Kappel Klemens, Sandøe Peter
Bioethics. 1992 Oct;6(4):297-316. doi: 10.1111/j.1467-8519.1992.tb00208.x.
... We can therefore conclude that either we should go for equality; and in that case QALYs are unfair because they haven't got enough of an ageist bias. Or we should accept consequentialism; and in that case QALYs have just the right sort of ageist bias. No plausible case can, however, be made for the claim that QALYs have an unfair bias against old people. Other things being equal we ought when distributing resources essential for survival favour the young. This ethical claim can be supported both by reference to equality (the life-time-view) and by reference to consequentialism (and the premises that resources generally will be more useful when given to young people).
因此,我们可以得出结论:要么我们追求平等,在这种情况下,质量调整生命年是不公平的,因为它们没有足够的年龄歧视倾向;要么我们接受结果主义,在这种情况下,质量调整生命年具有恰当的年龄歧视倾向。然而,对于质量调整生命年对老年人存在不公平偏见这一说法,无法给出合理的论证。在其他条件相同的情况下,我们在分配生存所需资源时应该偏袒年轻人。这一伦理主张既可以依据平等(终身视角)得到支持,也可以依据结果主义(以及资源给予年轻人通常会更有用这一前提)得到支持。