Thursday, October 9, 2014

The "Double Jeopardy" Objection to QALYs (

If you have limited medical resources, you have to allocate them somehow, and it's best to favor cases that will result in the greatest benefit and eschew the ones in which the resources will not accomplish much. Richard Chappell argues that since there is less room for improvement in the lives of those are better off, QALY-based distribution is actually likely to favor those who are suffering more. Furthermore, if the point of medical practice is to improve the health of individuals as much as possible, then it makes no sense to allocate it to individuals who are still not going to enjoy much health:
Regardless of one’s antecedent welfare levels, if one’s post-treatment welfare would be very low, then this treatment is not as worthwhile as one that offers greater benefits to its recipients. In practice, this does mean that patients with low quality of life and who would continue to have low quality of life even post-treatment will be less eligible for life-extending treatments than patients who would instead have high post-treatment quality of life. And this could be considered “double jeopardy” in a sense. But it should not be regarded as an objectionable form of double jeopardy. It’s simply to prefer treatments that benefit patients greatly over those that offer less benefit. If one’s condition admits of “little amelioration”, as Harris puts it, then that is certainly a tragedy—but our outrage should be directed at the unfairness of the world, rather than (mis)attributing “unfairness” to the policy of prioritizing treatments that will help their patients more.
But I wonder, isn't there a point of diminishing returns in the quality of a life? Isn't succoring misery more significant than ameliorating discomfort? Suppose that a medical treatment will be exactly as effective for a seriously ill person as for one who merely has a headache. It should be given to the former rather than the latter. In fact, I think this is true even if it is much less effective for the seriously ill person. 
On the other hand, I'm not sure how this reasoning would apply to life-extension treatments, which I gather are more controversial. If you extend a miserable person's life without making him or her less miserable, what good is that? (not a rhetorical question at all!)

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(BTW did you know that the "blogosphere" is actually a hypersphere, and that every blog has a 4th-dimensional antipode?)