AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. February 2005, Volume 7, Number 2.

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February 2005 Contents

Quality of Life and Clinical Decision Making

Ethics Poll

Quality-of-life instruments use a 0 to 1 scale where 0 equals death or conditions worse than death and 1 equals full health. Using this scale, how would you rank living with paraplegia?
Do you think it is useful to solicit numerical quality-of-life assessments from patients for the purposes of clinical decision making?
For purposes of Medicaid coverage, a state is deciding how to rank the importance of a given intervention for a chronic disease. Those asked to rate the improvement in quality of life the intervention confers should be:
Do you think it is useful to use numerical quality-of-life assessments to inform policy decisions concerning allocation of health care resources?

From the Editor

Measuring the Immeasurable? Quality of Life and Medical Decision Making
Matthis Synofzik
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Educating for Professionalism

Clinical Cases

Quality of Life and Prenatal Decisions
Commentary by Ludger Schols and Georg Marckmann
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Optional Treatments and Quality of Life
Commentary by Mary Jane Massie and Johannes Gobertus Meran
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Helping the Patient Achieve Quality-of-Life Goals
Commentary by Thomas Finucane, Alfred Simon and Muriel Gillick
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Journal Discussion

Evaluating the "Disability Paradox" in Conjunction with Resource Allocation
John Brazier
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Quality of Life and the Problem with QALY Researchers: Comments on 2 Papers
Tom Koch
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Values for Resource Allocation Should Expose the Adaptation Process, Not the Outcome
Elly A. Stolk and Floortje E. van Nooten
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Thoughts on Koch's Postulates
Peter A. Ubel
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Clinical Pearl

Assessing Quality of Life in Patients with Lumbar Sciatica
Bernd E. Will and Matthis Synofzik
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Law, Policy, and Society

Health Law

Bouvia v. Superior Court: Quality of Life Matters
Bryan A. Liang and Laura Lin
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Policy Forum

What's Wrong with Quality of Life as a Clinical Tool?
John Wyatt
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The Oregon Plan and QALYs
Fritz Allhoff
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Some Ethical Corrections to Valuing Health Programs in Terms of Quality-Adjusted Life Years (QALYs)
Erik Nord
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Quality of Life as the Basis of Health Care Resource Allocation: A Philosopher's Perspective on QALYs
Richard E. Ashcroft
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Medicine and Society

Medicine Goes to the Mall: Enhancement Technologies and Quality of Life
Carl Elliott
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Resources

Suggested Readings and Resources
PDF

Test Questions
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About the Contributors
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