ABSTRACT
Economics (and its literature applied to health) is-or used to befundamentally consequentialist. As a result, economists, with growing exceptions,2 and support from philosophy, tend to be concerned about states of affairs and less concerned about process issues, except to the extent that free choice is instrumental in bringing about desirable states of affairs. Those who have advocated the use of the QALY (quality-adjusted life-years) maximization rule have, however, been advocates of explicitness as well: their argument was that implicit rationing led to an allocation of health care that was not consistent with normative criteria, a point on which philosophers might be expected to agree. Indeed, one might see QALY proponents as advocates of a more extensive approach to the use of explicit normative criteria-the principle is not new as explicit statistical formulae are already used to establish a measure of geographical equity in the distribution of funds in the UK.
