 Even if this debate about how QALYs should be developed is resolved, this may have little impact on the dilemma mentioned. If disability objectively reduces quality of life, then the expected overall benefit of a health resource will tend to be adversely affected and CEA will disadvantage persons with disabilities; but on the other hand, if not, and disability does not impact on the capacity to benefit from a health resource, then people with disabilities will be disadvantaged by the provision of these resources that do not take their disabilities into account. As Amaryta Sen helpfully explains the point, the value of any resource is not constant across a population since some differences between people affect their ability to “convert” the resource into what is value, either objectively, or to them alone (Sen 1999; Ruger 2010). There are differences between people that make a difference to the value extracted from the same resource, and disability is perhaps the clearest example of such a difference.