Sometimes in healthcare, the value of someone else’s life must be placed over another person’s life when deciding who does or does not receive treatment. It seems unethical to decide who lives and who does not; however, sometimes it is necessary no matter how difficult. So, how do healthcare professional make such difficult decisions? One way these decisions can be made are by using QALY’s which are controversial in the field.
QALY stands for the Quality Adjusted Life Year and it is often used in a situation where resources are few. The QALY method is “a new measure of quality of life which combines length of survival with an attempt to measure the quality of that survival” (Harris, 1987). With this system, a year of healthy life expectancy is worth one, but a year of unhealthy life expectancy is worth less than one. The general statement behind this system is that if a person were given the choice, they would prefer a shorter and healthier life rather than to live a long life of suffering.
In this article, the author argues against the use of QALY’s. He believes that by using this system, everyone is ok with choosing death so that another person can live because they have a better chance at having a higher quality of life. QALYs acknowledges an individual situation but does not acknowledge a situation in which an individual’s quality of life is compared to another person’s quality of life. The author does make another point that QALYs can be ageist because it is typically easier and more productive to save the life of a young person than an older person. So, using the QALY’s can be quite biased in such a situation.
Initially, when reading about QALY’s, I thought that the system was reasonable; however, the author does make a good point that it may not be the most fair system to be used. However, in my opinion, in a situation where resources are scarce, choices like these have to be made and evaluated somehow and I believe that the use of QALY’s is efficient and logical. There are other alternatives to using QALY’s such as discounted future earnings (DFE’s) and willingness to pay (WTP). DFE determines a person’s quality of life based on what a person could be expected to earn if they survived. WTP considers how much a person would be willing to pay for treatment (238). I do not agree with these alternatives. They place the value of a person’s life on monetary matters which I do not believe have a place in the medical field. QALY’s takes into account a person’s potential length and quality of life after survival if they receive treatment. These are reasonable considerations that could be very useful in a case, such as an organ transplant, where resources are scarce.
Beauchamp, T. L., & Childress, J. F. (2013). The value and quality of life. In Principles of
biomedical ethics (pp. 238-239).
Harris, J. (1987). QALYfying the value of life. Journal of Medical Ethics, 13(3), 117-123. Doi:
10.1136/jme.13.3.117
Hi Kianna
You make some really good points when explaining QALYs and the author’s argument. When you were comparing QALYs to other options such as WTP and DFE, I see where you are coming from. You argue that the other methods are much more monetary than QALYs.
I think that health is something that is pretty predictable, especially in terms of illness and length of survival. Could social status and social income be something that is also predictable? And to what sense do we determine what “quality” really is when everyone has their own individualistic sense of quality of life.
Ultimately I think that using the QALY system and utilizing it while considering its drawbacks can be a very powerful tool in our healthcare system today.
Hi Kianna
While looking into the problem of QALY, it is important to understand the pros and cons of the system.
Some advantage that QALY is that health can be described as changes in life expectancy and quality of life. There could also be a possible comparisons over a wide range of clinical outcomes. However, because it is a system with only rational judgment, it might find it hard to determine the relation to individual and social preferences for health.
Overall, I feel this system is a great attempt to evaluate one’s personal health in the situation needed.
Hi Kianna,
I really liked your rebuttal against the alternatives to QALYs that use monetary matters as a means to decide which life is most worth protecting. Ability to pay should carry no weight in necessary healthcare procedures – it is not right to deny healthcare to someone in a case where certain circumstances made them unable to pay. I also agree with your assessment of the QALY system, which was that you said it was logical. When healthcare resources are scarce, it is important not to waste them. So, they should be used on the people with the best prospects for success. It’s like that discussion we had in class about the surgery fundraiser – there is no point in throwing resources at something that is incapable of improving. However, we need to be careful and as objective as possible in determining who has the best prospects for success. If we are not, then we get problems like ageism and an inability to adequately and objectively compare two situations to figure out which one has the best chance for successful treatment.