Do you think it is acceptable for health professionals to decide which patient is more important to save based on QALYs, quality-adjusted life-years? Using this method the number of years an individual can live is favored over the number of lives that can be saved. “QALYs are calculated by estimating the years of life remaining for a patient following a particular care pathway and weighting each year with a quality of life score” (Beauchamp and Childress 239).
The article “QALYfing the value of life” gives the following example: “Andrew, Brian, Charles, Dorothy, Elizabeth, Fiona, and George all have zero life-expectancy without treatment, but with medical care all but George will get one year complete remission and George will get seven years’ remission” (Harris 118). Using QALYs, George would be treated over the other six patients since he has a longer remission than the other patients. By valuing life-years, QALYs may require the physicians to sacrifice six lives in order to save one. This situation exemplifies the tension that can form between QALYs and beneficence. QALYs instructs the physician to assist the patient with the highest QALY score, while they are also obligated to help all of the patients due to their duty to rescue and help. Using this example as a baseline of how QALYs would be implemented in health policy, I think that QALYs should not be implemented into the system because it is ageist, favors patients that require relatively cheap treatments, and does not make a distinction between life-saving and life-enhancing treatments.
QALYs is ageist because younger individuals tend to have higher QALYs on average than older people. As a result, if there were ever a situation in which a physician had to choose to assist one of two patients, an older and a younger individual, the physician will always choose the younger patient. I believe that this is unethical and brings into question the issue of justice in bioethics. This method of valuing one’s life requires the disregard of the generalized assumption that every individual is considered equal, and no one person should be regarded as more important than another. By using QALY, physicians are obligated to prioritize younger patients over others, and thus consider those patients more important.
In addition to being ageist, this particular way of valuing one’s life also favors patients that require cheap treatments. Using this system, “the quality of life of those with illness or disability is ranked, on the QALY scale, below that of someone without a disability or illness” (Singer). In general, under QALY “if a ‘high priority health care activity is one where the cost-per-QALY is low, and a low priority activity is one where cost-per-QALY is high’” then individuals with conditions that are cheap to treat are prioritized over individuals that require more expensive treatments (Harris 119). This system discriminates against groups of patients that unfortunately suffer from a disease that is expensive to treat. QALY requires physicians to systematically save specific groups of patients, at the expense of others.
Lastly, this method of valuing life does not create a distinction between life-saving and life-enhancing treatments. In general, most people think that life-saving treatments should take priority to life-enhancing treatments; however, that is not the case with QALYs. Instead, QALYs prioritizes individuals that have higher QALYs on average, meaning that they can live longer and at a higher quality of life. As a result, if a patient who is seeking a life-enhancing treatment has higher QALYs than a patient seeking a life-saving treatment, the patient with the higher QALYs would be prioritized regardless of the treatment that they are seeking.
Calculating QALYs is also a debated topic because in order to calculate it, one must decide what the patient’s potential quality of life will be. As we have discussed earlier in this class, it is impossible for one to know how another individual would value their quality of life since we all have different experiences and values. Reflecting upon that, I think that the method of calculating QALYs is unethical because it involves making assumptions on another’s behalf that may not be entirely accurate.
Taking everything into consideration, while using QALYs would be beneficial in deciding which patient to treat first when the two patients in question are in all regards considered equal, it is not realistically practical since most two patients are not alike. Using QALYs as a method to decide which patient to treat first or which patient should be prioritized is not ethical as it discriminates against certain groups of individuals and forces an outsider to determine what the patient’s quality of life is. As a result, QALYs should not be used in health care.
Works Cited:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.
Harris, John. “Qalyfing the Value of Life.” Journal of Medical Ethics 13.3 (1987): 117-23. JSTOR [JSTOR]. Web. 30 Mar. 2017.
Singer, P., J. McKie, H. Kuhse, and J. Richardson. “Double Jeopardy and the Use of QALYs in Health Care Allocation.” Journal of Medical Ethics. U.S. National Library of Medicine, June 1995. Web. 30 Mar. 2017.
Hi Morgan!
I didn’t know anything about quality-adjusted life-years prior to reading this blog. This blog was exceptionally interesting and I thoroughly enjoyed it. I agreed with your opinion that using QALYs is not necessarily ethical. I believe this issue involves a disparity between the principle of beneficence and the principle of nonmaleficence. Doctors using QALYs must weigh the benefits they can provide a patient versus the harm they might inflict on another. I think using QALYs can only truly be ethical in a severe setting, where medical resources are scarce and health-care allocation is particularly necessary. In fact, “The QALY was originally developed as a measure of health effectiveness for cost-effectiveness analysis, a method intended to aid decision-makers charged with allocating scarce resources across competing health-care programs”. (Weinstein et al.) Taking this into account, I support your assertion that using QALYs in average healthcare settings is not ethical or fair to patients.
References
Weinstein, Milton C., George Torrance, and Alistair McGuire. “QALYs: The Basics.” Value in Health 12.1 (2009): n. pag. International Society for Pharmocoeconomics and Outcomes, 2009. Web. 31 Mar. 2017.
Thanks for sharing your thoughts on QALY! If QALY is an unethical, then what would be a more ethical way of prioritizing patients? Does an ethical way of prioritizing exist at all? Who are we to ever say whose life is more worth saving? This reminds me of the Trolley problem and its multiple variations.
Hi Morgan! You touched on very important points about using QALYs in the medical setting. I really like the point that you made about the prioritization of treatment options based on the QALYs score. I would like to add that in addition to your points, it’s kind of unethical in my opinion to base treatment based off a QALY score because they are subjective and they don’t provide a meaningful basis to treatment options. I will say that in the research that I do, we use QALYs in the clinic, but I’ve never seen them used as a prioritization type of thing, but more so as a way for the patient to weigh their options and to see whether or said a certain treatment is in their best interest. I definetly think that QALYs are useful in this sense, because they can be a point of reference, but I think the key here is that they are a point of reference for the patient deciding on the treatment and NOT the doctor performing the treatment. Great post!
Hi Morgan,
I really enjoyed your post and I agree with the points you made. The fact that QALYS prioritize some individuals over others is unethical because its placing more value on the lives of some individuals over others.
While I read your post, I thought about what QALYS mean for the rich and the poor. People who are rich have an advantage because they can afford treatment and maintain their health. People who are poor do not have the same opportunity. Using QALYS, the rich people would be preferred because they will live longer. Access to treatment is great, but sometimes the environment and other social factors prevent positive health outcomes for some individuals.
Lastly, as mentioned before in class, QALYS are useful for populations because they show which diseases are prevalent in countries. This information helps public health workers know what is affecting people and how to address it. In addition, QALYS can useful for preventive health.