Palliative Care and the QALY Problem

Health Care Analysis 13 (4):289-301 (2005)
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Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, palliative care fares badly under a policy of QALY-maximisation, since procedures which prevent premature death (provided the life is of reasonable quality) or improve quality of life for those with longer life expectancy will produce more QALYs. This paper examines various responses to this problem and argues that in order to justify increased resources for palliative care its advocates must reject the ‘atomistic’ view of the value of life implicit in the QALY approach in favour of a ‘holistic’ or ‘narrative’ account. This, however, has implications which advocates of palliative care may be reluctant to embrace.



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Jonathan A. Hughes
Keele University

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Just Health Care.Norman Daniels - 1985 - New York: Cambridge University Press.
Equality or Priority?Derek Parfit - 2002 - In Matthew Clayton & Andrew Williams (eds.), The Ideal of Equality. New York: Palgrave Macmillan. pp. 81-125.
Life's Dominion.Melissa Lane & Ronald Dworkin - 1994 - Philosophical Quarterly 44 (176):413.
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