Eugenics and the Welfare State
Sven R Larson, Ph.D.
Senior Fellow in Economics
Wyoming Liberty Group
One of the central tenets of totalitarianism is that government knowingly kills or harms people in the name of a higher ideological purpose. In Cambodia, the Pol Pot regime killed more than 1.3 million people in order to impose its communist ideal on the people. In Mao’s China people were sent to labor camps to work for and learn to appreciate Communism. During its fight against South Africa’s terrible, racist Apartheid regime, the ANC sank to almost the same levels of totalitarianism. They forcefully sent black South Africans to “education camps” to teach them to appreciate ANC’s collectivist ideology.
The government of Communist East Germany locked in its people behind barb wire, concrete walls and guards with a standing order to kill anyone who tried to leave their ideological paradise. The Soviet government locked up critics in mental institutions. The Cuban people is still forced to starve on food rations because the Castro regime prioritizes socialism over a well-fed population.
Nazi Germany was the first totalitarian regime to take oppression into the industrial age. Their scale of tyranny reached beyond the subjugation of the individual. Part of the Nazi ideology was the idea of a master race, a genetically superior people. That was not the people of Germany at the time when the Nazis seized power.
In order to make the people fit within the framework of their ideological ideal, the Nazis began a program of population re-engineering. An individual who did not fit the master race template was simply and brutally discarded. First in line were the Jews, whose very existence was a problem to the master-race ideologists. The Gypsies, the Slavs, and many others were considered unfit for the perfect society that the Nazi regime wanted to engineer.
But their obsession with population hygiene did not stop there. Under a policy principle labeled lebensunwertes leben, life unworthy of living, the Nazis set out to clean the German population of individuals whose lives were considered a burden to society. The basic idea was that a person with a disability beyond a certain degree of severity would never be able to make a positive contribution to society. Therefore he should be discarded.
In a matter of speaking, the unworthy-life policy imposed a cost-benefit analysis on each individual member of the German population. If he or she did not meet the ideologically motivated standards for a productive, life-worthy individual, he or she was supposed to be euthanized.
Amazingly, there have been efforts made to give this abhorrent policy scientific legitimacy. Called eugenics, this “science” elevates the pursuit of an alleged higher-quality human genetic pool to the same level as the science of saving people’s lives – a.k.a., medicine. In the 1920s and ‘30s academic researchers from a variety of disciplines published a large body of work with the explicit intention to elevate eugenics to serious science. In 1937, Frederic Olson, anthropologist and research associate at the American Museum of Natural History published an overview of the current state of eugenics in the American Sociological Review. Based on the materials presented at a eugenics conference held in New York that same year, Osborn suggests that physicians…
should keep in close touch with the eugenist so that they will understand the eugenic implications of all medical work and its effect on the distribution of births. Doctors are in a position to influence a favorable distribution of births more perhaps than any other group.
One would have hoped that this line of thinking would have stayed a purely academic matter. It did not. It became a dominating paradigm in public policy in Nazi Germany.
With the fall of the Third Reich eugenics was shamefully confined to the dusty shelves of history. Haunted by its own demerits, it disappeared from the public conscience, ideally never to return again.
But there is nothing ideal about the welfare state. So perhaps one should not be surprised to find a slightly polished version of eugenics embedded in the bureaucratic structures of the modern, redistributive state. The contemporary version of eugenics is of course not about “genetic hygiene”, but about something seemingly harmless. Today’s eugenicists are preoccupied not with discarding genetically unfit individuals, but about creating a population that is cost efficient enough to fit the budget of the welfare state.
Haushaltsunwertes leben. A life unworthy of the budget.
On the face of it, this is a bizarre notion. How could you possibly contain the costs of entitlement programs in a welfare state by singling out people whose lives would somehow be unworthy of living? And, more importantly, who would lend themselves to such morally reprehensible practices as to discard people because their very existence will cost government too much money?
These questions are especially pressing in a day and age when, according to those who want a big government, we have built an allegedly compassionate, caring and benevolent social system called the welfare state.
