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Justifying terminal care by 'retrospective quality-adjusted life-years'

Christopher Cowley
Journal of Medical Ethics
Vol. 36, No. 5 (May 2010), pp. 290-292
Published by: BMJ
Stable URL: http://www.jstor.org/stable/25699655
Page Count: 3
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Justifying terminal care by 'retrospective quality-adjusted life-years'
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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.

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