Objectors on ethical grounds to the use of QALYs in priority-setting in public health care systems are here categorised as (I) those who reject all collective priority-setting as unethical ; (2) those who accept the need for collective priority-setting but believe that it is contrary to medical ethics ; (3) those who accept the need for collective priority-setting and do not believe that it is contrary to medical ethics, but reject the role of QALYs in it on other ethical grounds ; and (4) those who accept the need for collective priority-setting in principle, but are unwilling to specify how it should be done in practice.
It is argued that the first two groups of objectors are simply wrong, if distributive justice is a proper ethical concern in this context.
The third group is of more interest, as this group appears to believe that QALYs are unethical because it is unethical to regard QALY maximisation as the sole objective of the health care system.
This paper argues that QALYs are relevant to a much wider range of objectives than QALY maximisation, and that they can accommodate a wide variety of health dimensions and sources of valuation.
They can also accommodate the differential weighting of benefits according to who gets them, so they do not commit their users to any particular notion of distributive justice. (...)
Mots-clés Pascal : Qualité vie, Indicateur, Santé, Rationnement, Contrôle coût, Economie santé, Priorité, Politique sanitaire, Homme, Ethique, QUALY, Espérance vie
Mots-clés Pascal anglais : Quality of life, Indicator, Health, Rationing, Cost control, Health economy, Priority, Health policy, Human, Ethics
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0056564
Code Inist : 002B30A09. Création : 21/05/1997.