Quality-of-life judgements and QALYs
- Topic
Deciding by quality of life is legitimate when the patient judges it; using it to value other people's lives can discriminate.
What it is
Two kinds of quality-of-life judgement are made in clinical care. The capable patient's own judgement is central: only they know whether a life with certain burdens is worth it to them. The judgement of others (family, team or a health system) is riskier, because observers tend to underestimate the quality of life of people with disabilities or chronic illness. In health policy, quality of life is measured with quality-adjusted life years (QALYs): years lived multiplied by a weight from 0 (death) to 1 (full health). They help compare interventions, but they can give less priority to those who «gain» fewer QALYs, such as older or disabled people. This page extends the one on limiting life-sustaining treatment and complements the one on cost-effectiveness.
Key facts
- Legitimate clinical uses: choosing between treatments according to what the patient values and judging the proportionality of a measure.
- Illegitimate uses: denying a treatment because, in the doctor's view, «that life is not worth living», or because of the person's social worth.
- Surrogates: decide by what the patient valued, not by how they themselves would live that life.
- QALYs and DALYs: QALYs measure health gained; DALYs measure health lost to disease.
- Incremental cost-effectiveness ratio: extra cost divided by the extra QALYs.
- Other criticisms: QALYs add up benefits without looking at who receives them, and utility weights depend on whom you ask and how.
Two kinds of quality-of-life judgement
| Feature | Patient's judgement | Others' judgement |
|---|---|---|
| Who judges | The patient | Family, team or health system |
| Basis | Their values and experience | Scales, averages or impressions |
| Risk | Influence of a passing crisis or depression | Prejudice against disability or age |
| Proper use | Individual clinical decisions | Policies, with equity safeguards |
In clinical practice
- Ask what a good day looks like for the patient before judging whether a treatment is «worth it».
- If a surrogate says «I wouldn't want to live like that», redirect the question: «what would he have wanted?».
- Check whether a very low quality-of-life judgement stems from a treatable symptom, such as pain or depression.
- In committees and policy, ask that QALY analyses be accompanied by equity criteria.
Legal framework in Colombia
- Resolución 813 de 2026, art. 17.2: the record of adjusting therapeutic effort includes what the patient considers harm and intense, unbearable suffering and their concept of quality of life; if they cannot express it, it is built with relatives, close persons or representatives.
- Resolución 813 de 2026, art. 16: the patient may request adjustment of therapeutic effort according to their clinical condition and their concept of quality of life and human dignity.
- Ley 1751 de 2015, art. 15: the criteria for excluding services from public funding are a cosmetic purpose, lack of evidence of safety, efficacy or effectiveness, lack of authorization, an experimental phase and provision abroad; the law does not mention QALYs.
- Official texts checked on 2026-11-13 at minsalud.gov.co and normograma.supersalud.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
Which quality-of-life judgement carries most weight in a clinical decision?
That of the capable patient, according to their values and experience; judgements by others are used with caution.
How is a QALY calculated?
By multiplying years of life by a utility weight between 0 (death) and 1 (full health).
What is the main ethical criticism of QALYs?
That they can give less priority to older or disabled people, who gain fewer QALYs from the same treatment.
How should a surrogate decide about the patient's quality of life?
By what the patient valued and would have wanted, not by how the surrogate would live in the same situation.
Elsewhere in DurgiPedia
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Making Choices in Health: WHO Guide To Cost-Effectiveness Analysis (World Health Organization, 2003); Chapter 20: Economic evidence (Cochrane, 2024); Boletín Jurídico No. 04 de 2026, sección 2.2.6: Resolución 813 de 2026 (Ministerio de Salud y Protección Social, 2026); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Superintendencia Nacional de Salud, Normograma, 2015).
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Representative model, for educational purposes only.