Are you worth keeping alive?

A committee of kind, professional strangers has done the arithmetic on Eleanor Mitchell's life. She's eighty-two. The experimental treatment costs $1.2 million. The expected benefit: three months. Cost per quality-adjusted life year: too high. Treatment denied.

The logic is sound. The faces are kind. His grandmother is still going to die.

Eleanor was a writer - thirty books over five decades, a lifetime of asking hard questions. In the months before her death, she'd been quietly investigating the system that would eventually process her, tracing the money that flows from treatment denials to grief counselling foundations to companies that bet on when patients will die. She left her grandson Daniel her research and an unfinished manuscript.

Six months after her death, Daniel opens the box. What begins as an investigation driven by grief becomes something more uncomfortable. He finds no villains, no conspiracy - just an ecosystem where everyone acts rationally and the sum of those rational actions grinds people into numbers. The compassionate counsellors are funded by the insurers who save money when treatment is denied. The foundations that help families accept loss are partnered with companies trading mortality-linked securities. The data brokers compile patient profiles and sell them to estate planners and funeral services.

Then Daniel discovers he's not outside the system. He's inside it - and has been all along.

A novel about the impossible arithmetic of human worth, the complicity we share in systems we didn't design, and the question of whether bearing witness means anything when everyone profits from the telling.

For readers of Being Mortal, When Breath Becomes Air, and Never Let Me Go.