The answer is as brutal as it is simple. When government takes over the health care system of a country it makes promises to the entire population to provide them with all the health care they need. That promise is independent of government’s ability to pay for all the health care it just promised to deliver. When it raises taxes to pay for the health care, and when it raises taxes to pay for other promises it has made in other areas – public education, general income security, retirement security and job training programs (just to mention a few of the staples of a modern welfare state) – government imposes a burden on the private sector that is eventually strong enough to depress productive economic activity.
As a result, government has less tax revenues to pay for the health care it has promised. At this point the tax-paid health care system must start making priorities between patients. Early on in this phase priorities are relatively harmless and essentially invisible to patients. However, with time the priorities come creeping closer to essential parts of the medical delivery system. Treatment is rationed, access to medical specialists is restricted, costly procedures are given to fewer and fewer patients.
Eventually, the need to contain health care costs forces a fundamental shift in the policy priorities of the health care system. Its original prime directive to deliver the best health care possible to everyone who needs it is replaced with a dictate to deliver whatever health care is feasible within a certain budget. The budget, then, becomes tighter and tighter over time, and with that tightening the health care system invents new, morally tougher rationing methods.
This is where eugenics enters the stage. It has already become a convenient tool in modern-day health care. Disguised as advanced science, hidden behind an inconspicuous acronym called QALY, the practitioners of contemporary eugenics do their best to make it fit within the image of the welfare state as compassionate, considerate and benevolent.
The road along which eugenics is making its return to the public policy center stage is paved by representatives of the academic discipline called “medical ethics”.
Philosophers with specialty in medical ethics have for a long time advocated the application of raw utilitarianism in the distribution of government-provided health care. In a matter of speaking, there has been an escalation of support for eugenics-style policies. It was therefore not much of a surprise when in March 2012 two professors of medical ethics, Alberti Giubilini and Francesca Minerva, proposed ethical support for infanticide. Their article, published in peer-reviewed Journal of Medical Ethics, suggests that mothers should be allowed to kill their newborn, disabled babies in order to relieve themselves – and society – of the burden and the cost of caring for them.
They start softly, using valid reasons for abortion as a ground for elevating infanticide from the dungeons of medieval savagery (emphasis added):
Severe abnormalities of the fetus and risks for the physical and/or psychological health of the woman are often cited as valid reasons for abortion. Sometimes the two reasons are connected, such as when a woman claims that a disabled child would represent a risk to her mental health. However, having a child can itself be an unbearable burden for the psychological health of the woman or for her already existing children, regardless of the condition of the fetus.
Before we get to the deep, dark and very profound implications of their argument, we should note that they want to give mothers this right to kill their baby even though the mother has had a long range of opportunities to make a decision not to have this baby. The mother has had unprotected sex, she has found out that she is pregnant and knowingly declined to have an abortion. She has then carried the baby for nine months and given birth.
After all these opportunities to prevent and terminate her pregnancy; after months upon months of preparing for the arrival of her baby; she should still be allowed, according to Giubilini and Minerva, to kill the baby if she feels that its existence will be too much of a “burden” for her.
These two medical ethicists use utilitarianism as their value theory. They reduce life to a utility function, where the determination of a person’s utility experience is not in the hands of that person – but in the hands of someone else. Person B becomes the final arbiter of whether or not Person A’s life is worthy of living.
Or worth the cost.
It could be objected that a newborn baby is unable to take responsibility for its own utility experiences and that therefore someone else should have the authority to make those decisions. The problem is that if we make this transfer of responsibility from Person A, the baby, to Person B, the mother (or whoever has custody over the baby), then we also assume that there could be a point where a baby’s life is unworthy of living. The only reason to transfer responsibility for the baby’s utility to Person B is so that someone can make that decision for the baby.
A much more reasonable approach would be to stipulate that the baby’s life is axiomatically worth living. Then, and only then, would we have a health care system whose prime directive it is to save and improve life.
Giubilini and Minerva, the two medical ethicists who think some lives may be unworthy of living, do not regard life as the prime directive of health care. They are instead ready to solidify their argument that abortion and infanticide are two branches on the same tree:
A serious philosophical problem arises when the same conditions that would have justified abortion become known after birth. In such cases, we need to assess facts in order to decide whether the same arguments that apply to killing a human fetus can also be consistently applied to killing a newborn human. Such an issue arises, for example, when an abnormality has not been detected during pregnancy or occurs during delivery.
