Utilitarianism and the Measurement and Aggregation of Quality – Adjusted Life Years

It is widely accepted that one of the main objectives ofgovernment expenditure on health care is to generate health. Sincehealth is a function of both length of life and quality of life, thequality-adjusted life-year (QALY) has been developed in an attempt tocombine the value of these attributes into a single index number. TheQALY approach – and particularly the decision rule that healthcare resources should be allocated so as to maximise the number of QALYsgenerated – has often been equated with the utilitarian philosophyof maximising `the greatest happiness of the greatest number'. Thispaper considers the extent to which the measurement and aggregation ofQALYs really is utilitarian by developing a new taxonomy in order toclassify utilitarianism and the different aspects of the QALY approach.It is shown that the measurement of QALYs is consistent with a number ofdifferent moral positions and that QALYs do not have to be aggregatedaccording to the maximisation rule. Therefore it is inappropriate tonecessarily equate QALYs with utilitarianism. It is shown thatmuch turns on what in principle the QALY represents and howin practice it can be operationalised. The paper highlights thecategory confusion that is often present here and suggests possibleavenues for future theoretical and empirical research.