The fifth edition of CPLB Dilemmas is now online. This edition asks: in deciding between funding different health programs with limited resources, what number of deaths of newborns is as intrinsically important to avoid as the deaths of 100 young adults?
After an overview of the dilemma by CPLB’s Monica Magalhaes and Nir Eyal, Lisa Robinson of Harvard’s Center for Health Decision Science gives an overview of cost-benefit analysis, a method employed by policy analysts to approach such trade-offs, and a summary of current empirical research on the comparative valuations for reducing risks of death to newborns and young adults. NIH Bioethicist Joseph Millum lays out two considerations that a policy-maker would consider in making that trade-off, and that may pull in different directions: gradualism about the badness of death, and the distribution of the benefits of a death-averting intervention. Julian Jamison of the University of Exeter (UK) describes a decision procedure where some considerations lend extra weight to newborns, and some to young adults, such that the final decision ends up weighing all lives equally. Espen Gamlund of the University of Bergen (Norway) and Carl Tollef Solberg of the University of Oslo (Norway) discuss possible approaches the decision-maker can take, looking to the past, to the present, and to the future. CPLB’s Dan Hausman and CPLB Director Nir Eyal close the debate by explaining their respective views, by way of cats. For Hausman, value differences between the deaths of newborns and young adults hinge on whether the deaths interrupts a biography or stops one from beginning. For Eyal, the answer depends on how important continued existence is to the good of the being in question.
Dilemmas is a section of the CPLB website devoted to conversations on pressing normative questions of health policy and population health. Dilemmas will bring together contributions from a diversity of disciplinary perspectives, including those of population-level bioethics, medicine, epidemiology, economics, health policy, philosophy, law, and others. Rather than attempting to converge on a consensus, the goal is to think together about a hard question relating to ethics and health.