to be disgusted at these comments made by Lord Sumption

[DoreensEatingHerSoreen]

www.google.co.uk/amp/s/amp.theguardian.com/law/2021/jan/17/jonathan-sumption-cancer-patient-life-less-valuable-others

Lord Sumption today told Deborah James, who is living with stage 4 bowel cancer, that her life is less valuable than the lives of others.

As a fellow stage 4 cancer patient, I find it appalling that someone could suggest our lives are less valuable than those without cancer.
In spite of my diagnosis, I live a wonderful and fulfilling life, and intend to carry on doing so for as long as is possible.
It's terrifying to think that I may be denied access to a ventilator should I become ill with Covid, and I believe we have a collective duty to do everything we can to reduce pressure on the NHS and minimise the horrific collateral damage of Covid on those living with other illnesses and conditions.

I think a big part of the issue here is semantics.

'Value/valuable' is a highly emotive word which most of us use conversationally to talk about our friends, families, people who have contributed to society, and so on.

But it's also one which is also used in specific clinical decision-making contexts, which have to be by their nature highly pragmatic and devoid of emotion.

Same word, different meanings. Or at least contexts. And rightly so -- otherwise healthcare systems would struggle to make practical decisions on anything.

A friend of mine has a life-limiting condition. She's the same age as me (well, give or take a year). Her condition is reasonably well-managed and there are a lot of treatments she receives and is entitled to.

There are also other treatments, for other illnesses, that I would get that she wouldn't, based on expected clinical outcome. Ultimately in certain contexts the 'system' will place a higher treatment value on my life compared to hers, because statistically I'm likely to live till I'm 80-something whereas she won't see 50.

The 'system' doesn't care about all the valuable things she's done in her life, or the questionable decisions I've made in mine. Or vice versa. The decisions are made purely on a basis of statistics, risk, and likelihood of outcome.

The semantic difference between clinical value and what we might better term worth doesn't mean that she's a less valuable person than me in a broader societal context, and to her loved ones (which include me, her friend).

I think a lot of people in the Big Questions audience, in the press, and here are eliding the two things.

What he said was right. Our doctors are having to make that decision all the time. Where the government is silent, I imagine they might take comfort that rationality still exists.

@NastyBlouse

I think a big part of the issue here is semantics.

'Value/valuable' is a highly emotive word which most of us use conversationally to talk about our friends, families, people who have contributed to society, and so on.

But it's also one which is also used in specific clinical decision-making contexts, which have to be by their nature highly pragmatic and devoid of emotion.

Same word, different meanings. Or at least contexts. And rightly so -- otherwise healthcare systems would struggle to make practical decisions on anything.

A friend of mine has a life-limiting condition. She's the same age as me (well, give or take a year). Her condition is reasonably well-managed and there are a lot of treatments she receives and is entitled to.

There are also other treatments, for other illnesses, that I would get that she wouldn't, based on expected clinical outcome. Ultimately in certain contexts the 'system' will place a higher treatment value on my life compared to hers, because statistically I'm likely to live till I'm 80-something whereas she won't see 50.

The 'system' doesn't care about all the valuable things she's done in her life, or the questionable decisions I've made in mine. Or vice versa. The decisions are made purely on a basis of statistics, risk, and likelihood of outcome.

The semantic difference between clinical value and what we might better term worth doesn't mean that she's a less valuable person than me in a broader societal context, and to her loved ones (which include me, her friend).

I think a lot of people in the Big Questions audience, in the press, and here are eliding the two things.

Well put

From the Daily Mail:

Former Supreme Court judge Lord Sumption today suggested coronavirus policy-makers would value fundraising hero Captain Tom Moore's life less than a 25-year-old.

The controversial ex lawlord, himself 72, said if resources were limited the £33million charity walker would be a lesser priority than the younger man.

Well - they would, wouldn't they? I don't see the controversy here. And for once, I am in agreement with the top rated DM comments.

@NastyBlouse

I think a big part of the issue here is semantics.

'Value/valuable' is a highly emotive word which most of us use conversationally to talk about our friends, families, people who have contributed to society, and so on.

But it's also one which is also used in specific clinical decision-making contexts, which have to be by their nature highly pragmatic and devoid of emotion.

Same word, different meanings. Or at least contexts. And rightly so -- otherwise healthcare systems would struggle to make practical decisions on anything.

A friend of mine has a life-limiting condition. She's the same age as me (well, give or take a year). Her condition is reasonably well-managed and there are a lot of treatments she receives and is entitled to.

There are also other treatments, for other illnesses, that I would get that she wouldn't, based on expected clinical outcome. Ultimately in certain contexts the 'system' will place a higher treatment value on my life compared to hers, because statistically I'm likely to live till I'm 80-something whereas she won't see 50.

The 'system' doesn't care about all the valuable things she's done in her life, or the questionable decisions I've made in mine. Or vice versa. The decisions are made purely on a basis of statistics, risk, and likelihood of outcome.

The semantic difference between clinical value and what we might better term worth doesn't mean that she's a less valuable person than me in a broader societal context, and to her loved ones (which include me, her friend).

