Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- 1 Introduction: diverse ethics
- 2 Darwinism and ethics
- 3 Creation and relation
- 4 Embryo experimentation: public policy in a pluralist society
- 5 Ethical considerations in genetic testing: an empirical study of presymptomatic diagnosis of Huntington's disease
- 6 Identity matters
- 7 The virtues in a professional setting
- 8 Medical ethics, moral philosophy and moral tradition
- 9 Roman suicide
- 10 Women and children first
- 11 Moral uncertainty and human embryo experimentation
- 12 Morality: invention or discovery?
- 13 Quality of life and health care
- 14 Dependency: the foundational value in medical ethics
- 15 Not more medical ethics
- Index
13 - Quality of life and health care
Published online by Cambridge University Press: 04 April 2011
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- 1 Introduction: diverse ethics
- 2 Darwinism and ethics
- 3 Creation and relation
- 4 Embryo experimentation: public policy in a pluralist society
- 5 Ethical considerations in genetic testing: an empirical study of presymptomatic diagnosis of Huntington's disease
- 6 Identity matters
- 7 The virtues in a professional setting
- 8 Medical ethics, moral philosophy and moral tradition
- 9 Roman suicide
- 10 Women and children first
- 11 Moral uncertainty and human embryo experimentation
- 12 Morality: invention or discovery?
- 13 Quality of life and health care
- 14 Dependency: the foundational value in medical ethics
- 15 Not more medical ethics
- Index
Summary
Quality-Adjusted-Life-Years
In recent years, Alan Williams and certain other health economists have been developing the notion of a QALY in the hope that it might supply a sound and rational basis for various decisions which medical practitioners and administrators are often required to make. That hope, given the caprice of many such decisions at present, seems to me an admirable one. The foundation of their project is, as far as one can make out, consistently utilitarian. The QALY is offered as a criterion by which the most efficient of various outcomes can, and indeed ought to be, selected. Behind the advocacy of the QALY, then, lies what Philippa Foot has called the compelling and ‘rather simple thought that it can never be right to prefer a worse state of affairs to a better’. I myself find this thought compelling.
Before proceeding, I should make clear what I understand by a QALY, Williams himself gives the following account:
[W]e need a simple, versatile, measure of success which incorporates both life expectancy and quality of life, and which reflects the values and ethics of the community served. The … QALY … measure fulfils such a role.
The essence of a QALY is that it takes a year of healthy life expectancy to be worth 1, but regards a year of unhealthy life expectancy as worth less than 1. Its precise value is lower the worse the quality of life of the unhealthy person (which is what the ‘quality adjusted’ bit is all about). […]
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- Information
- Medicine and Moral Reasoning , pp. 171 - 183Publisher: Cambridge University PressPrint publication year: 1994