Quality‐adjusted life years (qalys) versus willingness to pay in matters of life and death

Qalys (quality‐adjusted life years) are used to make judgements about resource allocation in medical care and other matters. Since this may involve the qalys of prospective individuals (who are not yet born but may be born under some relevant alternative and not in another), the use of qalys involves a fundamental philosophical problem related to optimal population, believed to be “insoluble”. This paper provides a solution to this problem that is based on the classical utilitarian position modified to account for the partiality of existing people towards their own welfare. However, a different difficulty with qalys is raised since the use of qalys may be Pareto inefficient in comparison to using willingness to pay. The objection to willingness to pay based on inequality is responded to.