When Person A’s utility function – and thereby, according to this utilitarian argument, Person A’s right to life – is placed in Person B’s hands, it is entirely up to Person B to determine whether or not Person A suffers from any “abnormality.”
Giubilini and Minerva offer an example of an abnormality that they consider justifiable ground for infanticide, and in doing so they also start making the case for transferring the authority over Person A’s utility function and life to someone else than the mother:
One example is the case of Treacher-Collins syndrome (TCS), a condition that affects 1 in every 10 000 births causing facial deformity and related physiological failures, in particular potentially life-threatening respiratory problems. Usually those affected by TCS are not mentally impaired and they are therefore fully aware of their condition, of being different from other people and of all the problems their pathology entails. … [Sometimes] the disease is caused by a gene mutation that intervenes in the gametes of a healthy member of the couple. Moreover, tests for TCS are quite expensive and it takes several weeks to get the result.
In other words, Giubilini and Minerva make the argument that the life of a baby is worth $1,830. (And it should be noted that TCS is far less common than the authors want to have us believe – one in 50,000 according to several sources). A woman should, they argue, have the right to choose to kill her baby instead of spending the equivalent of less than two weeks’ worth of pay for an average American family.
If we can kill a baby over such a small amount of money, then what is the price for an older child’s life? What if an “abnormality” is detected when a child is, say, ten years old? A bipolar disorder, which requires lifelong medication and regular hospitalization, is rarely diagnosed before a child becomes a teenager.
Before the two medical ethicists involve government, they make a formal nod of compassion to parents of children with Down’s Syndrome:
An examination of 18 European registries reveals that between 2005 and 2009 only the 64% of Down’s syndrome cases were diagnosed through prenatal testing. This percentage indicates that, considering only the European areas under examination, about 1700 infants were born with Down’s syndrome without parents being aware of it before birth. Once these children are born, there is no choice for the parents but to keep the child, which sometimes is exactly what they would not have done if the disease had been diagnosed before birth. … It might be maintained that, even allowing for the more optimistic assessments of the potential of Down’s syndrome children, this potential cannot be said to be equal to that of a normal child. But, in fact, people with Down’s syndrome, as well as people affected by many other severe disabilities, are often reported to be happy.
After this lip service to the respect for life, Giubilini and Minerva add the welfare state to the picture, effectively paying homage to the practice of eugenics in the Third Reich (emphasis added):
Nonetheless, to bring up such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.
If these children are deemed to become an “unbearable burden … on society” because government pays for their care, then it follows by the logic of Giubilini’s and Minerva’s argument that the state can seize control over a baby’s utility function.
And right to live.
This utter disrespect for “abnormalities” among human beings is not just an intellectual exercise among academics. Consider the following observation by former Alaska governor Sarah Palin:
The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
In Europe, government-run health care has already put this new ethical standard to work. In July of 2012 the Swedish news site Världen Idag (World Today) reported that tax-paid abortion is being used by parents in Denmark and Britain as a means to discard babies with cleft palate:
The disability is not life threatening. But in the quest for the perfect the Danish couple chose abortion. The baby they were expecting had cleft palate. In England 26 babies have been aborted for the same reason – one in the 28th week of the pregnancy.
This is bad enough. But the active de-selection of less-than-perfect babies is by no means limited to easily curable condition. It casts its dark shadow over more serious conditions as well:
In Denmark there is no room for children with Downs Syndrome. Unborn babies with this chromosome abnormality are aborted almost without exception … . But now this practice has expanded in a world with growing intolerance toward that which is not perfect. Every year almost 500 pregnant women in Denmark apply to have an abortion after ther 12th week – which is the Danish limit for free abortion – because the baby they are carrying has a medical condition or a disability. In most cases the condition is so serious that the child has a very small chance to survive. However, the abortion is far from always in response to [the child having a] life threatening condition. Recently the national newspaper Politiken reported that unborn babies are being discarded after having been diagnosed with medical conditions with which they can live a long life, provided they get the right treatment.
