If there was a medicine that could give both a 20-year-old and a 70-year-old ten more years of life, but only one of them could receive it, which of them would you choose? Most people would choose the younger person, but what happens when those numbers change? Dr Matthew Robson of ESE and Smarter Choices for Better Health has been researching this interesting dilemma for over four years, hoping to help shape fairer policy.
Dr Matthew Robson’s early research focused on lab experiments studying inequality aversion and selfishness in controlled settings. Now, as a postdoctoral researcher at ESE, Robson is dedicated to work that directly influences policy and aims to create real-world change. He has been researching the topic of Fair Innings for years. “The Fair Innings Argument, explored by philosophers like Bognar and Harris, suggests that individuals with lower life expectancy should be prioritised in healthcare decisions because they have not yet had the chance to live a full life.”
“But this is still very vague,” Robson continues. “When have you had your fair innings? If medication would extend the life of both the 30- and 80-year-old by 10 years, we would probably prefer giving it to the younger individual. But what if it only extends the younger person’s life by one year and the older person’s by ten? At some point, efficiency becomes a factor.”
A key distinction in this debate is between age and life expectancy. While age is strongly correlated with life expectancy, it is not the decisive factor, Robson explains. “Imagine three individuals: Peter, Joyce, and John. Peter and Joyce are 30 years old, whilst John is 50. Peter and John will die later today, but Joyce will live until she is 70. All live in perfect health throughout their lives. The total years of life they experience are 30, 70, and 50, for Peter, Joyce, and John, respectively.”
“In our studies, most participants prioritise John over Joyce,” Robson says. “Although Joyce is younger, John has a lower life expectancy. This suggests that prioritisation is based on life expectancy rather than age itself. Age serves as a predictor of life expectancy, and because younger people often have lower life expectancy due to illness or other circumstances, they tend to be prioritised. However, it is not their age that drives the decision, but rather the expectation that they will not achieve a full lifespan; their fair innings.”
To understand public attitudes towards fairness in healthcare, Robson has been working with Prof. Tom van Ourti, Prof. Owen O'Donnell and Prof. Erik Schokkaert to study how people in the UK would distribute healthcare resources to individuals with different ages and life expectancies. “The NHS is funded by taxpayers. Since we live in a democracy, I would say it’s logical that those taxpayers should have a say in how their money is spent, especially when it comes to something as important as ethics in healthcare.”
“The participants of the study are placed in the role of policymakers,” Robson explains. “They are given a fixed budget, and have to allocate resources among different individuals. Three elements vary: the age of the person receiving healthcare, their expected lifespan without intervention, and the effectiveness of the treatment.”
“By varying these factors, we can quantify how much weight participants place on fairness, efficiency, and the prioritisation of individuals with lower life expectancy,” Robson explains. Because attitudes towards fairness in healthcare may differ across cultures, the research is primarily focused on the UK. However, Robson and his colleagues plan to make their experimental and analytical code publicly available on Robsons website, allowing researchers in other countries to replicate the study and compare results.
“Right now, most health policies in the UK seem to be mostly focused on cost-effectiveness. The National Institute for Health and Care Excellence (NICE) will mostly look at the benefit on the average population, compared to the cost. We would love to see them look at it with a more distributional scale, assigning more weight to treatments benefiting the people who are worst off,” Robson explains. While these ideas are not yet fully implemented, there are signs of progress. “And it looks like they’re starting to think about it, which is great.”
- Researcher
