Counting (part 2)

His forces are beyond number (Joel 2:11)
I started our exploration of numbers by looking at QALYs. I am hoping that some of you at least were intrigued by where such a notion of using numbers to allocate health care arose. The easiest way to understand its origins is to see it as having two precedents. The first is the increasing difficulty and expense of treatment. It was recognised a number of years ago that our health service would need a virtually infinite budget to provide every possible treatment to every available ailment. There had to be some principles to limit the amount spent. The attraction of a numerical method is obvious. It is simple to apply, clear in its outcome and, by the rules laid down, visibly fair. No one can blame the health service for adopting it.
The second precedent is a move within society and particularly politics away from a morality based on the teachings of Jesus and the historical formularies of the Christian religion, and towards something known as Utilitarianism. This idea was made popular by an 18th century reformer called Jeremy Bentham. Simply stated he argues that an action is right if it produces the greatest happiness for the greatest number of individual people. In his system both happiness and people are measurable. With the second you can just count heads. The first is a little trickier, so he produced a system. It is, to be frank, fairly vague and largely useless as an accurate measurement, but that is, thankfully for him, irrelevant as it's mostly pretty obvious in public works if happiness is increased. Applied to reform of prisons and sewers, it was a cause of significant improvements in public welfare.
His system has many weaknesses, which any half-decent A Level ethics' student can point out. Justice is dependent on increasing happiness, which seems the wrong way round, particularly if you are unjustly accused. It allows a lot of people to be made unhappy as long as more people are made happy. And in modern formulations it can even be seen to justify infanticide, but I'll leave you to work that one out. But it is a reasonable short-hand method of making decisions in difficult areas, which anyone can understand, so its adoption in a society that has lost its roots in the Bible is unsurprising. However, there is an even more fundamental difficulty. When we are in a really difficult place, our whole being rebels against it.
In a recent blog by a doctor, much quoted on line, an argument was made that we are spending too much to protect 500,000 lives. The estimated cost to the economy of £350 billion is more than double the justifiable spend. Such an argument intrigues, but it also appals. People can be counted, but their value cannot. And this crisis exposes that. If it is wrong to sacrifice 500,000 people to save the economy then it is wrong to use a system like QALYs, as explained yesterday, to decide on treatment in normal times.
But why do we rebel against it? It is a logical method. It has flaws but doesn't any system? I don't think the problem is with the way it undermines moral values like justice. No I think the reason is that it treats people as objects. It turns an infinitely valuable person into a measurable thing. And maybe that's what's wrong with counting people per se, that is the sin of David's census. He turned the people of God into a quantity to be measured and they are not.

I loved this vase and then...