How should different life expectancies be valued?BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7166.1155 (Published 24 October 1998) Cite this as: BMJ 1998;317:1155
Existential model may be better than scale that uses quality adjusted life years
- Tim Benson (firstname.lastname@example.org), Chairman.
- Electronic Point of Care, Wembley, Middlesex HA0 1SU
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam PO Box 1738, 3000 DR Rotterdam, Netherlands
EDITOR —Problems with the valuation of life expectancy and quality adjusted life years1 can be traced to the underlying philosophical paradigm. The quality adjusted life year paradigm is based on 19th century classical utilitarianism. The greatest good is perfect health, which is valued at 1; being dead (and the event of death) has the value of 0. Other states are given values of <1; states judged worse than death may be given negative values.2
This century, philosophers such as Martin Heidegger and Sir Karl Popper have put forward ideas that differ from those of the utilitarians and suggest an alternative model of how to value health. Heidegger's premise is that we are unaware of things when they are normal; our conscious concern is with the abnormal. For example, we are not aware of using a door handle when we enter a room unless it is broken.3 We are not …