Money is a strength of human life

Before we now deal with how medicine deals with this delicate subject and what position it occupies in this regard, our considerations lead us through some other, no less interesting subject areas.

If we were to begin with ethical considerations regarding the value of a human life, we would first have to limit ourselves to one essential (even if, of course, correct) statement: Nobody is entitled to determine the value of a human life. But if we made this doctrine the basic idea of ​​our discussion, we would come to the end of our deliberations; It should therefore be stated from the outset that we will treat all of the following statements apart from ethical views. There is no doubt that the dignity of every human being is inviolable.

 The essential question that we ask ourselves right at the beginning is probably that of the composition of such a value for a human life. Is the value of a life defined by what one has already experienced or by what one will still experience? Is it made up of what you are or what you will become? Is it determined by our abilities, strengths and weaknesses? Or from our biochemical composition, the market value of our organs? Or even from our income and the size of our bank account? There is no doubt that the value of human life is determined to a far greater extent by non-monetary and non-quantitative variables. A socio-politically substantiated discussion would probably lead us to the result that the value of a person is determined by what he means for his (social) environment or what he contributes to society. We may conclude that its value is calculated based on the benefit it brings to society or those around it. This “benefit” approach can already be found in the 19th century, when Adolf Jost calculated the value of the human being based on the difference between the benefit and harm for the general public (a social policy which, by the way, was consequently implemented under National Socialism). But just as quickly as we come to this result, we will also notice the first discrepancies that we should question: Is the life of a criminal inferior because it has a negative impact on the welfare of society? What is the value of a person who lives isolated and alone and has no social environment and therefore no benefit for others? The worth of a homeless person? Or, more provocatively, the value of an American for the value of an Asian?

As absurd and unethical as this differentiation according to nationality may seem, recent events have shown us that such “value differences” cannot be dismissed out of hand: the UN has quantified the damage caused by Hurricane “Katrina”, which recently had large parts the southern United States destroyed and flooded with $ 25 billion; the damage caused by the tsunami in Southeast Asia, on the other hand, “only” amounted to 10 billion dollars, although around sixty times more people died in Asia, but the damage was only about half less than in the USA. A (lost) human life has a higher value in America than in Asia.

The past also shows very clear differences in value depending on the nation. The value of a Jewish human life under the Nazi regime did not even come close to that of a German one. Is it the society, the nationality or the origin that determine the value of a life? Or we can decide for ourselves how much our life is worth to us and what we are ready to keep it:

... when the young man got upstairs, there was an older man standing there. He asked: “Hey, what do you want to do? Do you want to jump down? " The young man looked surprised and then asked: “What is that got to do with you?” “It's actually none of my business,” replied the older man. “You can do whatever you want. I only have one friend who is in dire need of a kidney and would pay a very high price for it. He's been waiting for so long and he's very rich. And if you kill yourself anyway, you can use it to help someone else and do a business on the side. Money is so important these days. It would be a shame if such a young person simply threw his life away while an older person longs for this vital force. "

The young man paused. Suddenly he stopped thinking about suicide. "How much would the kidney be worth to him?" He asked. "At least 100,000 francs," he replied. “But actually money doesn't matter. Name a price and he will pay it. ”The young man looked uncertain. "100,000 francs? I haven't even dreamed of so much money. Or maybe 200,000 or 500,000 francs? Then why should I kill myself? ”The older man was silent for a moment. Then he said: "Well, you have to know that yourself."

Suddenly the young man became thoughtful. “If just one kidney is worth so much, how much could I get for my other parts of the body? Eyes, liver, heart? ”The older man said nothing for a moment. “I don't think it can be expressed in numbers. A mathematician would say: the value is infinite. That means: You can't pay for it with money. ”“ If my life is so valuable, then I would be very stupid if I just tossed it away, ”replied the young man. Together they took the elevator to the first floor.

(The author J. Schütz gives help for young people at risk of suicide) The inclusion of religious aspects in this discussion about the value of human life could take us a step further: No matter which religion we include (the caste system of Indian Hinduism may be an exception), it will always lead to the fact that every human being is unconditionally valuable and unique and that the dignity of every human being must be equally respected and respected. A believer will regard his life and that of others as a divine gift and will find his life incomparably high. But even this consideration under the premise of (divine) love, forgiveness and universal justice allows us to only vaguely understand the value of a human life.

The historical developments of the past centuries show that the value of a human life seems to change over time. As early as the end of the 17th century, debates arose about the (economic) value of a person, which primarily served the purpose of rewarding workers (the value of a person was for a long time equated with his workforce). In the time of absolutism, humans were seen as an important economic factor, but against the background that they guaranteed state power as a labor and armed force. "The real power of domination resides in the number of people“, Stated G. W. Leibniz at the time. In the 19th century, medicine joined this discussion and defined a person's worth through their health. A new medical direction developed which "Experimental hygiene“, Whose founder Max von Pettenkofer (1818–1901) combined hygiene and economics. For example, he analyzed clothing, home or diet according to scientific criteria with regard to their impact on health in order to ultimately define hygienic standards. (An undesirable reaction to this hygienic endeavor by Pettenkofers was later shown in the "racial hygiene" of National Socialism). Since the beginning of the First World War, much more so in the Second World War and in some cases even up to the present day, there have been increasing qualitative differences and the associated different values ​​of people, especially with regard to their nationality (like the examples mentioned above). Although a purely qualitative value of a human life is often more satisfying, easier to define and perhaps also more realistic, and it may seem presumptuous to us to decide on the "true", in this case monetary, value of a human life (Immanuel Kant already recognized that the Human being does not have a price, but a dignity), in some cases there is still the need to quantify this value.

