Running head: QUALITY ADJUSTED LIFE YEARS
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Ethical Considerations of Quality Adjusted Life Years for Assessing Health Interventions
Jane Student
California Baptist University
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When evaluating the effectiveness of a public health program or intervention
public health officials often consider the number of the years of life added for individuals
in order to determine the efficiency of the program. One way of evaluating with this
method includes the use of QALYs, also known as quality adjusted life years (Bernheim,
Childress & Melnick, 2015). Measuring the quality adjusted life years does not include
simply the number of years that are added onto someoneàlife, rather it involves the
evaluating the quality of life that will be lived when adding these additional years onto
oneàlife expectancy (Bernheim, Childress & Melnick, 2015). There can be many issues
involved when using the QALY approach to evaluate a health system including ethical
issues, social justice, economic inequality and legal concerns.
When discussing the use of QALYs to determine the effectiveness of a public
health program there are several issues that arise regarding social justice. Older
populations and unhealthy communities in particular are discriminated against in the case
of QALYs. The older the population is the lower number of years of life they have ahead
of them. If an intervention is only aiming to add more years of life to a population the
older populations will not benefit because they do not have as many years to give. This is
not socially just because it does not allow for older populations to have the same rights as
younger populations. This is not providing social equality between these two groups of
society members. The economic issue is caused by the poor health found in lower
income communities. Since these communities do not have the same access to health
care and tend to have more health issues they may not receive the benefit using the
QALY approach because they do not have the same capacity to benefit that would be
found in a higher income community. For example, if a high income community and a
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low income community were competing for funding to implement a program to improve
the air quality in the community the high income community has a better chance of
receiving the government funding because they will have more quality years added to
their life since they do not have the same health problems as the lower end community.
When looking at this approach for the elder and lower end communities using QALYs to
evaluate the need for these programs is unjust due to the considerations of social justice
and economic inequality.
Another issue that arises using the QALY approach includes the consideration of
it being unjust to view the life years of certain individuals as being more valuable than
the life years of others. For example, when evaluating this approach it seems that the
population that would most often receive these benefits are younger populations with few
health issues. Since these populations would be eligible for many years of quality life
they would most likely receive any benefits or funding when QALYs are used to evaluate
the health program or intervention. But, what makes the lives of these individuals more
important than the lives of other populations? While these individuals do have the
potential to live long and healthy lives we should not ignore the other populations who
may not have as fortunate of health. An intervention also may be able to positively affect
the lives of a few in this population or it may be able to affect the lives of hundreds in a
less healthy population.
In respect to political and legal considerations involving using QALYs as a
measure of evidence in public health practice and delivery there are several issues that
come into play. Some political considerations may dictate which population or party will
receive the benefit, such as certain political leaders supporting and valuing particular
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groups over others. Politicians may feel the need to support certain groups or provide for
some populations in an attempt to support their political viewpoints. This in particular
can be applied to abortion. For example, if a fund is being distributed to a group in
attempt to provide family planning services and a politician is in support of abortion they
are more likely to support a group or population who will designate the money into
making abortion readily available to more individuals. Some legal considerations include
the equality and discrimination involved in allocating funds for groups who are believed
to lead a more quality life. When certain grants and funds are distributed to groups based
off their health standing, age and other factors this could be seen as discrimination
towards the groups that are not as fortunate. This aspect of using QALYs to evaluate
health interventions could produce some legal issues because it is not providing the same
opportunities for all and discriminating against those who are in poor health.
While using the concept of determining the number of QALYs added to ones life
can be an effective tool in evaluating the effectiveness of a public health program or
intervention there are still many issues that can arise from this concept. There can be
issues involving social justice, economic and legal inequality, and political interferences
involving the use of QALYs.
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References
Bernheim, R. G., Bonnie, R. J., Childress, J. F., & Melnick, A. L. (2015). Essentials of
Public Health Ethics (1st ed.). Burlington, MA: Jones & Bartlett Learning.

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