At the start of May 2020, the New York governor Andrew Cuomo was under pressure to relax Covid restrictions. “The faster we reopen, the lower the economic cost, but the higher the human cost because the more lives lost,” he said in a televised address. “The question comes back to how much is a human life worth. That’s the real discussion that no one is admitting openly or freely, but we should.”
That taboo question is at the centre of this riveting book. We may recoil from discussing it, but behind closed doors the price of a human life is being calculated all the time. So who is making these decisions, to what purpose, and according to which criteria? And what do the figures reveal about who – or what – we value?
For her first book, Sex Robots & Vegan Meat, the journalist and broadcaster Jenny Kleeman met the scientists and entrepreneurs working at the frontier of technological innovation. Here, again, she seeks out human stories that make the impersonal intelligible, interviewing those who hold the algorithmic scales, and those whose lives are in the balance.
We begin with the price on someone’s head. Kleeman has dinner with a former hitman. He is reluctant to talk numbers, but she discovers that the average bounty in the UK is about £15,000. She hears the harrowing accounts of Vietnamese women trafficked to Britain as domestic slaves. She visits relatives of Rachel and Paul Chandler, a retired couple from Tunbridge Wells who were kidnapped by Somali pirates on a sailing trip in 2009. The British government won’t pay ransoms, so the couple’s family had to negotiate it themselves. The average global demand in 2021 was $368,901.
The director of a US company that sells donated bodies (for about $5,000, excluding shipping) insists that his cadavers are used only for medical research; others may end up as crash-test dummies or nose-job guinea pigs. Some are bought (via an intermediary) by British universities requiring scarce body parts for anatomy courses: a head may fetch about $600.
Kleeman tours the Lockheed Martin factory in Fort Worth, Texas, which makes the F-35 fighter jet, the most expensive weapons system in the world. To work out the price of the lives it takes, Kleeman divides the cost of a jet – around $110m – by the approximate number of people it has killed. The answer is, she admits, inexact to say the least, but it raises the question of why such an exorbitant killing machine exists.
You might expect life insurance to provide a better measure, but payouts just depend on the premiums contributed. Actuaries assess your likely lifespan, not how much you’re worth. The Criminal Injuries Compensation Authority will pay the families of murder victims £11,000. More is paid for a serious injury that entails lifelong care.
After the 2017 London Bridge terrorist attack, the families of those who were stabbed to death were entitled to statutory compensation, but those struck by the van the attackers were driving received millions from rental company Hertz. Commercial insurance payouts themselves vary wildly: they are compensating not for a life lost, but for the cost – practical and emotional – to those left behind.
Kleeman shows how prices are contingent on social status, where you live, market conditions and pure chance. While some of the variations reveal injustice, others are less meaningful and harder to compare. As Kleeman acknowledges, £200 to hire a killer or the $500 paid for a child bride in Afghanistan are really measures of desperation. It is when we get to the more abstract top-down allocation of resources, the necessary weighing of one life against another, that this book provides the most satisfying answers to the philosophical questions posed with such thoughtful clarity at the start.
Followers of the philanthropic movement known as effective altruism believe charitable donations should be determined by cool-headed quantification of the benefits, rather than a leaflet through the letterbox with a picture of an injured puppy. Effective altruists will prioritise helping a stranger on the other side of the world over a homeless person on your street if it represents more bang for your buck. They will tell you how to save a life for just $4,500 – as long as it’s a life in Africa, because those are deemed the least expensive. One advocate ruminates on the optimum age to save a person’s life. “I think my peak value is the death of an eight-year-old,” he says.
England and Wales’s National Institute for Health and Care Excellence (Nice) must also be dispassionate, but in the service of a cash-strapped NHS rather than billionaires’ consciences. Its deliberations are fascinating, and take place largely out of public view. Nice uses a measure called a Qaly: a quality-adjusted life year. One Qaly means one year in good health, and is worth £20,000-30,000. If a drug costs that much or less for each additional year of good health it provides for a patient, then Nice will approve it.
Kleeman meets the mother of a child with a rare genetic disease who was just over the age limit for access to the world’s most expensive medicine. She appealed to Nice through the media and it relented, showing its human face. The organisation has to reconcile the competing interests of the individual and the collective – as the mother put it, “I appreciate that there isn’t a never-ending supply of money, but when it’s your child … ” This tension is vastly exacerbated by market capitalism. “As long as pharmaceutical companies are run for profit,” Kleeman notes, “there will be a price on life.”
Her book is a mind-bending exploration of intrinsic and fungible value, recalling Shylock’s pound of flesh and his muddling of ducats and daughters. First you deplore the imposition of rigid metrics on tender human beings, then you remember that monetary worth is itself elastic. Kleeman has picked an illuminating lens through which to explore the quantification of everything in a data-driven society, and the pros and cons of cost-benefit analysis. Surprisingly, Nice’s Qaly figure was pretty much plucked from the air: it’s a relative measure, an arbitrary tool for comparison. “The danger comes,” Kleeman observes, “when people treat tokens as if they truly represent the real price of a human life.”
Having mooted a cost-benefit analysis for lockdowns, Cuomo bottled it. “To me, I say, the cost of a human life … is priceless, period,” he declared. The then chancellor Rishi Sunak promised, likewise, to “do whatever it takes”. But “whatever it takes” has a price tag. Divide the cost of lockdown by the number of life years it saved, and you get £300,000: 10 times the Qaly threshold. If you piously dismiss these sums as cold calculation, Kleeman points out, more people might die, now or in the future. Putting a price on life can amount to exploitation, but sometimes it’s a way of being fair.
• The Price of Life: In Search of What We’re Worth and Who Decides by Jenny Kleeman is published by Picador (£18.99). To support the Guardian and Observer, order your copy at guardianbookshop.com. Delivery charges may apply.
