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Comment by raleec | Hacker News Reader

My first thought is how many people were abandoned because of a reliance on the incomplete picture that the old tech bundle provided.

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I like to believe this would be less than 1%. Medicine is science, and I hope while designing modern CPR guidelines they did tests to see if pursuing CPR even while all signs suggest death, for long periods of time, would revive more people.

Then they probably had to make a key decision between keeping an emergency team busy for 90 minutes for every case where death was probable, just in case there's that less-than-1% chance of revival, or dismissing the team and freeing the resources for patients who have a higher probability of survival, and increasing the probability of survival of those due to faster response times.

Medicine is science and as such is always evolving.

I recently got certified in CPR and defibrillator use. Turns out that CPR guidelines keep changing as scientific research advances our knowledge of what is actually going on. One of the reasons why a first responder should keep getting re-certified every year or so.

Given those numbers, you'd have a statistical expectation of one life saved for every 150 hours spent. Say $100/hr for salaries+bennies for two parametics, 15K per life saved. I think it's worth it.

But what's the expectation of lives lost due to late emergency crews?

I wonder how overburned most areas are? I had a friend who was an EMT and said they really liked being called (didn't get the impression they were that busy) because it was far better to be safe than sorry and people were often too hesitant about calling for emergency services.

$100/hr for salary and benefits? Maybe a half that...

I like to believe this would be less than 1%.

But unfortunately medical errors kill a lot of people: http://www.bbraunusa.com/index-A3866CA8D0B759A1E395A615A2C00...

Then they probably had...increasing the probability of survival of those due to faster response times.

This is the problem; today everything is a cost/benefit analysis.

I'd say the opposite. We spend vast amounts of money prolonging the life of people who we know in advance are extremely unlikely to generate quantifiable benefit. How do you suppport what you've said?

I would not want to do business with you or any business associated with your line of thinking.

I see where you're coming from, but what if there is someone else who also needs emergency medical care and has a higher chance of survival? End-of-life care is among the most expensive kinds of medical treatment because often doctors are staving off the inevitable, and that sucks up resources that could be used to treat other people.

This seems like a very grim economic calculus, but following a disaster or disease epidemic doctors must make such decisions many times a day, sometimes with only minutes to evaluate patients. Likewise, those who run hospitals (especially public hospitals) have to balance the probability of a successful outcome against the cost of leaving other patients untreated.

It's not something that can be quantified, though. The problem is that meaning is an entirely subjective phenomenon, so when we talk about trying to save people who are more likely to live, we make the assumption that long life is the correct metric to use. More than that, we assume that there is a correct metric to use in the first place. As a concrete counter-point, what if the person saved will have a terrible life to look forward to? What if it's an abused wife or a (unknown to the doctors) drug addict? What if the person with the lower chance of survival is a parent or Mother Therasa? What if the person with the better survival rate doesn't want to live and will commit suicide shortly?

The problem with applying linear mathematics to human issues is that it's a gross oversimplification of a complex problem. Couple that with the relative weight of values (i.e. every person placing a different value on life) and it's clear that rather than being a more objective measure, it is in fact firmly grounded in subjectivity. I think that the objective illusion only serves to calm the conscience. A more objective and fair way of doing this, which also calms the conscience, would be to flip a coin.

The other issue is that the line of thinking you have described is the same one used to justify horrendous actions. Sacrificing someone who is seemingly less deserving of effort (again, by our completely subjective criteria) for someone more deserving is the logic used to justify locking people up in prisons, burning witches, gassing Jews, it's all the same - those "less deserving" are sacrificed for those who are "more deserving". And all that with a subjective metric.

I think that the root cause of this irrationality is that even the most rational people tend to miss the fact that perfecting one's logic is not enough. After that point, assumptions are everything. Logic is merely a tool for transforming one set of assumptions into another. If you use shit as the input, you'll get an equivalent output.

That's all true, but scarcity is a fact of life. Often, the scarce commodity is time for evaluating a complex decision. Part of responsibility is accepting the fact that your foresight and insight are limited and that you may have to face the results of a bad decision; most ethical codes require that you submit to the judgment of your professional peers in that event, but also direct the person to just dealing with the problem at hand, eg a patient's immediate medical condition rather than an overall life situation.

You're entitled to your preferences, but a community filled with people who always reject cost-benefit analysis will have more premature, preventable deaths than another community that does the macabre math.

I'd rather live longer, with more friends and family who live longer, in the cost-benefit community.

You don't want to do business with someone who points out that we value life so much that the costs expended to save those lives are independent of any consideration of benefits?

Okay rationalist, what if you were sick and someone important deemed that you were "extremely unlikely to generate quantifiable benefit"?

You're reading it wrong. Here's an annotated version of what you replied to:

I'd say the opposite [everything is NOT a cost/benefit analysis]. [As evidence of this,] We spend vast amounts of money prolonging the life of people who we know in advance are extremely unlikely to generate quantifiable benefit. How do you suppport what you've said [that everything is a cost/benefit analysis]? [The evidence shows your position to be incorrect, therefore my position that life is more valuable than cost/benefits indicate is true.]

That's a stretch, to put it mildly.

I don't see how you can read it any other way. There was no judgment made in cturner's post; only a presentation of evidence to refute the claim that everything is a cost/benefit analysis.

Well one perspective from the sick persons point of view, "The entire resources of the universe should be spent on keeping me alive". If you decide that there is something wrong with this, you need a strategy to allocate the resources. Then you've got a cost/benefit analysis.

How about if you were sick, but there was a serial killer who had a 98% of dying that, due to this sort of argument, was utilizing resources that would increase your chance of survival from 10% to 95%?

This argument fails to show that when it comes down to it, there's more than one person and their associated who get affected by the decision to invest those resources. The benefits to one person come at the expense of another in current healthcare situations.

Should we ignore cost?

Well, I just refreshed my EFR cert, and can tell you that the official statistic is that only 5% of those requiring CPR survive, and that's what all the assumptions are based on.

.) Well, yes the new method is better than the prev. tech available, still it is as well only providing an estimate of the true situation... so, not all of the prev. abandoned ppl had a 100% chance to recover as in the described case.

.) Yes, it is fascinating to see how the emergency-medicine tech evolves over time... I mean, keeping a man "alive" for that long outside of a situation room, wow!

.) Plus: as always, the ppl actually handling those emergencies, deciding what to do on site. "Life over Death" with a clear head... wow^2

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