Thinking and Deciding

358 DECISION ANALYSIS AND VALUES
The value of human life
Governments must often make decisions that involve a tradeoff between money and
human life. Lives are saved by regulation of motor vehicle safety, workplace safety,
pharmaceutical sales, nuclear power plant operation, and release of chemicals into
the environment. In each of these cases, additional lives could be saved if regulations
were strengthened, but more money would be spent by businesses and government
agencies. Money could also be saved by weakening the regulations, but more deaths
would result. Individuals and insurance companies must make the same tradeoff in
deciding whether to purchase additional safety, whether that takes the form of new
tires for the family car or a costly medical test that is unlikely to discover anything
wrong. How much should be spent to save one human life?
To some, the need for consistency implies that this question has an answer. It
seems inconsistent to spend $6 million on a heroic medical procedure to save one
life when we could save another life for only $1,000 by vaccinating more children
against measles. But inconsistency of this sort may not be a useful guide to decision
making. If we can redirect the $6 million to saving six thousand lives instead of
one life, that is surely better (other things being equal). If, however, redirecting the
$6 million is not an option, then it is not necessarily wrong to spend this on one
life. If we do not have a better option, the existence of hypothetical better options is
irrelevant. It therefore matters who the decision maker is. An individual physician
in private practice cannot direct his patients, or their insurers, to donate money for
vaccination in the Third World instead of lung transplants in the United States, even
if vaccination saves more lives per dollar than transplants. A government might be
able to do this through law, but at the risk of not staying in power to do other good
things. Consistency, then, is not the only virtue here.
On the other hand, it may sometimes be useful to attempt to measure the monetary
value of human life for certain purposes. For example, the U.S. government
sets standards for chemicals in the environment and for food additives. It has been
argued that some of these regulations are so costly and ineffective that weakening
them could save tens of millions of dollars per life or more, while strengthening
other regulations could save lives for a few thousand dollars each (Breyer, 1993;
Tengs, Adams, Pliskin, Safran, Siegel, Weinstein, and Graham, 1995). The government
has the power to bring these regulations into line by specifying a fixed cost per
life year and then imposing regulations only when the cost of the regulations per life
saved is less than that cost (assuming no other effects of the regulation). Siegel, J. E.
Several methods have been used to set a monetary value for life (Schelling, 1968).
The most sensible measures are based on the measurement of willingness to pay for
reductions in the probability of death (or to accept money for taking risk). 9 For
example, if you were exposed to a virus that had a .000001 chance of causing sudden
and painless death within a week, how much would you pay now for the cure (if this
were your only chance to buy it)? Risk is used because it does not make much sense
9 Less sensible methods are based on such indices as production (which makes retired people worthless)
or the value of a person to others (which neglects the desire of a person to live).