So say hypothetically a demon appears in the prime ministers room one night and says:
Ahah prime minister. You must make a choice. Tomorrow I'm going to kill 50000 70 year olds. However if you press this red button I'm going to kill one 40 year old a day for 40 years. What will you do?
Well. You might think one person a day isn't very much. In the grand scheme of things tomorrow no one will notice. I mean yes the persons family will notice but not the press and the NHS and everyone. We won't have to worry about burying 50000 bodies all at once. It'd be chaos. If you do the maths maybe you figure out 40 years for 365.25 days (gota account for those leap years) thats 14690 deaths. Thats a lot fewer deaths than the 50000. However the 70 year olds have on average 10 years left to live (80 years is an average life expectancy). The 40 year olds have roughly 40 years to live. If you compare the number of years of life to live you loose 500000 years of life doing nothing. Pressing the red button you loose 587600 years of life just lost over a longer period of time.
The mathematically right decision is to let the 50000 70 year olds die all at once. But could you imagine any politician doing that? Knowing the uproar that would be in the press tomorrow. Everyone asking him why he didn't do something? Why they are piling up bodies in hospital carparks and talking of mass graves.
Maybe you don't think it's fair. If you value a life by the years some one had left doesn't that mean old peoples lives are worth less? But if you had an otherwise healthy 16 year old and 60 year old both needing the same transplant heart which one would you give it to? In the NHS it'd be the 16 year old.
This is the kind of calculation that needs to be done when you respond to a pandemic. You balance horrendous short term effects against long term ones that seem small over the short term but may end up being worse over the long term. And no one knows for sure whether they got it right. Because no politician wants to commission the research that might tell him that he has to tell the nation its in the national interest to let a lot of people die when action could prevent it.
It gets even worse when you get to the quality adjusted life year. If a life year is a measure of life length the QuALY is a measure of quality of life and time. 1 QuALY = one year of life in perfect health. The notion being that if you are so sick, maybe locked in with nothing but eye movement, or maybe you're in horrendous constant pain, maybe one more year of life means nothing to you. Maybe you'd rather die anyway. QuALYs is the NHSs way of trying to recon for the idea that a year of life in health might be worth more than 2 in bad health. Such choices do exist in medicine. Maybe you're treating for cancer and you say I can give you a month with out treatment or 6 with chemotherapy and transplants but you'll spend most of that 6 months in hospital feeling ill. People need to make a choice about what that extra 5 months is worth. And this is fairly simple ethically when it's a personal choice. But when it's a choice made for a group of people, say which drugs the NHS will or won't buy. Or will or won't we lock down, well its a lot harder isn't it.
The way QuALYs are calculated in practice is highly dubious. They go and ask people hypothetical questions like the one I mentioned above:
Press this button and you get AIDS but I extend your life by 10 years. Press the other button and I grow your leg back but your life is shorter 10 years.
Thing is it's quite hard to ask people with actual experience of a condition how many years they'd give up to avoid a rare condition. So a lot of the time they're asking people who've no experience of the condition they're being asked to contemplate about having it in exchange for more life. Which way you ask the question. Whether you ask a young or old person, some one with or without children, it all makes a difference. The QuALY isn't a great unit of measurement. But it's indispensable for the number crunchers in government.
The logic of government used to be that for most things a QuALY was worth 60000£ So say you want a handrail put up by a dangerous cliff. Well if you would save one person with one QuALY of life left fall to the death and the hand rail costs less than 60000£ its probably a good deal. Not for the NHS though if you want the NHS to spend money on you it's 15000£ per QuALY. Why? Because they recon if they gave the NHS 15000£ extra they could save about one QuALY of life with it. So anything that comes out of the NHS budget has a higher bar to pass, 4 times higher, than getting the government to pay for say traffic calming measures.
Arguably the QuALY system devalues the lives of disabled people based on the opinions about disability of people who are themselves often not disabled. With lockdown people like to talk about protecting the vulnerable of society but those with mental health issues or complex support needs are some of the most vulnerable people in society and lockdown is extremely bad for them. You could make the argument that by locking down you are sacrificing one set of vulnerable people (the mentally fragile, those with special / complex needs, those already isolated or who are susceptible to substance abuse or at risk of DV) for the sake of another set of vulnerable people, (the elderly and immune-compromised). Of course the elderly are a big voting block which other vulnerable sections of society are often not.
People on this forum seem to think lockdown was this simple black and white choice and any one who opposes covid restrictions is ignorant. It's much more nuanced. The real issue we should be worried about is the use of the QuALY in government health economics. Because the QuALY they put on autism is sure as hell not derived from the input of autistic people like you and me.
