title: Justifying terminal care by 'retrospective quality-adjusted life-years'.
abstract: A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In this paper I suggest a different way of construing 'quality' (as meaningfulness rather than physical comfort) and 'life' (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of 'retrospective QALYs' to justify funding.
authors.affiliation: School of Philosophy, University College Dublin, Dublin 4, Ireland. Christopher.cowley@ucd.ie
authors.forename: Christopher
authors.initials: C
authors.lastname: Cowley
mesh_terms: D006801:Humans; D010549:Personal Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods*; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation / Q000941:ethics; D012189:Retrospective Studies; D013727:Terminal Care / Q000941:ethics / Q000592:standards*