The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it is a misdiagnosis to lay it at the feet of an anti-discrimination principle. The problem in fact comes from a basic tension between respecting reasonable patient preferences and other ways of ranking treatment options. As such, adopting a QALY system does not solve the problem they identify.

中文翻译：

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破泡泡？QALYs 和歧视

在医疗保健分配中使用质量调整生命年 (QALY) 被批评为对残疾人的歧视。本文考虑了 Nick Beckstead 和 Toby Ord 对这一批评的回应。他们说，即使 QALY 是歧视性的，试图避免歧视——再加上分配系统应该支持的其他核心原则——有时会导致周期性偏好形式的非理性。我建议，虽然贝克斯特德和奥德已经发现了一个问题，但将其置于反歧视原则的脚下是一种误诊。事实上，这个问题来自于尊重合理的患者偏好和其他治疗选择排名方式之间的基本张力。因此，采用 QALY 系统并不能解决他们发现的问题。