Rosenberger Michael
Institut für Moraltheologie, Linz, Osterreich.
Z Arztl Fortbild Qualitatssich. 2007;101(5):356-61. doi: 10.1016/j.zgesun.2007.04.013.
While economy tries to solve the problem of scarcity by rationing, i.e. increasing efficiency, ethics reflect the path of the just distribution of scarce goods, necessarily including the means of transparent and fair rationing. But how can such rationing be realised in a healthcare system? Non-medical criteria such as the patient's social function or age, though vividly discussed, are inappropriate. Only medical criteria can bring sustainable solutions. The QALY and DALY models are such an attempt. Careful reflection of these measures of quality of life and, in some aspects, accompanying rules to avoid extreme unfairness will be critical to their success.
虽然经济学试图通过配给来解决稀缺问题，即提高效率，但伦理学反映了稀缺物品公正分配的途径，这必然包括透明和公平配给的手段。但在医疗系统中如何实现这种配给呢？诸如患者的社会功能或年龄等非医学标准，尽管讨论热烈，但并不合适。只有医学标准才能带来可持续的解决方案。质量调整生命年（QALY）和伤残调整生命年（DALY）模型就是这样一种尝试。对这些生活质量衡量标准进行仔细思考，并在某些方面制定配套规则以避免极端不公平，将对它们的成功至关重要。
