1. Introduction -- 2. The Background to the QALY. The Nature of Economic Evaluation. Three Types of Economic Evaluation. Including Quality of Life. Measuring QALYs. Types of QALYs. Whose Preferences? Ethical Underpinning -- 3. Age Discrimination. The 'Fair Innings' Argument. Eliminating Ageism? Maximizing QALYs and Maximizing Utility. The Prudential Lifespan Approach. Four Problems for the QALY Approach. Saving Lives versus Maximizing QALYs -- 4. Quality of Life. QALY Levels and QALY Gains. Money for the Rich. The Compensation Objection. The Equity Objection. The Need Objection. The 'Safety Net' Objection -- 5. Double Jeopardy. Random Allocation. The Equal Value of Lives. The Veil of Ignorance. Rational Choice and Likelihood -- 6. Public Opinion. An Australian Survey. Public Opinion, Ethics and Economic Evaluation. A Role for the Expert Committee -- 7. Conclusion
