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.