I think a lot of people in the Big Questions audience, in the press, and here are eliding the two things.

Exactly. This is all people trying to stir.

[quote McSilkson]@bluecheesefan
Solitary confinement is used as a punishment for a reason. It is unbearable for any length of time.

And yet that is what has been imposed on the 8+ million adults living alone in the UK for almost a year. Not to mention the people in homes who are not allowed to receive visitors and denied any human touch: extreme cruelty in the name of possibly prolonging their lives a little.[/quote]
Yes I know. My MIL being one of them.

Yet still people want to keep them all locked up indefinitely so they can start going to the pub again.

I think that is your own interpretation of what is being said. I am presuming you are of a similar age to me and I have been devastated when a friend died of cancer who is my age. But what covid means is not that I think it is less tragic, just that it has some higher level of inevitability to it. Covid is really cruel in that it seems to pick out vulnerabilities and illness and capitalises on them. I would not see the death as less tragic. At all. But covid decided that it would take advantage and there is not a lot anyone can do about how this virus works. So not less tragic, but these are the facts we have to live with?

It is the same as other diseases and conditions - Sickle Cell for black people, Rhett's Syndrome for girls, for example. These conditions target some people only.

None are less tragic, but become more uncontrollable because of the nature of who the ideal host is for the illness.

It's not about someone with cancer being more at risk of dying of Covid (in fact its recognised that this is not actually the case for a lot of cancer patients now anyway). It's about the fact that if the NHS were to become overwhelmed, which it would without a lockdown, then stage 4 Cancer patients would be at the bottom of the pile because 'You're gonna die anyway at some point'.

And yet that is what has been imposed on the 8+ million adults living alone in the UK for almost a year

That is simply not the case. When you need to lie to make your case, you have already lost the argument,.

Deborah James does always make it personal, and will always make any discussion about these issues very emotive. She did it in the Panorama documentary she did last year. For this reason sometimes I think she is not the best person for an objective discussion.

However, the flip side of that is that she does force people to see the human side of it, as a real person. She represents a lot of people. And if anyone, like Lord Sumption, is going to say stuff like 'the lives Stage 4 Cancer patients are less valuable' then they should be made to say that to the face of an actual stage 4 Cancer patient and see that its a real person they are talking about, not an abstract philosophical concept.

realised he's said something crass and is trying to deflect by saying that he didn't mean Deborah's life specifically.

But he didn’t mean Deborah’s life specifically. Or not because she’s Deborah, if you see what I mean. He was speaking in the abstract, not specifically about her. She chose to personalise it (sort of “I fit these abstract criteria, so does this apply to me?) and he essentially said, “Well, yes, if you for these abstract criteria, then yes it does.” Very, very different from saying - in isolation - “Deborah, your life has low value”. You do have to consider the context (here and always).

@chomalungma

Nasty comment. As I think others have pointed out it is the suggestion that her life is less valuable than someone the same age which is objectionable

What makes the life of a 10 year old more valuable than her?

Is it because that 10 year old has, all things being equal, more chance of a longer, healthier life?

No, I think that children's lives are particularly valued in the UK because they haven't had much chance of life yet.

@NataliaOsipova

realised he's said something crass and is trying to deflect by saying that he didn't mean Deborah's life specifically.

But he didn’t mean Deborah’s life specifically. Or not because she’s Deborah, if you see what I mean. He was speaking in the abstract, not specifically about her. She chose to personalise it (sort of “I fit these abstract criteria, so does this apply to me?) and he essentially said, “Well, yes, if you for these abstract criteria, then yes it does.” Very, very different from saying - in isolation - “Deborah, your life has low value”. You do have to consider the context (here and always).

When I listen to it, it sounds as though he means her specifically, but taking your point, if he didn't, and he means the people she represents (young people living with incurable illnesses) then I still don't find it acceptable that he said our lives are less valuable, for all the reasons I've discussed previously.

To reiterate - I do not have any issue with his comments regarding feeling that his life is less valuable than his children / grandchildren.

I totally get that lockdowns are imposed (and have been imposed around the world) to protect health services. The NHS is particularly low on beds and capacity in relation to the general population compared to some other European countries, but most countries have imposed lockdowns irrespective of the size and strength of their health services.

It just made me wonder what would have happened if we had a limitless health service. Would we have let the virus tear through the population?

Stupid question really, there’s no such thing as a limitless health service and no way of knowing what we’d do if we did have such a thing. But I do wonder if we’d have thought it was ok in those circumstances to let the virus burn through the population killing whoever it kills. Because it seems to me that’s what we’re saying when we talk about the purpose of lockdowns being to protect the NHS.

These decisions should absolutely not become personal or you end up with the types of scenarios where someone’s character is considered as part of the decision.

I’m surprised that anyone is shocked that the NHS makes decisions on treatment based on their cost and availability. You only have to see those GoFundMe campaigns where the NHS has stated that it won’t fund a treatment that is futile and expensive. The family concerned absolutely thinks spending £500k on some wacky treatment in Puerto Rico by a quack doctor is worth a try. The NHS doesn’t.

