Canadian Death Panels

You don't have anything if you're dead, which is why health-care spending is so fundamental. You can buy all the luxury cars you want but if your pacemaker goes on the fritz because you didn't replace the batteries then you won't be the owner of those luxury cars for much longer.

Despite the primacy of health-care spending, there are still limits on the amount of money available for health-care in all societies. Given finite resources, rationing must take place. In Britain, they have the "National Institute for Health and Clinical Excellence," a public body that judges whether medicine is cost-effective. Here in Ontario, we have death panels the Committee to Evaluate Drugs (CED)*.

And this is the system they have in the States.

The CED is comprised of cancer experts, so it is basically an appeal to expert authority. In the Ministry of Health's own words, their decisions are "based on the best scientific evidence." (As opposed to the other committees the government came up with that use mediocre and below-average scientific evidence.)

So the question is, "Is it appropriate to rely on science to decide who gets the cancer drugs they need and who doesn't?" I would answer, "Yes!"

Not every appeal to authority can be justified so let's analyze the CED through a critical lens by asking the following five questions:

1) Relevant? -> Is the authority cited in fact an authority in the area under discussion?
2) Reasonable? -> Is this the kind of question that can now be settled by expert opinion?
3) Accurate? -> Has the authority been cited correctly?
4) Reliable? -> Can the authority be trusted to tell the truth?
5) Why? -> Why is an appeal to authority being made at all?

1) Yes, the CED is an actual authority in the area of cancer care because it has cancer care experts on it.
2) Yes, there is enough consensus and respect for the CVs of cancer experts that questions about cancer care can be settled using their opinions. Other countries faced with similar issues have their own committees that came to the same expert opinions.
3) We can safely assume that the cancer care experts are capable of citing themselves and other cancer experts correctly.
4) We can trust cancer experts because they have no ulterior motive to lie.
5) An appeal to authority is being made because someone needs to make an objective decision in a tricky, emotion-fueled area of public policy.

An appeal to expert authority can be faulty logic but it isn't always. According to my "Understanding Arguments" book, reliance on experts is inevitable in a world where issues are complicated and the issue of limited health-care dollars is a particularly prickly one. Even the best authorities cannot guarantee no errors so we cannot say the CED is a perfect solution, but someone or something needs to make a decision on what form rationing will take and science-based experts are supposed to be the most objective and rational . Unfortunately, that objectivity and rationality will always be uninspiring next to vivid emotional appeals made on behalf of a single, sympathetic human being.

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One weird thing, though, about the CED is that the Ministry boasts it "includes cancer experts". That's good, but who else is on there? Why have non-experts on the committee at all?

Maybe the non-cancer experts on the panel are financial and statistical folks that input cost info along with what the cancer experts are telling them their public policy formulas to give the oncology the necessary context to make what is essentially a fiscal decision. Those extra steps are inescapable because of the fiscal nature of the root question being asked. However, when multiple fields of authority are being blended together, it raises a couple problems.

First, it is problematic because you have more fields that each have their own margins of error and confidence intervals, and each time you add another piece of information that is probabilistic in nature you must multiply those margins of error together. Second, interdisciplinary decisions are problematic because you are effectively creating a new, hybrid field so you lose the specialist's claim to authority.

Another weird thing about the CED is that the experts do not actually make decisions, they only make recommendations. Saying, "The ministry will ... make funding decisions on drug products based on the advice of experts," is not quite the same as saying that the experts will make the decisions. That type of setup is ideal for the politicians because it means they can wield the ultimate power if they want to but they have political cover the rest of the time as long as they go with what the experts recommend. Politicians don't want to be stuck deciding who lives and who dies, so being able to hand the problem off to technocrats certainly suits their interests.