The Allocation of Health Care Resources: An Ethical Evaluation of the 'Qaly' Approach
Ashgate Publishing Company, Jan 1, 1998 - Medical - 151 pages
The competition for limited health care resources is intensifying. We urgently need an acceptable method for deciding how they should be allocated. But the goods that health care produces are of very different kinds. Health care can extend the lives of children and of older people. It can make it possible for a person to walk, when without health care that person would be permanently bedridden; and it can reduce the pain and distress of people who are terminally ill. How can we possibly decide which of these - and many more - diverse achievements of health care are more deserving than others? We need a common unit by which we might be able to measure these very different goods. The Quality-Adjusted Life Year, or QALY, is the most developed proposal for such a unit of measure. In this book a distinguished team of ethicists and economists defend the core of the QALY proposal; that health care resources should be used so as to produce more years of life, of the highest possible quality. This leads to a discussion of such fundamental questions as whether all lives are of equal value, whether health care should be allocated on the basis of need and whether the QALY approach incorporates an adequate account of fairness or justice. The result is the most thorough account yet of the ethical issues raised by the use of the QALY as a basis for allocating health care resources.
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The Background to the QALY
Including Quality of Life
Types of QALYs
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50 per cent allocate resources allocating health allocation of health analysis argued argument Arne basis of QALYs better cent chance choice choose cost cost-benefit analysis cost-per-QALY cost-utility analysis Daniels death decision discrimination distributive neutrality double jeopardy egalitarian elderly equal priority example expected fair favour forgo give greater groups Harris health care resources Herbert human improvement individual issue justice Kymlicka less life-saving treatment lives maximizing QALYs measure Medical Ethics moral Nora normal species functioning normative ethics number of QALYs objection option outcome pain patients person Peter Singer possible post-treatment QALY potential preference utilitarianism preferences problem programmes QALY approach QALY gains QALY maximization QALY method QALY-based allocation quality-adjusted question rational egoist Rawls Rawls's reason reflective equilibrium relevant response restoring normal species result rules sense society someone standard gamble suffering technique theory tion trade-off treating University of Glasgow utilitarianism veil of ignorance Waldo whereas worst-off Zach