Caring for identified versus statistical lives: An evolutionary view of medical distributive justice

Abstract

A central medical ethical concern is distributive justice, which may be framed as a problem in valuing identified lives versus statistical lives. Framing the issue in this way is important for two reasons. First, the growth of medical costs has been fueled and will continue to be fueled primarily by the growth of medical technology focused intensively, and often with little benefit for cost, on the care of identified lives. Second, there is some evidence that less expensive primary care, as opposed to high-tech medicine, is positively correlated with improved life expectancy, decreased infant and neonatal mortality, and fewer cases of low birth weight. However, shifting resources from high-tech medicine to primary care will be difficult because people find it psychologically painful to deny care to identified lives. People value identified lives more than statistical lives because we are influenced by certain cognitive preferences inherent to human nature. Natural selection has primed these cognitive preferences. There are no easy solutions to the profound problems facing healthcare systems. However, evolutionary insights can help us understand these problems and could productively inform attempts to promote primary care as opposed to high-tech medicine, thereby improving benefit for cost and enhancing social welfare.