Double jeopardy and the veil of ignorance - a reply

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and 7eff Richardson, to defend QALYs against the argument from double jeopardy which Ifirst outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so farfrom all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the-use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device ofJ7ohn Rawls 's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use ofpersonal data. In an interesting and engaging paper (1) Peter Singer, John McKie, Helga Kuhse and Jeff Richardson (hereafter Singer et al) attempted to revive the ageing and ailing QALY, and give it an extension of life by attempting to improve its immune response to the argument from double jeopardy. They note that the double jeopardy argument, which I first outlined in 1987, has itself recently been given new life by its belated, and not thoroughly convincing, adoption by the United States Secretary for Health and Human Services. In