Ashley事件から生命倫理を考える（ミラー）

腎臓癌の患者がいる。おそらく２，３年後には死ぬ。
Sutentという薬を使えば進行を遅らせて6ヶ月程度の延命が可能だが、54000ドルもコストがかかる。
たった数ヶ月の延命がそれだけの費用に値するだろうか？

たとえ、その6ヶ月のQOLがよくは無いとしても
支払い能力のある人が金を払い、薬を飲んで延命するのは、その人の勝手だ。

しかし、その患者のコストをあなたの健康保険でカバーしてやるとしたら、どうだろう？
保険会社がこの患者にsutentの使用を認めたために、あなたの保険料が高くなるのだとしたら？
たった6ヶ月の延命にそれだけの価値があると考えるだろうか？

もし、その治療が5万ドルではなく、100万ドル、1000万ドルだったとしたら、どうだろう？
他人の命を6ヶ月延ばすだけのための治療を保険会社に認めよと考えるだろうか？

いや、どこかで上限を決めてもらわないと、と考えるなら
あなたも私と同じく配給医療を導入せよと考えているのである。

Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities.