IF YOU had to put a price on your life, could you do it? What would it be? Where would you even start?
We may think valuing human life this way is the stuff of darkest history, now confined to the malevolent underworld of human trafficking. We look with shame to an era when a human being could legally be bought and sold, their worth tied solely to the profit their work would yield. In the mid-19th century, before slavery was abolished in the southern states of the US, a “prime male field hand” could be purchased – roughly . Other human beings were bought and sold for far less.
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Our repulsion at the idea of putting a monetary value on people is consistent with the modern principle, outlined in documents such as the UN’s , that all human lives are equal – and, we like to believe, equally priceless.
Yet we routinely trample on those exalted ideals. The scientific literature and the news are both rife with examples of how unequally we value life – young over old, those like us over those who are different, the identified victim over the faceless masses.
Putting a price on life: Keeping me alive has cost $1.6 million…and counting
We don’t just value lives differently in a moral sense, but in real money. It is how we divvy up limited resources – from deciding how much to invest in building safer roads to setting compensation for families of soldiers and civilians killed in war, or those who were wrongfully imprisoned. And depending on who is doing the pricing and why, those numbers can vary, a lot. Life, it turns out, doesn’t have a price. It has a hundred.
One of those numbers is a calculation of how much should be spent to prevent your death. To decide which potentially life-saving interventions are worth it, government bodies look at a quantity called the value of a statistical life (VSL), or as the UK Department for Transport (DFT) puts it, the value of a prevented fatality. “This is not the amount of money people would accept in exchange for certain death,” says at Vanderbilt University, Tennessee, who helped introduce the VSL to US agencies. “It’s really just a reflection of their attitude toward a very tiny risk of death.”
Put simply, it’s the type of calculation we make when deciding whether it’s worth spending extra to buy the car with more safety features, just on a grander scale. Take the risk of dying from salmonella infection, for instance. If people are on average willing to pay $7 to reduce that risk by 1 in a million, then the VSL is $7 million. This would then be the figure used by the US Food and Drug Administration (FDA) to justify the cost of efforts to prevent salmonella outbreaks.
The VSL a country adopts tends to vary with its wealth (as a benchmark, the Organisation for Economic Co-operation and Development recommends that member nations use a figure between ).
Then there is the matter of how you determine what people would be willing to pay for a given reduction in their risk of dying. In the US, where the average VSL works out at about $9 million, economists make the calculation mostly by looking at what people do – wages someone accepts to take a risky job, for instance. In the UK, where the preferred technique is simply to ask people what they would be willing to pay, the DFT uses ($2.3 million). A that compared the two approaches in Canada found that when the VSL is based on wages and risk, it’s worth about a third more. Based on reviews of both methods, Australia’s Office of Best Practice Regulation recommends a VSL of ($3.2 million).
VSL also varies with the cause of death being considered. In the US, it has ranged up to : reducing the risk of workers dying in a coal mine was worth more than reducing the risk of death in a fire caused by your flammable couch upholstery.
$201 million
When you get into that other form of death prevention, healthcare, things only get more complicated. To decide whether medical interventions are worth it, healthcare providers and insurance companies consider how much decent-quality life you might get for the money. The measure they use is called a Quality-Adjusted Life Year (QALY): if 1 is perfect health and 0 is dead, then four years in middling health equals two QALYs.
In the UK, one good year of life is worth around . That threshold is set by the National Institute for Health and Care Excellence (NICE), which oversees what new drugs or treatments the UK’s National Health Service can provide. To do this, it looks at the cost per QALY of new treatments compared with that of existing care.
If a new drug offers one extra QALY for every additional £20,000 spent, that’s well within budget. “NICE focuses on that increment,” says , a health economist at the University of York, UK, and a member of the NICE appraisal committee from 1999 to 2012. “What are the additional benefits, what are the additional costs, are they worthwhile?”
Although NICE does make exceptions for particularly innovative drugs or end-of-life care, if costs start to push past ÂŁ30,000 approval becomes much less likely. Sofosbuvir (sold under the name Sovaldi), the wonder drug for patients with hepatitis, made the cut. But bevacizumab (Avastin), a drug that could give certain cancer patients about three more months when given together with chemotherapy, did not. It cost .
The provokes controversy from time to time. That is in part because, as former NICE chair Michael Rawlins , it is not based on “empirical research” so much as “the collective judgment of the health economists we have approached across the country”. Since it was first put into use in 1999, there have been efforts to pin it to more robust research. But it remains as is, unchanged even for inflation.
In countries such as Canada and New Zealand there is no explicit threshold. But when you analyse resource allocation decisions, in practice, it works out at . Contrast that with the situation in the US where, so long as an intervention is deemed ““, then the government-run health plan Medicare . When you take into account that this could happen with a third-line cancer treatment costing , it’s no wonder that the US spends nearly a fifth of its GDP on healthcare. Private insurers are not held to the same standards, and many clearly do consider expense – the more cost-effective a drug, the less their customers may have to pay out of their own pocket, for instance. But these systems are not always transparent and Medicare is still by far the largest healthcare funder in the country.
$40,000
Medicare does try to trim costs – or at least maximise benefits – in some ways, says James Chambers at Tufts Medical Center in Boston. They may only pay for drugs and devices for the sickest patients, for instance. But, legally, there is no straightforward way to do it. “There has been a view that you cannot, you cannot set a price on life,” says , an economist at Rutgers University in New Jersey who specialises in healthcare policy. “Which really comes down to, you can’t admit you have to.”
Valuing someone’s life gets even harder once they are dead. Some guidelines exist when mortal danger is part of the job, but a huge number of variables remain. Members of the US military who die on active duty are entitled to a tax-free , a life insurance payout of , and a host of other benefits from burial costs to money for their children’s healthcare and education. By , the total can range from $250,000 to more than $800,000. The breakdown is , although much depends on the person’s salary and age at death.
For and firefighters, it is a similar patchwork of pensions, workers’ compensation, life insurance, union benefits and dedicated state and federal funds. One programme run by the US Department of Justice gives families a sum of .
Outside of the line of duty, unexpected deaths reveal even more inconsistencies in how we value life. If compensation is settled in a wrongful death lawsuit, there’s a purely economic component that works out logically enough, based on estimates of the victim’s lost lifetime earnings, medical costs, funeral expenses and so on. But when it comes to grief and lost companionship, it’s all over the place. English courts limit bereavement awards to , far below NICE’s lower threshold for the value of one good year of life. This is derived from an set by Parliament in 1982. “It’s very arbitrary,” says , a human rights law specialist at the University of Oxford. “And it’s the very low level of it that’s probably the most insulting.”
In your absence
In the US, compensation can vary by all sorts of factors, including the nature of the death, the amount of insurance held by those responsible, and even whether the sum is set by a judge, jury or two lawyers across a table.
“The view that you cannot set a price on life really comes down to, you can’t admit you have to“
There is a lot of inconsistency, says at the New York University School of Law. “How do you figure out how much my spouse suffers by way of loss of companionship if I die prematurely?” he asks. “Is that $100,000 or $100 million?”
He says that judges tell juries there is no set way to do it, so jurors tend to look for some reference figure. “If somebody suffered $100,000 in medical expenses, maybe we’ll triple it, we’ll use that for an anchor, we’ll say pain and suffering will be $300,000.”
Local laws also make a big difference. The parents of 6-year-old Brandon Holt were compensated after he was shot dead by another child in 2013. This was in New Jersey, where the wrongful death statute doesn’t allow juries to take the family’s emotional distress into consideration.
In contrast, the wrongful death of 12-year-old Tamir Rice, who was shot by police in 2014 while holding a toy gun, was . That case was decided in Ohio, where juries may consider mental anguish. The social context mattered here, too: Rice’s death was part of the broader controversy about black lives and the police.
Ultimately, though, these cases did not attempt to value the lost life itself – nor does the law require it. studies these types of lawsuits at the Benjamin N. Cardozo School of Law in New York. “There’s damages for pain and suffering before you die, there’s damages for loss of income to your family after you die. But for the life itself that was lost, it’s worth nothing.”
That’s why the context makes so much difference. After 9/11, the 2007 Virginia Tech massacre and the Boston Marathon bombing in 2013, attorney was tasked with distributing funds to survivors and families of those killed. The total amount available was different in each event, but individual payments weren’t meant to reveal anyone’s fundamental worth. Instead they were an exercise in demonstrating patriotism, strength and the compassion of a people.
After 9/11, the US government established a fund for injured victims and the families of the nearly 3000 dead. By Congressional mandate Feinberg had to follow certain aspects of wrongful death law, so he awarded funds partly based on the victims’ incomes; the next of kin of CEOs received more than those of janitors. But there was also a non-economic portion, based on a flat rate: $250,000 per death, plus $100,000 for each surviving spouse and dependent. Payouts ranged from $250,000 to $7.1 million.
“Congress wanted to demonstrate to the world its empathy and support for the victims,” Feinberg explained in his book, Who Gets What: Fair compensation after tragedy and financial upheaval. The programme was “proof positive that Americans stood together, a single community ready to help one another in our collective hour of need”.
The money for the Virginia Tech and Boston Marathon victims was donated by individuals and businesses – “evidence of citizen compassion”, as Feinberg put it. So different rules applied: all lives were treated equally. Families of victims of the Virginia Tech massacre each received $208,000; families of those killed in the Boston Marathon bombing .
In the UK, the Criminal Injuries Compensation Authority handles payments to victims of violent crime. Their baseline number for a death is , or £5500 each if multiple people deserve payment, plus extra for funeral expenses, income loss and lost parental guidance. There’s a £500,000 ceiling, but according to , for victims of the London bombings in 2005, the highest award so far was nowhere near that: £141,050.