Of 488 applications for late term abortion in Denmark in 2011,
…only eleven were denied, while 118 applications to abort a baby with Downs Syndrome were approved. In the remaining cases the majority was about conditions that were so serious that the child would probably not have survived birth. But the report also shows an other, emerging trend. The [Danish paper Politiken] reports, e.g., about 13 unborn babies who were diagnosed with Turner’s and Klinefelter’s Syndrome, who were also aborted. Both diseases are caused by chromosome abnormalities … and affect among other things growth, the production of hormones and the ability to have children.
Thanks to steady advancements in medicine, the outlook for children with these conditions is increasingly positive. It is patently absurd that at the same time there is a growing trend to abort babies with “abnormalities”.
The motive behind this baby discard trend is a growing need to contain costs in socialized medicine. With that need comes a social and cultural climate that is harsher, stingier and more unforgiving toward abnormalities that:
a) increase the individual citizen’s need for medical care throughout her life span, and
b) decrease the likelihood that she will be a net taxpayer throughout her life (as opposed to a net consumer of government services).
The point about people being net taxpayers over their life span is a crucial one. It carries a lot more weight in the resurrection of eugenics than many people may realize. In my book Remaking America: Welcome to the Dark Side of the Welfare State I report numerous cases where the Swedish government forces people with serious medical conditions back to work despite their apparent inability to even hold a part-time job. One of the stories is about a man with leukemia who was declared able to work by government under the premise that government needed more tax revenues.
Under a regime of socialized medicine, babies are subjected to the same life-span taxpayer calculations as adults are. Once government has established a moral norm that approves of abortions of disabled babies, that norm will proliferate and affect decisions where government is not even directly involved. Back to the Världen Idag story:
However, using cleft palate as a reason for abortion is not an isolated phenomenon. Last year, data on how many babies had been aborted – and especially for what reasons – sent shock waves through Britain. The publication [of the data] followed a long legal battle spearheaded by the Pro Life alliance. It started when Joanna Jepson, priest in the Anglican Church, went to the Supreme Court with a case of a baby that was aborted in 2001 at the 28th week of pregnancy due to cleft palate.
After a six-year long court battle, the Pro Life Alliance, defeating resistance from the British Department of Health, found that…
26 babies with cleft palate had been aborted over a nine-year period, seven of them in 2010. That same year, 147 babies were aborted after the 24th pregnancy week. … Twelve of the aborted babies had myelomeningocele (spina bifida), eight had club foot, ten had Downs Syndrome and as many had Edward’s Syndrome, also a chromosome abnormality.
It does not matter if the motives for killing babies with “abnormalities” are racially motivated or driven by “fiscal responsibility” and “cost containment”. The moral message is the same, namely that government is morally justified in putting other values above that of a human life. The very fact that tax-funded government-run health care system pays for this type of abortions is approval enough for many people. But it is easy to draw the conclusion that governments in Europe purposely allow taxpayers to fund abortions of disabled babies so that the general public will develop a habit of such abortions. That way government-paid doctors do not have to spend as much time convincing parents of disabled babies that their child falls under the principle of haushaltsunwertes leben.
What turns this deplorable practice into a modern form of eugenics is the extension from abortions to infanticide. The aforementioned medical ethicists, Giubilini and Minerva, make a long and intricate case against babies with “abnormalities”, but it is not a case for aborting those babies.
It is a case for killing them after birth. They claim that there is no difference between aborting a disabled baby to save taxpayers money on future health care and killing that baby after it has been born:
On these grounds, the fact that a fetus has the potential to become a person who will have an (at least) acceptable life is no reason for prohibiting abortion. Therefore, we argue that, when circumstances occur after birth such that they would have justified abortion, what we call after-birth abortion should be permissible. In spite of the oxymoron in the expression, we propose to call this practice ‘after-birth abortion’ rather than ‘infanticide’ to emphasise that the moral status of the individual killed is comparable with that of a fetus (on which ‘abortions’ in the traditional sense are performed) rather than to that of a child. Therefore, we claim that killing a newborn could be ethically permissible in all the circumstances where abortion would be. Such circumstances include cases where the newborn has the potential to have an (at least) acceptable life, but the well-being of the family is at risk.
This open advocacy of organized, government-sanctioned infanticide is not a matter of pure theory. A horrifying story from the British newspaper Daily Mail reveals that fiscal eugenics is already being practiced bythe British tax-paid, government-run National Health Service:
Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’. Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults. But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.
How “severely disabled”?
