If it saves one life, goes a common refrain, then it's worth it. "It" typically refers to paternalistic infringements on personal freedom or economic liberty. Such abstract notions ought to give way completely, say progressives, to prevent increases at the margin of suffering.

That equation apparently does not apply to VCU's West Hospital. As Sheldon Retchin, CEO of the VCU Health System, explained at a recent hearing on Richmond's master plan for downtown, the decades-old building simply does not suffice to meet the needs of a modern teaching hospital.

Others have made the same point: The structure is ill-suited to the demands of high-tech medicine. Nevertheless, preservationists insist VCU owes it to Richmond not to demolish the building, which they see as an iconic structure whose presence beautifies its surroundings. (The tens of millions of dollars VCU spends each year on indigent care for Richmonders seem to have been overlooked.)

The stance suggests mere aesthetics should hold back medical progress. Preservationists -- and advocates of the city's ostensibly "bottom-up" planning process who also have denounced VCU's plans -- doubtless will protest such a characterization. Nevertheless, at least some of them seem to care more about how VCU's hospital looks to those walking by on the outside than how much it can help the people in need on the inside. It is a badly skewed set of values that places a higher priority on lifestyle than on life itself.