The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.

It is common to allocate scarce health care resources by maximizing QALYs per dollar. This approach has been attacked by disability-rights advocates, policy-makers, and ethicists on the grounds that it unjustly discriminates against the disabled. The main complaint is that the QALY-maximizing approach implies a seemingly unsatisfactory conclusion: other things being equal, we should direct life-saving treatment to the healthy rather than the disabled. This argument pays insufficient attention to the downsides of the potential alternatives. We show that this sort (...) of discrimination is one of four unpalatable consequences that any approach to priority setting in health care must face. We argue that, given the alternatives, it is far from clear that we should revise the QALY-maximizing approach in response to this objection. (shrink)