I think there could be a case that QALY/DALY/etc. calculations should factor in dignity in some way, and view mismatches between, say, QALY calculations and what feels “right” in terms of dignity as sign that the calculations may be leaving something important out. For example, if intervention X produces 10 QALY and makes someone feel 10% less dignified, then either we want to be sure the 10 QALY figure already incorporates that cost to dignity or it is adjusted to consider it. Seems like there is a strong case to be made for possibly more nuanced calculation of metrics, especially so we don’t miss cases where ignoring something like dignity would cause us to think an intervention was good but in fact it is overall bad once dignity is factored in. That this has come up and seems an issue suggests some calculations people are doing today fail to factor it in.
Thanks Gordon—I think that’s my intuitive sense as well. It also chimes with some of the work by IDinsight about how respondents differently value lives depending on age (putting a very strong emphasis on saving children’s lives). I should plan to spend some good time talking with people who work on calculating QALYs to see if there are opportunities to integrate this.
I think there could be a case that QALY/DALY/etc. calculations should factor in dignity in some way, and view mismatches between, say, QALY calculations and what feels “right” in terms of dignity as sign that the calculations may be leaving something important out. For example, if intervention X produces 10 QALY and makes someone feel 10% less dignified, then either we want to be sure the 10 QALY figure already incorporates that cost to dignity or it is adjusted to consider it. Seems like there is a strong case to be made for possibly more nuanced calculation of metrics, especially so we don’t miss cases where ignoring something like dignity would cause us to think an intervention was good but in fact it is overall bad once dignity is factored in. That this has come up and seems an issue suggests some calculations people are doing today fail to factor it in.
Thanks Gordon—I think that’s my intuitive sense as well. It also chimes with some of the work by IDinsight about how respondents differently value lives depending on age (putting a very strong emphasis on saving children’s lives). I should plan to spend some good time talking with people who work on calculating QALYs to see if there are opportunities to integrate this.