品質調整された寿命年数. 医師や政策立案者に対する倫理的意味合い

J La Puma¹, E F Lawlor

¹Center for Clinical Ethics, Lutheran General Hospital, Park Ridge, IL 60068.

JAMA

|June 6, 1990

まとめ

医療経済学では,品質調整寿命年数 (QALYs) が議論されている. 倫理的前提と意思決定のシフトにより,QALYは政策上の問題となり,臨床使用においては危険である.

科学分野:

健康経済学医療経済学
医療倫理医療倫理について
公共衛生政策公共衛生政策

背景:

品質調整寿命年数 (QALYs) は,経済分析における健康成果の指標である.
QALYは,健康状態における生命の延長と患者によって評価された生活の質の両方を含む.

研究の目的:

資源配分におけるQALYの使用を支える倫理的仮定を批判的に評価する.
QALYの実施が臨床的意思決定と患者の自律性に及ぼす影響を分析する.

主な方法:

コスト・パー・QALYガイドラインの6つのコア倫理的仮定のレビュー.
QALYsによる制御場所と臨床遭遇のダイナミクスのシフトの分析.

主要な成果:

QALYは,生活の質の測定可能性,功利主義,公平性,コミュニティ対個人の好み,年齢に基づく利益を得る能力,および医師の遵守に関する議論の余地のある仮定に依存しています.
QALYは,患者の自律性と臨床判断から,コミュニティの好みや公式のリソース割り当てツールへの移行を導入します.
これは,医療の意思決定における財務的倫理観を反映し,強化しています.

結論:

QALYの現在の適用は,健康政策において問題があり,投機的なものである.
クリニックのベッドサイドでQALYを使用することは危険と考えられています.

キーワード:

分析的なアプローチ保健医療と公衆衛生について

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