The Ethical Qualy - Ethical Issues in Healthcare Resource Allocations
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by Andrew Edgar, Sam Salek, Darren Shickle, and David Cohen
This book is the final fruition of a research project into the allocation of healthcareresources which was funded by the European Commission between 1993 and1996, under its BIOMED and PECO programmes. The project, which was originallyconceived by Dr Ian Harvey and others working in the Centre for Applied PublicHealth Medicine at the University of Wales College of Medicine sought to come toterms with the complex problems of scarce healthcare resources, by examining the role that quality of life measures could play in allocating those resources. From thefirst, the project was designed to bring together considerations of the technicalfeasibility of using quality of life measures, with the issue of justice or morallegitimacy of any such use.
The underlying question that the ‘Ethical QALY’ group debated repeatedly, albeit in different guises and in response to different particular issues was not simply whether the quality of life measures could be used in the planning and reform of a healthcare system, but whether they should be so used.
The objectives of the original project have been reproduced in Chapter 5 of thisbook, alongside a summary of our response to each problem set. The reader mightindeed usefully begin by looking at these objectives. A brief introduction to thegeneral debate over QALYs is not, however, out of place. The concept of the ‘QualityAdjusted Life Year’ or QALY was developed by health economists to refer to acomparative measure of a person’s health, and thus a means to assess the outcomeof medical care. Strictly, the ‘QALY’ is a specific, and rather unrefined version, of aquality of life measure. However, ‘QALY’ has taken on the connotations of a genericterm, and we use it here in that inclusive sense, to refer to the whole family ofquality of life indicators.) A crude measure of the success or outcome of healthcarewould be the extra years that a particular medical treatment adds, on average, tothe life of the patient. Such measures can be valuable but are insensitive to thecondition of the patient before and after treatment (and are indeed a poor measureof the success of treatments that seek to improve a patient’s health, withoutnecessarily thereby extending his or her life). The QALY, therefore, attempts to takeaccount of the health state of the patient, by adjusting the value of the number ofyears the patient survives, according to how healthy he or she is before and aftertreatment.
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