Is the Use of DALYs and QALYs Ethically Permissible in Triage Decisions? COVID-19 and Equity Considerations from a Queer-Crip Perspective




Disability Adjusted Life Years, Quality Adjusted Life Years, Triage, Equity, Queer-Crip Perspective


This paper explores the symbolic and material implications of the use of DALYs and QALYs as priority or tie-breaker criteria in triage decisions. It aims to answer the question of their ethical permissibility based on the particular case of the COVID-19 pandemic. For this purpose, theories framed in a queer-crip perspective and ethical frameworks of equity will be used. From a queer-crip perspective, the use of DALYs and QALYs in triage decisions discriminates against and excludes people with disabilities, as it allocates scarce resources based on ableist value judgments about people's quality of life, rather than on evidence. From the point of view of equity, it may imply and reinforce structural injustices involving inequities, that is, avoidable or remediable inequalities. This analysis will argue that the use of DALYs and QALYs categories in triage decisions allocates potentially life-saving resources based on ableist value judgments that lead to an unfair distribution of risks, burdens, and costs. Finally, two objections related to the relevance or necessity of using these or similar categories as criteria will be addressed: the independent cases of structural inequities and the inevitability of setting priorities in the face of a crisis.

Biografia do Autor


Lautaro Leani is a PhD student of Philosophy from UBA funded by a National Scientific and Technical Research Council (CONICET) fellowship. His research focuses on epistemic biases related to sexuality and disability and the mechanisms of pathologization and normalization present in the field of bioethics, particularly in end-of-life debates. His theoretical frameworks are made up of queer and crip theories and equity theories of justice. He is a member of the Program in Bioethics at FLACSO and of the research group on Applied Philosophy and Queer Politics.

Ignacio Mastroleo, University of Buenos Aires (UBA) / National Scientific and Technical Research Council (CONICET)

Dr. Ignacio Mastroleo has a Ph.D. in Philosophy, with specific training in research ethics. His recent research interests are in the ethics of medical innovation (new non-validated practice) and in the ethics of the use of unproven interventions outside clinical trials during public health emergencies (ethics of "compassionate use" during emergencies). He is a researcher at the National Research Council of Argentina (CONICET) and head of lecturers of Ethics at the Faculty of Philosophy and Literature of the University of Buenos Aires (UBA). Since 2020, he has been Associate Director of the Master's Program in Bioethics at FLACSO, a Pan American Health Organization (PAHO)/World Health Organization (WHO) collaborating center in bioethics since 2016. Since 2022, he leads the Artificial Intelligence Philosophy for Health Research Program at the Collaborative Research Institute for Intelligent Oncology (CRIION) in Freiburg, Germany.


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