Representatives of health and transport policy as well as insurance companies or jurisprudence often require an economic consideration of human worth. In order to pay out appropriate insurance amounts or to impose appropriate penalties, tables of values ​​must be drawn up that assess the value of a human life. After the sinking of the Titanic, for example, the following formula was established to calculate the value ("price") of a human life that was lost when the ship sank in 1912:

Price of the “saved” lifeboats - own damage amount in the event of ship sinking x probability of ship sinking = price of human life x number of additional deaths at full capacity

44 x 30,000 (pounds sterling) - 20,000,000 x 1/1000 = price of human life x 2,000

1,320,000 - 20,000 / 2,000 = price human life

Human life price = £ 650
(would be around 7,000 euros today)
 An economic view is generally based on the assumption that resources (in the form of money, time or raw materials) are limited. This scarcity requires an efficient distribution of the scarce resources. With every decision, an economist therefore considers the costs arising from the implementation of the measure on the one hand and the macroeconomic benefits resulting from the implementation of the measure on the other in order to filter out the "net value". An example should make this clear:

How much does a human life count?

Imagine being elected to the city council and entrusted with this proposal from the traffic department: Construction of a traffic light system for € 60,000 at a street crossing that was previously only secured with a stop or right of way sign. The benefit of the traffic light system is clearly an increased traffic safety (a reduction in the probability of fatal traffic accidents from 1.6% to 1.1% was statistically recorded). You now have to make a decision whether to invest in the new traffic light system.

To answer this question, you as an economist will carry out a cost-benefit analysis. You will quickly run into an obstacle: if you want to make a meaningful comparison of costs and benefits, they have to be measured in the same unit. The costs are measured in euros. But the benefit - saving human life - cannot be determined directly in monetary terms. To do this, one would have to assign a euro value to a human life.

The temptation is to put a person's worth as infinite because one would not give one's life for any amount of money. However, this would lead to nonsensical results in the cost-benefit analysis, because then you would have to put traffic lights on every corner.

When we finally get used to the idea that a human life has an implicit euro value, we are faced with the question: How can this value be determined? One approach that is sometimes used in courts to provide financial compensation for the consequences of death relies on the amount of income expected later in life. Against this, however, there is the appearance that the life of a pensioner or a disabled person has no value.

A better way of evaluating lives is to look at people's willingness to take risks in exchange for certain amounts of money. The mortality risk varies from occupation to occupation (construction workers on skyscrapers tend to have a higher mortality risk than office workers). However, by means of differences in wages and corrections for differences in education and experience, one can gain an indication of the values ​​that people attach to their own lives. Studies using this methodological approach arrive at values ​​for a human life of around) 20 million.

The traffic light system reduces the mortality risk by 0.5 percentage points. Thus, the expected value of the benefit from the traffic light system is 0.005 times) 20 million, i.e. it is) 100,000. This estimate clearly exceeds the cost of) 60,000. The overall economic benefit therefore exceeds the costs, the project should be implemented.

(Based on Mankiw, "Fundamentals of Economics") In 2004, a German economist put the average value of a human life (in Germany) at 1.65 million euros, whereby a man’s life has a higher value (1.72 million euros) than a woman’s life (1.43 million euros) ( However, his work has only been limited to employees who are subject to social insurance). Of course, these results are only the value of a "statistical" life. Such a value is often obtained through surveys:

Illustrative example for the calculation of the statistical value:

Suppose there are 10,000 people in a soccer stadium. They know that one randomly selected visitor has to die. They are asked how much they want to pay to avert this risk from the community - and therefore from themselves. The risk of death here is 1: 10,000, so the willingness to pay is correspondingly low. If it is - an assumed value - 300 euros, 10,000 people would pay a total of three million euros and the statistical value for this one life is three million euros.

(H. Spengler, economist at the Technical University of Darmstadt) However, it should be mentioned that Spengler only deals with an “undefined” statistical life in his example. If it were really about the life of a person, it would of course be unthinkable and highly immoral to stop rescue operations when the cost of a statistical life is reached (this is then a "concrete" life).

The concept of statistical life is not just a pure thought experiment, it is of great practical importance, for example in the calculation of compensatory wage differentials (Note: the central idea of ​​this approach is that, under otherwise equal conditions, employees are only riskier or less advantageous in other respects Accept employment if they receive compensation in the form of a wage supplement).

