The paper examines different interpretations of the QALY concept. It is suggested that the QALY interpreted as a measure of amounts of well-life does not carry sufficient empirical meaning. As a measure of individuals' personal appreciation of outcomes in their own lives the QALY does not seem to work in comparisons of life saving interventions with interventions that improve health or increase life expectancy. For the QALY to be a generally empirically meaningful concept, it looks as though it needs to be interpreted as a measure of social value. This conclusion has direct implications for how values for health states should be elicited.