There has been a tradition in health economics to regard all QALYs as being of the same significance and value.  One example of this is the practice in economic evaluation when estimating incremental cost-effectiveness of adding together the QALYs of the entire patient group and ignoring that some patients accrue more QALYs than others and their identity.  Another example concerns the use of a common cost-effectiveness threshold when making a series of recommendations across a range of clinical areas. A significant departure from this conventional approach has recently been introduced by the National Institute for Health and Clinical Excellence (NICE) in England when Appraisal Committees were instructed to treat life-extending, end of life treatments differently from other health technologies. This paper first discusses the criteria that must be fulfilled in order to qualify as an end-of-life treatment.  It then reviews the ways the instruction to weight end-of-life health gains could be and has been interpreted.  A key issue at the heart of the challenges of implementing this policy is whether it is the entire QALY gain or just the life extension that is to be weighted more highly.  Another issue is how inappropriate double-counting of health benefits is to be avoided.  The experience to date of implementing this policy with respect to about thirty drug treatments is reviewed and the implied valuation of end-of-life health gains is identified.  The paper closes with an appraisal of the success of this policy innovation and discussion as to how it might be further developed and refined.