title: Palliative care and the QALY problem.
abstract: 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.
authors.affiliation: Centre for Professional Ethics, Keele Hall, Keele University, Staffordshire ST5 5BG, UK. j.a.hughes@peak.keele.ac.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hughes
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006295:Health Resources; D006738:Hospices / Q000191:economics*; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation; D012945:Social Values