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Justifying terminal care by ‘retrospective quality-adjusted life-years’
  1. Christopher Cowley
  1. Correspondence to Dr Christopher Cowley, School of Philosophy, University College Dublin, Dublin 4, Ireland; Christopher.cowley{at}


A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In this paper I suggest a different way of construing ‘quality’ (as meaningfulness rather than physical comfort) and ‘life’ (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of ‘retrospective QALYs’ to justify funding.

  • Concept of health
  • quality/value of life/personhood
  • aged
  • quality of health care
  • attitudes toward death

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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