The need for evaluation of health care is a given in today's health service. Since demands are infinite and resources are finite there is an acceptance that cost considerations are integral to all interventions whether hospital or community based. This work looks at communitybased care and the dilemma of measuring services from practitioners engaged in providing community care. The article argues that any measurement should consider quality of life, a concept which continues to escape definition. There are questions around the effectiveness of Quality Adjusted Life Year (QALY) as an economic measure in this domain and some thought is given to an alternative ethical tool which seems to incorporate the individualism of today's society and the government's notion of community care.
Anderson, E. M. and Clark, L. (1982) Disability in Adolescence. London: Methuen.
2.
Aristotle (1915) Nichomachean Ethics, in W. D. Ross (ed.) The Works of Aristotle, vol. 9. London: Oxford University Press.
3.
Bhaskar, R. (1983) ‘Beef, Structure and Place: Notes from a Critical Naturalist Perspective’, Journal for the Theory of Social Behaviour13: 91–97.
4.
Brown, R. I., Bayer, M. B. and Brown, P. M. (1992) Empowerment and Developmental Handicaps: Choices and Quality of Life. London: Chapman and Hall.
5.
Callahan, D. (1989) What Kind of Life? The Limits of Medical Progress. New York: Simon and Schuster.
6.
Cohen, J. (1996) ‘Preferences, Needs and QALYs’, Journal of Medical Ethics22(5): 267–272.
7.
Cottingham, J. (ed.) (1996) Western Philosophy. Oxford: Blackwell Publications.
8.
Cummins. R. A. (1997) ‘Assessing Quality of Life’, in R. I. Brown (ed.) Quality of Life for People with Disabilities, 2nd edn.Cheltenham: Stanley Thornes.
9.
DHSS (1990) People First: Community Care in Northern Ireland in the 1990's. Belfast: HMSO.
10.
DHSS (1992) Patient's Charter.London: Department of Health and Social Services.
11.
DOH (1987) Promoting Better Health. London: HMSO.
12.
DOH (1989a) Caring for People: Community Care in the Next Decade and Beyond.London: HMSO.
13.
DOH (1989b) Working for Patients.London: HMSO.
14.
Drummond, M. F. (1991) ‘Output Measurement for Resources Allocation Decisions in Health Care’, in A. McGuire, P. Fenn and K. Mayhew (eds) Providing Health Care: the Economies of Alternative Systems of Finance and Delivery. Oxford: Oxford University Press.
15.
Etzioni, A. (1988) The Moral Dimension. New York: Free Press.
16.
Fallowfield, L. (1990) The Quality of Life: The Missing Measurement in Health Care. London: Souvenir Press (E and A).
17.
Felce, D. and Perry, J. (1995) ‘Quality of Life: Its Definition and Measurement’, Research in Developmental Disabilities16: 51–74.
18.
Finkelstein, V. and Stuart, O. (1996) ‘Developing New Services’, in G. S. Hayes (ed.) Beyond Disability: Towards an Enabling Society, pp.170–187. London: Sage Publication/Milton Keynes The Open University.
19.
Frisch, M. (1998) ‘Quality of Life Therapy and Assessment in Healthcare’, Clinical Psychology, Science and Practice5(1): 19–40.
20.
Goode, D. A. (1990) ‘Thinking about and Discussing Quality of Life’, in R. H. Schalock (ed.) Quality of Life. Perspectives and Issues.Washington DC: American Association of Mental Retardation.
21.
Griffiths Report(1983) London: Department of Health and Social Security (October).
22.
Griffiths, R. (1988) Community Care: Agenda for Action. London: HMSO.
23.
Gudex, C. (1986) ‘QALYs and Their Use By the Health Service; Discussion Paper’, University of York, Centre for Health Economics.
24.
Ham, C. and Hill, M. (1984) The Policy Process in the Modern Capitalist State. Brighton: Harvester Press.
25.
Hammond, M. (1995) ‘Care in the Community: An Ironic Project’, Paper given at conference: ‘Ethics and Community’, University of Central Lancaster, October.
26.
Harris, J. (1987) ‘QALYfying the Value of Life’, Journal of Medical Ethics13(3): 118-118.
27.
Harris, J. (1996) ‘What is the Good of Health Care?’, Bioethics10(4): 269–291.
28.
Harris, J. (1999) ‘Justice and Equal Opportunity in Health Care’, Bioethics13(5): 392–404.
29.
Hirst, M. A. (1989) ‘Patterns of Impairment and Disability Related to Social Handicap in Young People with Cerebal Palsy and Spina Bifida’, Journal of Biosocial Science21: 1–12.
30.
Hirst, M. A. (1990) ‘Multidimensional Representation of Disablement—A Qualitative Approach’, in S. Baldwin, C. Godfrey and C. Propper (eds) Quality of Life. London and New York: Routledge.
31.
Ho, Y.-S. (1982) ‘The Planning Process: Structure of Verbal Descriptions’, Environment and Planning B9: 397–420.
32.
Illich, I., Zola, I. K., McKnight, J., Caplan, J. and Shaiken, H. (1977) Disabling Professions. New York and London: Marion Boyars.
33.
MacGill, S. M. (1985) ‘Structural Analysis of Social Data: A Guide to Ho's Galois Lattice Approach and a Partial Respecification of Q-Analysis’, Experimental and Planning A17: 1089–1109.
34.
MacIntyre, A. (1985) After Virtue: A Study in Moral Theory. London: Duckworth.
