Jeff Richardson

The competition for limited health care resources is intensifying. We urgently need an acceptable method for deciding how they should be allocated. But the goods that health care produces are of very different kinds. Health care can extend the lives of children and of older people. It can make it possible for a person to walk, when without health care that person would be permanently bedridden; and it can reduce the pain and distress of people who are terminally ill. How can we possibly decide which of these - and many more - diverse achievements of health care are more deserving than others? We need a common unit by which we might be able to measure these very different goods. The Quality-Adjusted Life Year, or QALY, is the most developed proposal for such a unit of measure. In this book a distinguished team of ethicists and economists defend the core of the QALY proposal: that health care resources should be used so as to produce more years of life, of the highest possible quality. This leads to a discussion of such fundamental questions as whether all lives are of equal value, whether health care should be allocated on the basis of need and whether the QALY approach incorporates an adequate account of fairness or justice. The result is the most thorough account yet of the ethical issues raised by the use of the QALY as a basis for allocating health care resources.

On a snowy morning in January 1910, the Alaska Steamship Company liner Farallon ran aground on Black Reef in lower Cook Inlet, Alaska. Thirty-eight men escaped in the ship's lifeboats and reached the barren, ice-strewn shore of Iliamna Bay where they huddled under make-shift tents constructed from Farallon's sails. The ship had no wireless communication, and the men were stranded on a desolate, wilderness coastline in the full grip of winter with meager provisions, inadequate clothing, and little hope of rescue. Six of the men took to the open sea in a 12-foot lifeboat in a daring attempt to reach far-distant Kodiak Island and arrange for a rescue. They set out into vast Shelikof Strait--one of the most dangerous bodies of water in the North Pacific. These brave mariners, given up for lost, were finally rescued more than two months later. The Farallon incident is particularly unique in that a compelling photographic record of the wreck and the stranded party's travails were made at the time. John E. Thwaites, an amateur photographer and the ship's mail clerk, took more than 50 high-quality images of the stranded steamship shrouded in ice, the frostbitten men with burlap wrapped around their feet, and the barren, treeless lagoon. These stark pictures vividly illustrate the desperation felt by the stranded passengers and crew during their ordeal when temperatures dropped as low as -40 degrees Fahrenheit. After 29 days, they were rescued by the steamship Victoria. Author Steve K. Lloyd personally investigated the wild, storm-swept beach where wreckage from the Farallon remains visible today. Lloyd brings to life a riveting tale of hardy seafaring men who survived hunger and despair against incredible odds.

The competition for limited health care resources is intensifying. We urgently need an acceptable method for deciding how they should be allocated. But the goods that health care produces are of very different kinds. Health care can extend the lives of children and of older people. It can make it possible for a person to walk, when without health care that person would be permanently bedridden; and it can reduce the pain and distress of people who are terminally ill. How can we possibly decide which of these - and many more - diverse achievements of health care are more deserving than others? We need a common unit by which we might be able to measure these very different goods. The Quality-Adjusted Life Year, or QALY, is the most developed proposal for such a unit of measure. In this book a distinguished team of ethicists and economists defend the core of the QALY proposal: that health care resources should be used so as to produce more years of life, of the highest possible quality. This leads to a discussion of such fundamental questions as whether all lives are of equal value, whether health care should be allocated on the basis of need and whether the QALY approach incorporates an adequate account of fairness or justice. The result is the most thorough account yet of the ethical issues raised by the use of the QALY as a basis for allocating health care resources.