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-...