ABSTRACT
There are two components to QALYs: the 'life year' part and the 'quality of life adjustment factor'. In the previous chapter we looked at some of the problems surrounding the life year part, and in this chapter we look at some of the problems concerning the quality of life part. Again, we will concentrate on problems about justice and fairness, for some critics have argued that prioritizing health care on the basis of QALYs discriminates unfairly not only against the aged, but also against those whose conditions are the most resistant to successful treatment. Not only does the QALY approach discriminate against those with fewer remaining life years, some critics have ar gued, it also discriminates against those afflicted with the most grievous illnesses and injuries, because the lower an individual's anticipated quality of life after treatment the lower their QALY score (other things being equal). Not only might the 'life year' part har bour some injustice, then, but so might the 'quality-adjusted' part.
