DOUBLE JEOPARDY AND THE USE OF QALYS IN HEALTH-CARE ALLOCATION

The we of the Quality Adjusted Life-Year (QALY) as a measure of the be nefit obtained from health care expenditure has been attached on the g round that it gives a lower value to preserving the fives of people wi th a permanent disability or illness than to preserving the lives of t hose who are healthy and nor disabled The reason for this is that the quality of life of those with illness or disability is ranked on the Q ALY scale, below that of someone without a disability or illness. Henc e we can, other things being equal, gain more QALYs by saving the five s of those without a permanent disability or illness than by saving th e fives of those who are disadvantaged in these ways. But to do so put s these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, bur because of it, a l ow priority is given to forms of health care that can preserve their l ives. This, so the objection runs, is unjust or unfair. This article a ssesses this objection to the use of QALYs as a basis for allocating h ealth care resources. It seeks to determine what is sound in the doubl e jeopardy objection, and then to show that the defender of QALYs has an adequate response to it.