35.
Mendola, W. F. and Pellegrini, R. V. (1979) ‘Quality of Life and Coronary Artery By-pass Surgery Patients’, Social Science and Medicine13A: 457–461.
36.
Mooney, G. (1992) Economics, Medicine and Health Care, 2nd edn.New York: Harvester Wheatsheaf.
37.
Morris, J. (1993) Independent Lives? Community Care and Disabled People. Basingstoke: Macmillan.
38.
Nord, E. (1992) ‘Methods for Quality Adjustment of Life Years’, Social Science and Medicine34: 559–569.
39.
Nord, E. (1999) ‘The Value of DALY life: Problems with Ethics and Validity of Disability Adjusted Life Years’, British Medical Journal319November: 1423–1425.
40.
Oliver, M. (1996) Understanding Disability. Basingstoke: Macmillan.
41.
Parsons, T. (1951) ‘Social Structure and Dynamic Process: The Case of Modern Medical Practice’, in The Social System, pp.428–479. New York: The Free Press.
42.
Patterson, W. (1975) ‘The Quality of Survival in Response to Treatment’, Journal of The American Medical Association233: 280–281.
43.
Pellegrino, E. D. (1985) ‘The Caring Ethic: the Relationship of Physician to Patient’, in A. H. Bishop and J. R. Scudder (eds) Caring, Curing, Coping: Nurse, Physician, Patient Relationships. Birmingham: University of Alabama Press.
44.
Rawls, J. (1972) A Theory of Justice. Cambridge, MA: Harvard University Press.
45.
Rosser. R. M. (1990) ‘Is it too Late to Prevent the Abuse of Quality of Life Measures?’, Lecture. London School of Hygiene and Tropical Medicine, 13 March 1990.
46.
Rosser, R. M. and Kind, P. (1978) ‘A Scale of Valuation of States of Illness: Is There a Social Consensus?’, International Journal of Epidemiology13: 117–123.
47.
Rosser, R. M., Kind, P. and Williams, A. (1982) ‘Valuation of Quality of Life: Some Psychometric Evidence’, in M.W. Jones-Lee (ed.) The Value of Life and Safety, pp.159–170. Amsterdam: North-Holland.
48.
Savulescu, J. (1998) ‘Consequentialism, Reasons, Value and Justice’, Bioethics12(3): 212–235.
49.
Schipper, H., Clinch, J. and Powell, V. (1990) ‘Definitions and Conceptual Issues’, in B. Spilker (ed.) Quality of Life Assessments in Clinical Trials, pp.11–24. New York: Raven Press.
50.
Schumaker, S. A., Anderson. R. T. and Czajkowski, S. M. (1990) ‘ Psychological Tests and Scales’, in B. Spilker (ed.) Quality of Life Assessments in Clinical Trials, pp.95–111. New York: Raven Press.
51.
Sen, A. (1987) ‘The Standard of Living: Lecture 1, Concepts and Critiques’, in G. Hawthorn (ed.) The Standard of Living. Cambridge: Cambridge University Press.
52.
Shakespeare, T. (1993) ‘Disabled People's Self-Organisation: A New Social Movement?’, Disability, Handicap and Society8(3): 249–264.
53.
Shin, D. C. and Johnson, D. M. (1978) ‘Avowed Happiness as an Overall Assessment of the Quality of Life’, Social Indicators Research5: 475–492.
54.
Slack, W. V. (1977) ‘The Patient's Right to Decide’, The Lancet30July: 240-240.
55.
Smith, A. (1987) ‘Qualms About QALYs’, The Lanceti: 1134-1134.
56.
Taylor, C. (1992) Multiculturalism and the Politics of Recognition. Princeton, NJ: Princeton University Press.
57.
Tonnies, F. (1957) Community and Society. East Lansing: Michigan University Press.
58.
Torrance, G. W. (1976) ‘Social Preferences for Health States, and Empirical Evaluation of Three Measurement Techniques’, Socio-Economic Planning Science10: 129-129.
59.
Torrance, G. W. (1986) ‘Measurement of Health State Utilities for Economic Appraisal’, Journal of Health Economics5(1): 1–30.
60.
Turner. B. (1986) Citizenship and Capitalism. London: Allen and Unwin.
61.
Walker, A. (1989) ‘Community Care’, in M. McCarthy (ed.) The New Politics of Welfare. London: Macmillan.
62.
Waltzer, M. (1983) Spheres of Justice: A Defense of Pluralism and Equality. Oxford: Blackwell.
63.
Weinstein, M. C. (1986) ‘Risky Choices in Medical Decision Making: A Survey’, Geneva Papers on Risk and Insurance11(4): 197–216.
64.
Wilmot, S. (1997) The Ethics of Community Care. London: Cassell.
65.
Woods, M. (1982) Aristotle's Eudemian Ethics, Books 1,2 and 8. Oxford: Clarendon Press.
66.
Wood, P. H. N. and Badley, E. M. (1980) People with Disabilities: Towards Acquiring Information Which Reflects More Sensitively Their Problems and Needs. New York: World Rehabilitation Fund.
67.
World Health Organization (1974) Alma Ata Declaration. WHO: Geneva.
68.
World Health Organization (1984) Report of the Working Group on Concepts and Principles of Health Promotion. Copenhagen: WHO.
69.
Worthley, J. A. (1997) The Ethics of the Ordinary in Healthcare: Concepts and Cases. Chicago, IL: Health Administration Press.
