Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res. 2003;12:599-607. Menzel P, Dolan O, Richardson J, Olsen JA. The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis. Soc Sci Med. 2002;55:2149-2158.

Patients may succeed in reaching high levels of well-being despite chronic illness or impairment because they eventually learn to adapt to their situation. As a result, these patients generally rate their own health higher than the general public rates the health of patients in these circumstances. This phenomenon has attracted the attention of quality-of-life experts like Menzel [1] and Ubel [2], who have explored these differences further. From their analyses, we get a clearer picture of the psychological processes that contribute to the discrepancies between a patient's own health rating and the general public valuations of that patient's health state. An unresolved issue, however, is the question of whose values and rankings are more appropriate to use as the basis of health care allocation—those of patients or those of the general public? It is usually assumed that resource allocation decisions should be guided by societal preferences, because they affect the entire society [3]. However, Menzel and his coauthors questioned the appropriateness of this approach, arguing that if social values fail to anticipate and account for the adaptation process, they are factually mistaken and can misrepresent a patient's quality of life [1]. This raises the question of whether pervasive social values should be considered invalid for use in resource allocation with adapted patient values used instead. In this contribution we make clear our position in the ongoing debate on this matter. The term “adaptation” refers to the instability of internal standards by which people evaluate certain outcomes or health states. For most people, an improvement in health constitutes an improvement in well-being, and vice versa: loss of functioning decreases quality of life. This is reflected in the way unaffected members of society rank quality of life for less-than-full-health states. Patients without hope for recovery from a particular problem, however, often adapt to that state of health. They learn to cope with their disabilities or lower their expectations in order to achieve a more stable state of well-being. But does this ability to adapt mean that our health care systems should