@Uhhuhoyaye

If you as an individual or the country as a whole had to choose between a child or an octogenarian living, the child would be chosen.

All lives have equal value but scarce resources have to be allocated strategically.

What about a septuagenarian? If someone asked me to choose between my 70 yo mum being saved or an unknown child, I would pick my mum hands down.

@cadent. Perfect example of why it shouldn’t be a personal decision.

What about a septuagenarian? If someone asked me to choose between my 70 yo mum being saved or an unknown child, I would pick my mum hands down

You aren't the one doing the choosing though.

But he didn’t mean Deborah’s life specifically. Or not because she’s Deborah, if you see what I mean. He was speaking in the abstract, not specifically about her. She chose to personalise it (sort of “I fit these abstract criteria, so does this apply to me?) and he essentially said, “Well, yes, if you for these abstract criteria, then yes it does.” Very, very different from saying - in isolation - “Deborah, your life has low value”. You do have to consider the context (here and always).

Of course he means Deborah's life specifically - she fits the criteria of people that he deems to have a less valuable life, therefore he thinks her life is less valuable. Who is he talking about if he is not talking about her and the thousands like her? The problem with 'speaking in the abstract' is that for people like Deborah, and the OP, it's not 'abstract' it's reality.

These decisions should absolutely not become personal or you end up with the types of scenarios where someone’s character is considered as part of the decision.

Yes I agree.

But then again if you are using language like 'valuable life' then it does infer that character comes into it somewhere or something. The language of 'valuable life' and 'less valuable life' is pretty grim to be honest.

Well that is what the British Medical Association published regarding prioritisation of patients for ventilators in the even Covid overwhelms the ICUs. Basically elderly, disabled, and those with comorbid factors that decrease their likelihood of survival or increase the estimated time they would need on a ventilator to survive are less valuable than the young and healthy with higher survival likelihood and lower estimated time needed on a ventilator.

He’s only stating what they published back in April.

PlanDeRaccordement

And that prioritisation guidance was essentially only a brief version of one we use all the time - for resource allocation, ceiling of care etc. We do not keep treating severely ill, elderly people in normal times, if we deem the treatment to be more than the person can stand - sometimes the treatment can kill the patient, sometimes it would lead to a long, drawn-out and painful yes inevitable death.

@PlanDeRaccordement

Well that is what the British Medical Association published regarding prioritisation of patients for ventilators in the even Covid overwhelms the ICUs. Basically elderly, disabled, and those with comorbid factors that decrease their likelihood of survival or increase the estimated time they would need on a ventilator to survive are less valuable than the young and healthy with higher survival likelihood and lower estimated time needed on a ventilator.

He’s only stating what they published back in April.

Deborah James is well aware of this - which is why she was arguing in favour of lockdown to protect the NHS so that as few of these sorts of decisions as possible have to be made.

Lord Sumption wants no lockdown and then survival of the fittest in the event that the NHS becomes overwhelmed - knowing that that will mean that people like DJ would be bottom of the pile.

@PlanDeRaccordement

Well that is what the British Medical Association published regarding prioritisation of patients for ventilators in the even Covid overwhelms the ICUs. Basically elderly, disabled, and those with comorbid factors that decrease their likelihood of survival or increase the estimated time they would need on a ventilator to survive are less valuable than the young and healthy with higher survival likelihood and lower estimated time needed on a ventilator.

He’s only stating what they published back in April.

There's no evidence to suggest that Deborah James (or myself) would need longer on a ventilator to survive Covid than someone without cancer. It's a complex disease, and those of us living with it can often be physically fitter - and in a better position to recover from Covid, than some of those without cancer.

This aside - once someone is in that situation - in an overwhelmed ITU with a shortage of ventilators, then the decision about who gets treatment is rightly in the hands of the medical team. I have to put my faith in their judgement here, regardless of whether the decision goes in my favour.

Where I would have hoped our lives were perceived as more valuable than they evidently are by LS and some on here, is in the desire to keep ITUs as protected as possible, in spite of the hardships lockdown brings. I know it's shit - I am suffering, my family is suffering, there are so many ways I would prefer to be spending my precious days, however I really do believe that we need to prioritize the lives of the vulnerable - that is where we are feeling under valued.

Deborah James is well aware of this - which is why she was arguing in favour of lockdown to protect the NHS so that as few of these sorts of decisions as possible have to be made

Why then haven't we done a full lockdown since March then?
That would have ensured that the NHS would have been protected.

Or would there have been too big a hit to other people's lives and their lives need protecting as well?

By protecting some people's lives, other people's lives are being damaged.

How do you weigh up what is the right thing to do?

Yes, it would the decision of whoever is in charge of the medical team.
I agree it’s shit. I have comorbid conditions and neurological disability that could see me left to die even when I could had survived in favour of another patient with lower risk profile if it came down to it.

Would not want to be the medical professionals making those decisions though. I think that would be soul crushing.