One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone. Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ‘smaller and shrunken’.
Ten days. For ten days the hospital staff – and parents – watch a small, innocent child slowly die. And why? Because government has taken a monopoly on providing health care and determines that the baby will cost the health care system too much money over its life span.
A life unworthy of the government budget.
As the Daily Mail story continues, we learn (with emphasis added) that medical critics of the program…
say it is a form of euthanasia, used to clear hospital beds and save the NHS money. The use of end of life care methods on disabled newborn babies was revealed in the doctors’ bible, the British Medical Journal. Earlier this month, an un-named doctor wrote of the agony of watching the protracted deaths of babies. The doctor described one case of a baby born with ‘a lengthy list of unexpected congenital anomalies’, whose parents agreed to put it on the pathway. The doctor wrote: ‘They wish for their child to die quickly once the feeding and fluids are stopped. They wish for pneumonia. They wish for no suffering. They wish for no visible changes to their precious baby.Their wishes, however, are not consistent with my experience. Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days.
The ethical war on fiscally burdensome citizens extends beyond the walls of government-run hospitals and offices of professors of medical ethics. The European Union has decided that it can no longer afford to pay for assistance to disabled citizens. This decision comes after the EU has spent two decades expanding its funding of that same type of assistance. The Eurocrats have been exhibited the assertiveness of someone who thinks his checkbook will live forever. As a result, the EU has crowded out private solutions to the problems faced by citizens with disabilities. Now that government can no longer afford to meet its spending commitments, it deems the disabled too costly to care for.
Their lives are too costly to live.
Perhaps there is a cynical logic in the fact that babies are being killed within the borders of the EU, just so government won’t have to pay for their health care and disability assistance in the future.
The Daily Mail again:
‘Parents and care teams are unprepared for the sometimes severe changes that they will witness in the child’s physical appearance as severe dehydration ensues. The use of end of life care methods on disabled newborn babies was revealed in the doctors’ bible, the British Medical Journal ‘I know, as they cannot, the unique horror of witnessing a child become smaller and shrunken, as the only route out of a life that has become excruciating to the patient or to the parents who love their baby.’
When Obamacare brings this practice to America, the parents will probably be offered a painkiller.
There’s more. The Daily Mail explains that the sentencing of a baby to die by starvation and dehydration…
involves the discharge to home or to a hospice of children who are given a document detailing their ‘end of life’ care. One seen by the Mail, called ‘Liverpool Pathway for the Dying Child’ is issued by the Royal Liverpool Children’s NHS Trust in conjunction with the flagship children’s hospital Alder Hey. It includes tick boxes, filled out by hospital doctors, on medicines, nutrients and fluids to be stopped.
And that’s what the term “end of life care” means. No care at all.
Parents have to agree to their child going on the death pathway, often being told by doctors it is in the child’s ‘best interests’ because their survival is ‘futile’. Bernadette Lloyd, a hospice paediatric nurse, has written to the Cabinet Office and the Department of Health to criticise the use of death pathways for children. ‘‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die’ She said: ‘The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live.
These recommendations to parents do not come out of thin air. And they are not based on medical evaluations. They are based on one of the most cynical instruments ever developed by the economics profession. More on that in a moment. We are not done with the horror stories from the Daily Mail article.
It is very difficult to predict death. I have seen a “reasonable” number of children recover after being taken off the pathway. ‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die. ‘I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonising for him, and for us nurses to watch. This is euthanasia by the backdoor.’
Here is how health care officials characterize this government-sanctioned euthanasia:
Alder Hey confirmed that children and babies are discharged for LCP end of life care ‘after all possible reversible causes for the patient’s condition are considered’. ‘There is a care pathway to enable a dying child to be supported by the local medical and nursing teams in the community, in line with the wishes of the child patients, where appropriate, and always their parents or carers.’
Some of these children may be sick enough to have a short life span, but that is completely irrelevant. This government-paid health care system, which should be doing everything in its power to extend their lives, is actively sentencing children to death. Not only that: a person who has raped and killed a child for his own perverted pleasure would get a more humane execution than these innocent children.
At the bottom of this, of course, is the fact that the British government runs the National Health Service. Their prime purpose is not to deliver health care, but to deliver health care if government can afford it. In order to decide whose health care government can afford, the health care system applies something called Quality Adjusted Life Years (QALY). It is a system according to which government can assess the costs and benefits of providing care to individual patients.
