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Against lifetime QALY prioritarianism

Herlitz, Anders LU (2018) In Journal of Medical Ethics 44(2). p.109-113
Abstract
Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health... (More)
Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism. (Less)
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author
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Medical Ethics
volume
44
issue
2
pages
109 - 113
publisher
BMJ Publishing Group
external identifiers
  • scopus:85048157648
ISSN
1473-4257
DOI
10.1136/medethics-2017-104250
language
English
LU publication?
no
id
5c8ab05e-8cd9-42b0-8857-8fbb52578614
date added to LUP
2024-12-10 14:56:39
date last changed
2025-04-04 13:56:06
@article{5c8ab05e-8cd9-42b0-8857-8fbb52578614,
  abstract     = {{Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism.}},
  author       = {{Herlitz, Anders}},
  issn         = {{1473-4257}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{109--113}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Journal of Medical Ethics}},
  title        = {{Against lifetime QALY prioritarianism}},
  url          = {{http://dx.doi.org/10.1136/medethics-2017-104250}},
  doi          = {{10.1136/medethics-2017-104250}},
  volume       = {{44}},
  year         = {{2018}},
}