3 ms·

Rationing with waiting lists is dumb, always has been and always will be. The smart ways to ration are by money (better surgeons charge more), or by QALY (bette

Rationing with waiting lists is dumb, always has been and always will be. The smart ways to ration are by money (better surgeons charge more), or by QALY (better surgeons do more important operations on sicker people). And even with single-payer, there's no reason you can't pay better surgeons more. It's true that not everyone can have a top surgeon. But for serious surgery, the "complication" is frequently death. It's extremely silly to tell people that 1% chance of death vs. a 2% chance of death "shouldn't affect their choice". I don't know about you, but I don't want to die, even as I accept that small chances of death are sometimes unavoidable. Regarding medical ethics, obviously in the abstract we should prefer saving ten lives to one life. But in practice, it's often better to have a rule like "don't kill people" than "kill people when it serves the common good". "Don't kill people" is very easy to understand, and very easy to enforce. The "common good" is abstract and fuzzy, and can be used to justify anything from fighting malaria in Africa to Stalin's Holodomor ("can't make an omelet without breaking some eggs").

haldujai 13y ago
Sorry but you're incorrect. Your assumption of the complication being death is exaggerated, the surgery in question here is not that serious. Even if it were death someone would have to model the adverse effects of the increased waiting list. People waiting might result in an increase in mortality surpassing the doubled risk from surgeon error. How do you quantify which surgeons are better? I'm not an expert but surely this study's methodology is not without it's own assumptions. Things like complication rate vary wildly with patient population and other factors. This isn't a telemarketing job where you quantify easily. Similarly how can you quantify who the best programmer is? What is the economic cost of quantifying who the best surgeon is? How expensive is it to apply this study to every surgery? We must ensure that the rankings system is valid before applying it to prevent perverse incentives such as only taking low risk cases. You don't want a USNews Week type system like you have for universities which has obvious flaws and biases. You say waiting lists are dumb, but why? Are you 'killing people' by letting an inferior surgeon operate? Why is 'don't kill people' easy to understand and enforce? By not killing one to save ten are you not killing ten people? You're seeing this as black and white. This is not the case. Whether it is better to save one or ten I am not the person to judge, but you are oversimplifying this drastically. The ethical question here is NOT sentencing someone to death like killing someone to harvest organs. It's more similar to doing nothing to save someone most likely to die in order to save ten, like how they do military triage. Life is 'abstract and fuzzy'. This isn't an engineering challenge, as you say there are several things to consider. Stalin ignored the human aspect, is this right or wrong? How can you blindly answer this without supporting your conclusion. What seems humane isn't always the right answer to things. By your same argument are layoffs ever justified despite it being for the common good for the company and the remaining employees?
TeMPOraL 13y ago
> But in practice, it's often better to have a rule like "don't kill people" than "kill people when it serves the common good". Eliezer had a nice take on this principle in http://lesswrong.com/lw/uv/ends_dont_justify_means_among_humans/ http://lesswrong.com/lw/uv/ends_dont_justify_means_among_hum.... Relevant quote: "The end does not justify the means" is just consequentialist reasoning at one meta-level up. If a human starts thinking on the object level that the end justifies the means, this has awful consequences given our untrustworthy brains; therefore a human shouldn't think this way. But it is all still ultimately consequentialism. It's just reflective consequentialism, for beings who know that their moment-by-moment decisions are made by untrusted hardware.

haldujai 13y ago

Sorry but you're incorrect. Your assumption of the complication being death is exaggerated, the surgery in question here is not that serious. Even if it were death someone would have to model the adverse effects of the increased waiting list. People waiting might result in an increase in mortality surpassing the doubled risk from surgeon error. How do you quantify which surgeons are better? I'm not an expert but surely this study's methodology is not without it's own assumptions. Things like complication rate vary wildly with patient population and other factors. This isn't a telemarketing job where you quantify easily. Similarly how can you quantify who the best programmer is? What is the economic cost of quantifying who the best surgeon is? How expensive is it to apply this study to every surgery? We must ensure that the rankings system is valid before applying it to prevent perverse incentives such as only taking low risk cases. You don't want a USNews Week type system like you have for universities which has obvious flaws and biases. You say waiting lists are dumb, but why? Are you 'killing people' by letting an inferior surgeon operate? Why is 'don't kill people' easy to understand and enforce? By not killing one to save ten are you not killing ten people? You're seeing this as black and white. This is not the case. Whether it is better to save one or ten I am not the person to judge, but you are oversimplifying this drastically. The ethical question here is NOT sentencing someone to death like killing someone to harvest organs. It's more similar to doing nothing to save someone most likely to die in order to save ten, like how they do military triage. Life is 'abstract and fuzzy'. This isn't an engineering challenge, as you say there are several things to consider. Stalin ignored the human aspect, is this right or wrong? How can you blindly answer this without supporting your conclusion. What seems humane isn't always the right answer to things. By your same argument are layoffs ever justified despite it being for the common good for the company and the remaining employees?

TeMPOraL 13y ago

> But in practice, it's often better to have a rule like "don't kill people" than "kill people when it serves the common good". Eliezer had a nice take on this principle in http://lesswrong.com/lw/uv/ends_dont_justify_means_among_humans/ http://lesswrong.com/lw/uv/ends_dont_justify_means_among_hum.... Relevant quote: "The end does not justify the means" is just consequentialist reasoning at one meta-level up. If a human starts thinking on the object level that the end justifies the means, this has awful consequences given our untrustworthy brains; therefore a human shouldn't think this way. But it is all still ultimately consequentialism. It's just reflective consequentialism, for beings who know that their moment-by-moment decisions are made by untrusted hardware.