At the heart of QALY is the question: how can a tax-paid bureaucracy compare Jack’s and Jill’s need for health care? To make this comparison the QALY model converts Jack’s and Jill’s health experiences into one common denominator. This common denominator is a utility value scale. The theoretical basis for this scale is the ethical value theory of utilitarianism, with the explicit premise that government, not Jack and Jill, assign utility values to their health care experiences. A life in perfect health is considered to have a utility value of 1, while death has a utility value of 0. In between are various health conditions that span the entire continuum between 0 and 1.
It is important to understand that Jack and Jill do not get to assign utility to their own health experiences. A government bureaucracy does that job for them. If Jack and Jill disagree with the utility assignments that the bureaucracy has made, they can protest all day long if they want to. Government has the last word – in fact, the only word – on how much or how little they suffer from their health condition.
Suppose Jack and Jill want treatment at the same hospital. There is not enough resources to treat both of them, so a health care bureaucrat is assigned the duty to decide who will be admitted. He asks the question: how close to 1 or 0 are Jack’s and Jill’s health experiences? Jack and Jill both suffer from the same type of cancer. It is currently curable in both cases but if left untreated it will kill them. The bureaucrat now asks four questions to determine who will be admitted. … 1. How many more years is the patient likely going to live? 2. How many of those years will the patient be affected by his/her health condition? 3. How much less worth living will his/her life be without treatment? 4. Is the patient likely to be paying enough taxes over the course of his/her life to compensate government for the treatment costs?
Please note again that the patient is not involved in answering any of these questions. The only purpose with them is to find a difference in utility value between Jack and Jill so that the health care bureaucrat can determine who gets treatment – and who is left to starve and thirst to death in the compassionate hands of government-provided “end of life” care.
The choice is, however, not based simply on the utility calculation. There is another aspect involved as well. Suppose the health care bureaucrat finds that Jack’s utility from his remaining life years is only slightly higher than the utility that Jill will experience. At this point, the decisive variable will be – expected tax revenues. If Jill makes more money and her future expected income will produce a lot more tax revenues for government than Jack’s income, then she will get the treatment because he is more likely to pay for his treatment through taxes than Jill is.
There is another way to look at how QALY works. Suppose Jack and Jill have the same income, are the same age and suffer from the same type of cancer. Suppose Jack was in perfectly good health before the cancer but Jill suffered from a disability. The disability means that the doctors have to provide more complex, and more costly, treatment for her cancer. The cost of surgery on her is in other words significantly higher than it is to save Jack’s life.
In this case the QALY calculation will recommend that the government-run hospital admit Jack for treatment but let Jill go without it. Because she is less able to pay for the cost of her treatment – same income, more expensive surgery – government is less likely to recover the cost of surgery in her case.
A disabled person is less likely than an able-bodied person to get health care under a QALY-run government health care system. But it does not stop here. In an excellent piece for The Freeman, October 2006, Jane M Orient, executive director of the Association of American Physicians and Surgeons, explained that the QALY model actually allows health care administrators to assign negative value to life:
It ought to be obvious that there is an unbridgeable chasm between life and death. Nevertheless, the discontinuity apparently escapes those who set up relative value scales based on “quality-adjusted life-years” (QALYs). The unstated assumption is that at some point on the QALY scale, visible to experts, the value of a life becomes negative—even less than the value of death. British instructions for how to use QALY actually include a scale where life can be given a negative value.
This is why babies are left to die in British tax-paid health “care”.
The welfare state is sold to us as one big, warm compassionate embrace by a benevolent government. In reality, that embrace is a choke hold on anyone who does not fit the welfare state’s fiscal template and tight budget. While the practice of eugenics under the umbrella of the welfare state supposedly has nothing to do with racial hygiene, the actual effect is precisely that: a population clean of costly, fiscally unwanted abnormalities.
A population that fits the ideology of the welfare state.
 Available at jstor.org. Free registration required.
 Numerous articles by the Swedish philosopher and medical ethicist cover this topic. This blog is working on an article displaying the troubling role that utilitarianism plays in the theory and practice of medical ethics.