Seeking to understand life, death

Terri Schiavo dies, reads the Washington Post's news alert on my desktop. After gradually starving her to death, in accordance with American law and our jurists' interpretation thereof, Schiavo finally has left us. Unwittingly, she has helped us understand, once again, what a confused, ill-informed, sometimes opportunistically cynical, but ever bizarre nation we are.

Let us start with the seemingly pious politicians and pundits who saw in this case an opportunity to proclaim the sanctity of human life. Really? In a recent series of books on the plight of the millions of Americans without health insurance, the medical and social scientists working with the prestigious Institute of Medicine of the U.S. National Academy of Sciences reminded the nation that 18,000 people die each year as a direct result of the lack of health insurance, making it the sixth leading cause of death among people aged 25-64, after cancer, heart disease, injuries, suicide and cerebral vascular disease, but before HIV/AIDS or diabetes. The nation's infant mortality rate is one of the highest in the OECD nations. Citing the CIA Fact Book 2005, economics professor Alan Krueger reminds us in The New York Times (March 31) that our infant mortality rate is higher even than Cuba's.

It can fairly be asked what the pundits and politicians who waxed so pious on the sanctity of Schiavo's life have ever done to avoid this tragic, avoidable loss of human life in the rest of America. If we searched their records, we would discover that many and probably most of them either have countenanced that loss with equanimity, doing little to avoid that loss, or, worse still, have opposed as "socialism" any attempt to provide health insurance to all American children and, indeed, to all people living in this land.

Equally troubling, however, is the idea that an evidently estranged spouse — who has fathered two children with another woman with whom he now lives — should have more say over the life and death of an American citizen than that citizen's parents, who had invested so much more time, love, caring and money in that person. Alas, it appears to be the law of the land, and the jurists who upheld it in this case seem to be on firm procedural and professional grounds. Perhaps one of Schiavo's legacies will be a reexamination of that strange law.

As an economist, I take a cruder and much less sanctimonious view of Schiavo's life and death. From all reports we know that her parents loved holding her in their arms, feeling the warmth of her body, seeing in her eyes and hearing in her sounds real or imagined responses to their words. One can view the parents' comfort as the "utility," as we economists put it, yielded by a private consumption good, namely, Schiavo's continued living. It is a consumption good for which apparently the parents were willing to pay out of their own resources, or with resources donated freely by other citizens. On what ethical ground, then, should society prevent this act of privately financed consumption, as long as it did not come at taxpayers' expense and, thus, at the possible expense of someone else deprived of health care under tight public budgets?

The only ground I can think of at the moment — although I am open to further learning — is that living might have been painful for Schiavo, in which case her parents might be accused of seeking to buy their own comfort at the expense of her pain. Was there any scientific evidence that Schiavo would suffer such pain?

In the end, we must thank Schiavo for forcing us to debate life and death more forthrightly and more thoughtfully. That debate must go beyond thoughtless proclamations on the "sanctity of human life" or the mantra that "human life is priceless." Human life years have their price, and, with their public health policies, Americans are willing to waste many even low-cost human life years in their midst. Uwe Reinhardt is the James Madison Professor of Political Economy. He can be reached at reinhard@princeton.edu.