Department of Global Public Health and Primary Care, Global Health Priorities, University of Bergen, Bergen, Norway.
Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
J Med Ethics. 2018 Mar;44(3):192-198. doi: 10.1136/medethics-2017-104365. Epub 2017 Oct 27.
In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that an individual, loss of life itself (YLL) occurs when that individual's life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life.
在全球疾病负担研究中，疾病负担以残疾调整生命年（DALY）来衡量。DALY 的首要假设是，将残疾生存年（YLD）和生命损失年（YLL）加总具有意义。然而，这并非一帆风顺。虽然发病率（YLD）是个体所经历的事情，但生命的丧失（YLL）发生在个体生命结束时。YLL 量化了一些不涉及经验且不会发生在活着的个体之间的事情。这使人怀疑 YLL 是否真的是个体负担。如果不是，那么 YLD 和 YLL 就无法比较。对于这个问题，至少有三种回应，其中只有一种是合理的：伤害的反事实解释。采取这种策略需要重新审视我们如何计算 YLL，特别是在生命早期。