One last and very apt example of economic calculations before we turn to medical considerations:

When developing a new type of car, the technicians and engineers of a well-known American automobile manufacturer discovered in the development and test phase that the engine was placed in such a way that in the event of a rear-end collision, the car had a significantly higher probability of exploding at a very specific angle to the engine becomes. Modifying the concept and redesigning the car would cost billions of dollars.

Therefore, one calculated the most likely number of legal proceedings and claims for damages and the resulting estimable costs and plaintiffs' claims and then determined that even the most excessive damages payments would be less than a revision of the prototype. But enough of political, social or economic theories. Of course, what interests us most as health professionals is the medical position on the subject. The fact that medicine as such is also heavily involved in the discussion about the value of human life is shown by the newly developed professional profile of the health economist. These medical staff with appropriate economic knowledge put the effect and benefit of medical services (a wide variety of therapy and examination methods) in relation to the costs that are incurred as a result. In addition to all direct costs (medication, examination costs, wage costs for doctors and nursing staff, hospitalization costs, etc.), costs are also understood here as indirect costs such as loss of work or production, transport costs to the doctor, care costs and income from caring for relatives, etc., as well as intangible costs calculated for pain and loss of quality of life (these costs are naturally the hardest to quantify). Cost analyzes can be carried out from different perspectives and based on different interests. A health insurance company could, for example, carry out a cost analysis of rehabilitation measures and come to the conclusion that rehabilitation after a stroke is not cost-effective and therefore the rehabilitation costs are no longer reimbursed.The fact that pension insurance costs are then incurred for possible disability shows that this one-sided view is not very effective.

A health authority decides to no longer pay hospitalization costs based on the number of days spent in hospital, but only reimburses “diagnosis-related case costs”. The endeavor of the hospitals will therefore be to discharge the patients as quickly as possible. Any costs incurred due to the early discharge (increased risk of re-injury or illness, pain, etc.) or costs that arise from care by relatives are not calculated and in turn falsify the result.

A cost analysis from a “social perspective” should therefore be aimed for, in which all costs and not just those of a specific sector are recorded.

(J. Steurer; "Qualy's or willingness to pay?"; Medical Polyclinic, University Hospital Zurich The same calculation difficulties as with the costs arise even more with the benefits. The benefit, or “outcome”, is often referred to in medical analysis methods as QUALY (quality adjusted life year) and describes the “usefulness” of a therapy or examination method. This usefulness in turn is composed of the life extension and the quality of life (given as a numerical value between 1 = completely healthy and 0 = dead).

With therapy A, a year of life gained costs 45,000.00, with therapy B) 58,000.00. The quality of life in the year of life gained with therapy A is 0.4; with therapy B 0.7 (much higher).

Therapy A
) 45,000.- / LQ 0.4 =) 125,000.-

Therapy B
) 58,000.- / LQ 0.7 =) 82,360.-

Although therapy A is much cheaper than therapy B, the quality-corrected values ​​for therapy B are better!

(J. Steurer; "Qualy's or willingness to pay?"; Medical Polyclinic, University Hospital Zurich In some countries, the costs per QUALY already serve as a basis for decision-making. For example, if the costs per QUALY are less than $ 20,000, they will be covered by health insurance or the state without further ado. If it is over $ 100,000, the health insurance company will no longer reimburse the service. Whether such a quantification makes sense and is fair remains difficult to judge.

A calculation method that you do not want to withhold, and which seems particularly interesting from a medical point of view, is the completely neutral "material value" of a human body. A human body is made up of around 65% water, 20% protein, 10% fat, 4% minerals and 1% carbohydrates (liquid content depends on age). If we were to buy all of the following “ingredients” in a pharmacy, a human body would cost us just about five euros ... A person weighing around 70 kg consists of:

ELEMENT WEIGHT PERCENTDIMENSIONS
Oxygen (O)approx. 63% approx. 44 kg
Carbon (C)approx. 20%approx. 14 kg
Hydrogen (H)approx. 10%approx. 7 kg
Nitrogen (N)approx. 3%approx. 2.1 kg
Calcium (Ca)approx. 1.5%approx. 1 kg
Phosphorus (P)approx. 1%approx. 0.7 kg
Potassium (K)approx. 0.25%approx. 170 g
Sulfur (S)approx. 0.2%approx. 140 g
Chlorine (Cl)approx. 0.1%approx. 70 g
Sodium (Na)approx. 0.1%approx. 70 g
Magnesium (Mg)approx. 0.04%approx. 30 g
Iron (Fe)approx. 0.004%approx. 3 g
Copper (Cu)approx. 0.0005%approx. 300 mg
Manganese (Mn)approx. 0.0002%approx. 100 mg
Iodine (I)approx. 0.00004%approx. 30 mg

(www.wikipedia.at) It should be noted, however, that the market value of functioning organs is much higher. A dead organ donor, for example, means savings of almost 300,000 euros in our health system. Many medical professionals fear the development of an “organ market”, an (illegal) trade in organs that could hardly be controlled. Because, as we have now recognized, when looking at human life, it is not just about absolute ethics, but also about tough economics.

And if we can finally sum up one thing with certainty from this discussion, it is that the true value of a human life is always in the eye of the beholder…. © Barbara Laimer 2005