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November 21, 1990

QALYs: Their Ethical Implications

JAMA. 1990;264(19):2502-2503. doi:10.1001/jama.1990.03450190032016

To the Editor.—  The article by La Puma and Lawlor1 summarizes several common criticisms of quality-adjusted lifeyears (QALYs). Although there is considerable disagreement about the exact method for estimating QALYs, a growing consensus suggests there is a need for a general outcome measure that integrates morbidity and mortality into a common unit.2La Puma and Lawlor identify ethical problems with QALYs. Yet, in each of the cases they discuss we question their understanding of the concepts, and we failed to find a genuine "problem."They suggested that quality of life cannot be measured. In fact, there are a wide variety of measures for which there is substantial documentation of validity and reliability.3 Second, they challenge the QALY concept because community preferences are used to make decisions in individual cases. The QALY concept allows for circumstances in which individual rather than community weights are used. Community preference