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Love and Death: “Quality of life” calculations leave out much that matters

hedgehogreview.com

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Re: Love and Death: “Quality of life” calculations leave out much that matters

#11

Post by jlos »

> These people who live a vigorous life to 70, 80, 90 years of age—when I look at what those people “do,” almost all of it is what I classify as play. It’s not meaningful work. They’re riding motorcycles; they’re hiking. Which can all have value—don’t get me wrong. But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life.

I'm never really to sure which to find more shocking about these kind of public intellectuals, their hubris in thinking they can define what makes a life meaningful for someone-- everyone--else or that they are often given positions of actual influence.

Then again, maybe things makes more sense if the people running the world think the only thing giving other peoples lives meaning is work.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#12

Post by dancek »

wk_end wrote: post #9

I really disliked this essay. It seems to not be saying very much; what little it's saying doesn't really need to be said; and moreover what little it's saying doesn't need to be said, of all times, right now. It strikes me as a kind of mawkish attempt to rebut the comments of two doctors about weighing the lives and well-being of younger people more heavily than that of older people when forced to make public policy…

> what little it's saying doesn't need to be said, of all times, right now.

The philosophy of life and death needs to be considered and discussed especially when humankind is faced with difficult choices of life and death. The choice of optimizing saved life-years may be the right one now, but we as human beings must not become cynical. The value of life can not be measured in terms of events and activity.

I do understand your point of view. For someone who has lost much to Covid-19 and realizes how much we will lose, it is easy to read the article as childish and arrogant. But that is not the only way to read it.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#13

Post by jlos »

I think the main reason for the investment differential between the young and the old is that spending on the elderly is typically urgent. Problems for the elderly are mostly health related and if left unfunded will means someone, somewhere will be blamed. Problems for the young will show up later in some second order effect or missed opportunity. That's really hard to hold someone accountable for (especially public officials) and so its much easier to ignore.

That and kids don't vote or own property.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#14

Post by mongol »

jlos wrote: post #11

> These people who live a vigorous life to 70, 80, 90 years of age—when I look at what those people “do,” almost all of it is what I classify as play. It’s not meaningful work. They’re riding motorcycles; they’re hiking. Which can all have value—don’t get me wrong. But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life. I'm never really to sure which to find more shocking about these kin…

Seems they think that those lives serve no utility for others, thus they are not meaningful. Forgetting that a life is most meaningful for the person whose it is. Would have expected more stringency from an intellectual.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#15

Post by theptip »

An important conversation, but I don’t feel this piece contributes anything. Hand-waving words are not going to solve the hard problems of where to allocate limited dollars.

Quality Adjusted Life Years (QALY) are a widely used tool for measuring and reasoning about health care trade offs. They let you make utilitarian estimations on welfare to evaluate outcomes.

There are plenty of objections to this system; I’d hope for a recounting of some of these longstanding arguments, eg see https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year#D... for links to papers from the last few decades on this subject.

The author is basically using a sentiment-driven “think of the children!” style argument, without making any attempt to weigh or quantify harms on either branch of the decision tree. That isn’t a particularly helpful approach in public health policy in my opinion.

To be fair they seem to be responding to opinion pieces (not data driven arguments) from the other side of the argument so maybe I’m setting too high a bar. But I feel the QALY based approach is not the mainstream idea, particularly in the USA, so it warrants a bit more defending.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#16

Post by closeparen »

joe_the_user wrote: post #7
abellerose wrote: post #4

> But are these life-endings [of a young person and an old person] equivalent? Perhaps, on a philosophical level, they are. On a practical level, however, the death of an 85-year-old person from a preventable cause has cost them a few years at the end of life, while a 25-year-old has, on the same calculation, lost over 60 years of life, including their most active and event-filled years. Every time I think about the…

Older people in the US seem in better shape because earlier generations were on average wealthier and had higher incomes, hence greater savings. The present generation is not headed towards a happy retirement at the expense of the present. Edit: As another poster mentioned, the US values the lives of the rich and more of the old are rich, for now.

The previous generations got a lot of stuff for free by promising each other pensions and not funding them. Obviously they were better off than we were: we don't have access to this trick anymore, and have to make actual sacrifices today if we want to retire in the future. To say nothing of the taxes we will have to pay in exchange for services long gone.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#17

Post by EvilEy3 »

Oh boy, yet another "actshually" filled with emotions that supposed to give "another view".

You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#18

Post by wyattpeak »

EvilEy3 wrote: post #17

Oh boy, yet another "actshually" filled with emotions that supposed to give "another view". You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.

That's not the point that the article takes issue with. Not the difference in time, which the author acknowledges is important, but the classification of those later years as being inherently less valuable than the younger ones.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#19

Post by vixen99 »

wyattpeak wrote: post #18
EvilEy3 wrote: post #17

Oh boy, yet another "actshually" filled with emotions that supposed to give "another view". You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.

That's not the point that the article takes issue with. Not the difference in time, which the author acknowledges is important, but the classification of those later years as being inherently less valuable than the younger ones.

Surely, this evaluation relates to the public sphere perspective. Along with insurance companies, every single relevant government action that requires estimations of life value, tacitly or explicitly agrees that later years are indeed less valuable than the younger ones and likely, always will. NICE - the UK medical board that decides which medicines can be used in the NHS, constantly makes calculations on quality of life for all ages. This is inevitable if public funds are involved. In the private sphere, it’s a completely different matter. This seemingly 'uncaring' stance only applies where public decisions are involved. No reason for this evaluation to necessarily work at a personal level if the state (taxpayer) does not pay for it.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#20

Post by tomatocracy »

wyattpeak wrote: post #18
EvilEy3 wrote: post #17

Oh boy, yet another "actshually" filled with emotions that supposed to give "another view". You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.

That's not the point that the article takes issue with. Not the difference in time, which the author acknowledges is important, but the classification of those later years as being inherently less valuable than the younger ones.

It's not later years per se but level of health which is adjusted for.

We tend to think of this in terms of whether we should extend life with poor years or not but if you think about treatments or devices which won't extend life but might well have a dramatic effect on level of health, mobility etc during those years then it becomes clearer why this is an important consideration. I think most people would say that in a resource constrained world there still ought to be room to fund those things.

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