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: