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QALY: An Ethical Issue that Dare Not Speak its Name

Cardiff School of Nursing and Midwifery Studies, Cardiff University, Room 3.1, Ty Dewi Sant, Heath Park, Cardiff CF14 4XN, UK. Tel: +44 (0)29 2074 2265; Fax: +44 (0)29 2074 3883; hirskyj{at}cf.ac.uk

The current British Government's policy towards resource allocation for health care has been informed by the commissioned Wanless Report. This makes a case for the use of quality adjusted life years (QALYs) to form a rationale for resourcing health care and has implications for the staff and patients who work in and use the health service. This article offers a definition of the term ‘QALY’ and considers some of the strengths and weaknesses of this approach to resource distribution. An account is also given of an alternative formula, the DALY (disability adjusted life years), which can address some of the problems that are associated with QALYs. The values of the public, patients and nurses are identified and linked to the potential effect of a QALY formula. The implications of QALY use are applied to the health care of patients and a discussion is offered with regard to whether this method of resource allocation can be considered as just.

Key Words: NHS • nursing • patients • public • QALY • values

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