Then there is the matter of people who spend years of their lives unjustly behind bars. In the UK, there is no guaranteed compensation. Individual cases are assessed according to previous criminal record and lost income, among other things, but payment , or £1 million if more than a decade was served. That’s if it’s ever awarded. “They’re extremely strict,” Hoyano says. It’s not enough for a conviction to be overturned – people essentially have to find new facts to prove their innocence to the Ministry of Justice. The evidence bar is so high that many receive nothing at all. When Victor Nealon was released from prison in 2013 after DNA evidence exonerated him from a conviction of attempted sexual assault, he had served 17 years. He got .
In New Zealand, there is no legal right to compensation, but awards are granted based on the merits of individual claims. In those cases, the starting point per year spent in prison is ($72,000).
In the US, different states have different standards. In New Hampshire, it’s , no matter what. In Florida, exonerated people get , to a maximum of $2 million. , a wrongful convictions expert at Appalachian State University in Boone, North Carolina, says that part of the value of this kind of payment isn’t the money itself – it is recognition from the state that a mistake was made, even if that doesn’t amount to an apology.
Western governments that compensate families of civilians killed by their armed forces in Afghanistan and Iraq use a similar rationale: the payments are not apologies so much as expressions of sympathy and regret. The UK Ministry of Defence paid who lost his wife and son in a mortar bombing mishap; the German government paid after a deadly bombing; the US paid shot at a checkpoint in Iraq. “It’s hard to digest that the value of a human life is a few thousand dollars,” the retired US Army brigadier general Arnold Gordon-Bray . “But you know that in their economic situation, it is the equivalent of much more, and you feel better.”
US$6 million
It may be unsettling to think that the value we place on a human life shifts with political priorities, national boundaries and social context – that it differs depending on whether you are considering the cost of medication or safety belts. But just because it is difficult to place a fair value on human worth doesn’t mean that the attempt itself is unworthy.
Consider Benjamin Franklin’s “moral algebra”. Nearly 250 years ago, Franklin wrote a letter to a friend facing a difficult decision. He recommended making a list of all of the pros and cons, and then striking out those on either side that seemed of equal importance. This early cost-benefit analysis was not meant to downplay the gravity of the decision, just the opposite. When “the whole lies before me, I think I can judge better, and am less likely to make a rash step,” Franklin wrote.
The same idea applies today. Our reluctance to consider these most difficult calculations means we are left fumbling when we inevitably need to. “You make choices about what you spend on, there simply isn’t enough to do absolutely everything,” Russell says. “You can either make those choices with your eyes wide open, or you can do it with your eyes shut.”
Inhuman business
There are many legal ways we put a value on life (see main story), but there are plenty of illicit ones too. In cases of human trafficking, prices are often set based on the risk involved, transportation and labour costs and also market conditions. A child purchased in rural Africa for about $200 might later be sold for a far higher price, says Benjamin N. Lawrance, a historian and anthropologist at the Rochester Institute of Technology. That will depend on how many hands the child passed through on the way to say, mine shafts in another country, how many documents may have been forged for transport, and how many other desperate children arrived around the same time. Philosophical notions of human value have nothing to do with it.
Similar factors influence kidnapping ransoms. According to estimates from , which advises families and employers of kidnap victims on conducting negotiations to free the hostages, a hasty abduction on the streets of Venezuela by criminals who put in the bare minimum of planning might net just a few hundred dollars. A more elaborate operation by syndicates and corrupt officials targeting a very wealthy individual might land a six-figure sum.
“They’re looking at the hostages as commodities, like a businessman would look at something on his shelf,” says a spokesperson from Terra Firma, who asked to be kept anonymous. “The basic procedure is, they call and make a demand, then the other side makes an offer – a lot less – and all of a sudden, that victim is worth a certain amount of money.”
Forever young
When it comes to what philosophers call negative rights – the right not to be killed, chief among them – studies show that at a fundamental level we do believe all humans are equal. But for positive rights, such as the right to be saved, we aren’t so even-handed. (See main story.)
If there is only one dose of a life-saving treatment but there are two people who need it, how do you decide who gets it? done at the University of Pennsylvania by psychologists and set out to answer that question. When volunteers were forced to make a series of choices between people of different ages, a clear, if unsurprising, trend emerged: we tend to favour the young over the old (see graph).
Why? When asked to justify their choices, people made what is known as the fair-innings argument. “The basic concept is that everyone should have their fair shake at life,” says Landy. “The 50-year-old has gotten 50 years already, so we should save the 10-year-old.” Another way to frame it is the years-left argument – the younger person has more years of life ahead.
But that reasoning only goes so far, because it turns out that our most highly valued humans aren’t newborn babies. That is because you develop more – and more profound – social connections as you age. There is also something of a “sunk cost” effect: “Older children have had more work put into them by their societies – the payoff has not come yet,” says Landy.
The net effect is that we view adolescents or young adults as most worth saving. And, as they say, it’s all downhill from there.
This article appeared in print under the headline “What are you worth?”
