Debate Double jeopardy , the equal value of lives and the veil of ignorance : a rejoinder to Harris

Harris levels two main criticisms against our original defence ofQALYs (Quality Adjusted Life Years). First, he rejects the assumiption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Haris claimns for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Haris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. In a recent article in this journal we defended the use of QALYs as a basis for allocating health care resources.' John Harris criticised our efforts in the same issue.2 Harris exposed some shortcomings in our defence of QALYs, and we are grateful for his response to our article. Needless to say, we do not agree with everything Harris says. Indeed, we disagree with his two central claims: that all lives are of equal value, and that Rawls's veil of ignorance test does not support the QALY procedure. We hope in this rejoinder to clarify these basic, underlying points on which there remains disagreement between Harris and ourselves, and also to point out some areas of agreement. It is obvious that underlying several of Harris's criticisms is his contention that all lives are of equal value. One interpretation of this claim is the following: all individuals are equally entitled to life-saving treatment regardless of their quality of life or life expectancy, if their interest in continued life is equally as intense. However, Harris makes it clear that this is not what he means by the claim that all lives are of