<html> Recently I read Peter Ubel, M. D.'s book *Pricing Life* (MIT Press, 2000).  He does a good job explaining many of the thorny issues surrounding health evaluation (mostly from a clinical point of view).  He addresses issues that many people have raised about the abhorrent (and also not in accordance with most people's views) practice of valuing the lives of people with disabilities as some fraction of non-disabled people.  As a good liberal he uses "as an example" that a person with paraplegia life is 0.8 with 1 the norm.  After noting objections from some academic critics of QALY's he concludes that a person with a disability MUST be evaluated as less than normal because making them equal would "force us to conclude that curing paraplegia has no medical benefit." This is a very common logical/moral problem as I see it.  Really clever people create models in order to help them make sense of the world.  No problem with that, things are complicated and models bring clarity and direction to our thinking. The only problem is that at some point the clever person becomes boxed in by their models and can't see past them.  They start viewing the world as if the model were real (representation fallacy).  Dr. Ubel not only misses the possibility that the subjective experience of being disabled is "normal" (and hence utility of 1), he forces some problematic objective measure on them and finds that they are necessarily less than normal.  Dr. Ubel is probably a very empathetic person but his model has turned him into a monster.  It would be a lot smarter for him to acknowledge it is often the case with chronic illness, people are who they are and that is normal.  Now, if they want a cure fine, but if a person with some functional limit sees themself as normal then the outcome of "curing" them is equivalent to changing some cosmetic aspect of another person. At 06:19 PM 6/22/00, you wrote: <blockquote type=cite cite>I did not mean to imply that the demeaning of disabled is the entire picture but rather to point out that when the medical establishment (and bioethicists) set up quality of life standards that assume quality of life can be quantified and that disabled rank at the bottom because of an impairment as in the WHO DALE example, it is easier to justify NOT making expenditures to impaired people because their lives are considered "less than" a non disabled persons.  </blockquote> Peace, Jim "Able is the ultimate post-disability construct." --Stephen J. Raphael, more wag than dog <div>"Compromise used to mean that the middle of the road was a safe and reasonable place to be. Now it seems to mean acquiesence in getting run over there."</div> --Stephen J. Raphael,  more myth than legend </html>