Abstract
End-of-life care has a number of characteristics that make economic evaluation particularly challenging. These include proximity to death, the improbability of survival gain, individuals’ changing priorities, declining cognition and effects on close persons. In view of these particularities of end-of-life care, some researchers have determined that current ‘extra-welfarist’ approaches to defining do not adequately reflect well-being. As a result, suggestions are being made that would see the QALY approach either replaced or subject to significant redefinition. The purported goal of adopting alternative evaluation approaches is to extend the evaluative space ‘beyond’. The purpose of this chapter is to guide the definition of what should be included in the evaluative space in end-of-life care.
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Notes
- 1.
The use of the term ‘consequent’ should not be understood to imply consequentialism, the notion that the outcomes of actions are the basis by which to judge the moral correctness of those actions.
- 2.
Furthermore, determining a single metric for outcome measurement is a feature of the decision rules employed and does not necessitate a unidimensional evaluative space.
- 3.
Here I have understood ‘choice’ in terms of the act of making a choice, which clearly relates to the notion of preferences and is a consequent. However, it might also be interpreted (and it may be Coast’s intention to present it) as freedom or autonomy, which should be considered a domain. Thanks to Alastair Canaway for highlighting this.
- 4.
Arguments of this kind are more common in relation to the use of subjective well-being as a consequent [37].
- 5.
The influence of wider choice sets in the hypothetical should be seen as related to but distinct from the influence of uncertainty.
- 6.
There is practical value in generic instruments that are valid for the majority of patients, but these should not be seen as a panacea.
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Acknowledgements
Thanks to Alastair Canaway, Matthew Franklin, David Parkin and Jeff Round for valuable and timely discussion of the issues raised in this chapter and for comments provided on an earlier version. All views, errors and omissions are my own.
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Sampson, C.J. (2016). Identifying Objects of Value at the End of Life. In: Round, J. (eds) Care at the End of Life. Adis, Cham. https://doi.org/10.1007/978-3-319-28267-1_8
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