75 years of age. We did not find a statistically significant correlation (r = .08, p = 0.14) between a respondent’s age and their likelihood of reporting that “preventing a death is equally important irrespective of age.”

I don’t think that preventing death is equally important irrespective of age. Although I think that immortality would be bad, I also think it would be better if we could live longer, so long as we remain healthy. But since we’re all stuck with mortality, it’s worth asking which deaths are worse.

There’s broad agreement in the analytic philosophy of death literature that death is bad for the one who dies because it deprives that person of the good things she would have had if she had kept living (although there’s significant disagreement about the details of this account). This is called the deprivation account. If someone’s life is worth living—a life she wants to continue, a life where well-being outweighs ill-being, or however else you want to measure it—and if her life would have continued to be worth living, then her death deprives her of its value. Her death is bad for her because it means she misses out on more good stuff, however measured (happiness, achievement, time with friends and family, etc.). 

The flip side of this view is that death isn’t bad when the bads of life outweigh the goods. Assisted dying is ethical in part because death comes as a relief in some cases. It deprives people of continued suffering, and continued suffering is bad. Only Mother Teresa, the pope, and some other opponents of MAID fail to see the obviousness of this point. 

Certain things follow from this view. One is that, since death is bad because it deprives the person who dies of good stuff, and since dying younger means that person is deprived of more goodness, then it’s worse to die younger. (Again, in general. I’m setting aside some of the difficulties with specific counterfactuals and whatnot. You can dig into the details here.)

When I teach the deprivation account, students typically find this point easy to accept. It aligns with common intuitions: It’s bad when a ninety year old dies, but not as bad as when a ten year old does. It’s more of a tragedy when a child dies, so preventing the death of a child is more important than preventing the death of an old person.

Or so I thought! Sixty-three percent of U.S.-based bioethicists seem to disagree. Suppose there’s a resource shortage and for some reason a hospital can only save a ninety year old or a ten year old. So we ask the majority of bioethicists, “at which age is it most important to prevent someone from dying”? They respond: “Preventing a death is equally important irrespective of age.” I guess we should flip a coin.

This is the wrong view! The ten year old should be saved. The child is almost certainly going to benefit more, since she has, on average, seventy years left to live while the ninety year old has far less. (Capacity to benefit is widely accepted as a valid criterion for resolving allocation issues in healthcare.) Death is a greater harm for the ten year old than the ninety year old, we should be beneficent and non-maleficent, so we should save the ten year old. Justice also supports saving the ten year old: the ninety year old has lived a long life whereas the child is just getting started, so the fair thing to do is save the ten year old. 

To be clear, both deaths are bad—this follows from the deprivation view—so we should save both if we can. But since we can’t in my example, we should save the child, which contradicts “preventing a death is equally important irrespective of age”.

People might worry that the view I’m defending justifies age discrimination. Thankfully, on average, younger deaths are rarer. If young people died at the same rate as old people but of different causes, we’d have more reason to invest in preventing the deaths of young people, but that isn’t the situation. Again, all deaths are tragedies, but the deaths of young people are more tragic.

Strangely, in a separate question, the respondents were asked about acceptable criteria when deciding who should get an expensive treatment. “Nearly three-quarters (294, 71%) of respondents think it is permissible to consider ‘the patient’s expected post-treatment quality and length of life,’” says the study. These answers are incompatible, since they amount to saying “consider length and quality of life” and “don’t consider length and quality of life”. 

As the social scientists like to say, more research is necessary to figure out what’s going on here. I hope we get more surveys like this.