Everyone will die. The question is whether, say, two extra months spent in a miserable state is worth it.

QALY optimization doesn't necessarily optimize for quality of life like it claims on the tin, it optimizes for quantity of life. Would you like 1 year and unknown discomfort or 10 years and a colostomy bag?

Near end-of-life interventions (in the US) tend to be unnecessary and leave patients worse off, and it's done because hospitals and doctors are greedy.

https://www.scientificamerican.com/article/surgery-near-end-...

No — I meant worse health.

You die in both scenarios, you live slightly longer (eg, 8 months versus 6 months) and during the overlap, you are less healthy than you would have been. Losing 6 months of seeing family, enjoying trips, etc due to side-effects from treatment just to live 2 months extra, but incredibly ill the whole 8 months.

In my perspective: you experienced less total QALY by taking the treatment and had more time, in worse health. Even counting those 2 months at zero, the non-treatment option experiences more vitality, in total — because 2 sickly months at the end doesn’t offset 6 months of lost vitality immediately before.