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ARTICLE |

QALYs: Their Ethical Implications-Reply

John La Puma, MD
JAMA. 1990;264(19):2503-2504. doi:10.1001/jama.1990.03450190032018.
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In Reply.—  Like Dr Danford, we believe that outcome assessment should be important in determining how resources are allocated. We do not believe, however, that such numbers tell the whole story. Much of medical practice is process—listening, encouraging, reassuring, and advising. Valid, reliable assessments of clinical process are also needed. Effective, beneficial clinical processes should be identified, studied, and taught.Drs Kaplan and Ganiats fail to identify the genuine ethical concerns QALYs raise. Our colleagues doubt that physicians act as patient advocates when they make clinical decisions. They believe that "patients want treatments that produce QALY benefits."It is easy to miss the ethical concerns that QALYs raise. Some of them are these: "quality of life can be accurately measured and used, utilitarianism is acceptable, equity and efficiency are compatible, projections of community preferences can substitute for individual patient preferences, the old have less 'capacity to benefit' than the

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