KIE: The QALY (quality adjusted life year) is an index developed by economists at Britain's York University to take account of quality of life factors as well as duration of survival in assessing the outcome of health care procedures or services. After explaining the general design and potential usefulness of the QALY technique in decision making about which treatments are of most benefit to patients with a particular disease, Smith discusses practical and philosophical difficulties in applying it to decisions about which patients to treat. The allocation of resources within monetary constraints is essentially a political process, and the use of a quantitative algorithm for decision making obscures--but does not avoid--the arbitrary assessment of the value of one person's life by others whose values may be different.