ABSTRACT
If we were to base the allocation of health care resources solely on the QALY approach, we would be assuming, as we have seen, that the distribution of QALYs among the population is unimportant. We might refer to this as the assumption of distributive neutrality. But we have also seen that this assumption has been challenged. One way of addressing this challenge, while retaining an important role for the QALY, is by recognizing that QALYs measure only health-related quality of life and acknowledging that there are other factors that make up our overall quality of life. These other factors will, of course, be very varied. They will include our personal relationships, our satisfaction with our work and our leisure opportunities. They may also include the knowledge that we are living in a certain kind of society. For example, in deciding on the allocation of health care resources, we may take into account not only the maximization of QALYs, but also the extent to which we are taking good care of the least fortunate members of our society.
