QALYs as a test case

We are talking about Quality Adjusted Life Years (QALYs) because it gives us a test case to think about fairness and the original position. Today’s class introduced the charge against QALYs while Thursday’s class will bring the original position in to try to determine whether the charge is accurate.

What are QALYs?

QALYs are used to compare different ways of allocating resources to health care. The idea is that resources should be allocated so as to produce the greatest number of QALYs. That, the idea goes, represents the most efficient use of our health care budget.

As the name suggests, the Quality Adjusted Life Year is a unit that takes into account both the length of life and the quality of life. Quality is measured from 1 (full health) to 0 (death) and length is measured in numbers of years.

If a treatment would prolong my life for five years and in each of those years my life will have a quality measured at .9, that treatment will be worth 4.5 QALYS (5 years × .9 QALYS/year).

If a treatment would improve the quality of my life from .8 to .9 and I expect to live 20 years, that treatment would be worth 2 QALYs (20 years × .1 QALYs/year).

Individuals might sensibly use QALYs to think about care for themselves. If I have to decide between two treatments and one will give me a longer lifespan while the other will give me greater quality of life, I could calculate the QALYs that each treatment would produce to decide what to do.

What is the problem?

QALYs are controversial when they are used to make decisions about how to allocate resources among different people. Harris thinks that a society that used QALYs in this way would be unjust. His case goes like this.

  1. A society must treat its members as equals; it would be unjust not to do so.
  2. Treating people as equals means valuing their lives equally (Harris 1987, 118).
  3. Maximizing QALYs does not value lives equally.
  4. Therefore, a society that tried to maximize QALYs would be unjust.

The first two points are moral assumptions that Harris does not argue for. Most of his article is devoted to substantiating the third point. In order to do that, he presents a number of cases that, he believes, illustrate the point.

In all of these cases, Harris’s basic point is the one that Semassa summarized so well. The vast majority of people put the same value on their lives. One year of life for an old person in poor health is just as precious for that person as a year of good health is for a younger person.

More to the point, according to the first two premises in Harris’s argument, this is the way that a society should value its members’ lives: as equally precious.

Key concepts

  1. What QALYs are and how they are used.
  2. Why Harris believes it would be unjust for a society to allocate its health budget in ways that maximize QALYs.


Harris, John. 1987. “QALYfying the Value of Life.” Journal of Medical Ethics 13: 117–23.