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Published online by Cambridge University Press:  23 November 2016

Tyler M. John
Clinical Center Department of Bioethics, Building 10 Room 1C118, Bethesda, MD 20892, USA. Email:
Joseph Millum
Clinical Center Department of Bioethics and Fogarty International Center, Building 10 Room 1C118, Bethesda, MD 20892, USA. Email: URL:
David Wasserman
Clinical Center Department of Bioethics, Building 10 Room 1C118, Bethesda, MD 20892, USA. Email: URL:


One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the 'QALY trap': we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination.

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