Contemporary Moral Problems, Mehl

  Quality of Life

Quality of life judgments are made all the time by us and by those involved in medical care, both the patients themselves and the health care professionals.

In so far as possible the Patient should determine what care he or she does or does not receive, that is, what quality of life he or she judges to be desirable or undesirable.  This is part of your basic right to self determination.  If you are unable to express your wishes then others will be forced to decide for you, unless you have completed an Advance Directive form (or living will).

So sanctity of life is not the overriding principle in these contexts; while effort is taken to insure health and to prevent early death, the quality of the life of the patient is important.

Two important comments about quality of life judgments need to be made at the outset.  We need to ask:

1)  Who is making the judgment about quality of life--the patient or an observer; what an outside observer may judge to be intolerable, the individual from the inside may find tolerable.

2) What are the criteria used to evaluate the quality of life?   Here things get very difficult, for just as we noted with Utilitarianism, what is a good life or a bad life is not easy to say and may differ from person to person.   And when is it so bad that an individual would want to die??

Three distinctions:

  1) Restricted Quality of  Life: a person suffers from severe deficits of  physical or mental health.

Example: a patient with brittle diabetes will have to endure a dietary  and insulin regimen; a patient with laryngeal cancer will have an operation that destroys the ability to speak.

  2) Minimal Quality of Life: a person whose general physical condition has deteriorated beyond recovery, whose ability to communicate with others is severely restricted, and who appears to suffer discomfort and pain.

Example: a profoundly demented 85 year-old person is confined to bed with severe arthritis, persistent ulcers, and diminished respiratory capacity.  He must be tube-fed, restrained, and requires opiate analgesia for pain.

  3) Quality of Life below Minimal: a person suffers extreme physical debilitation as well as complete and irreversible loss of sensory and intellectual activity.

Example: a person has a respiratory arrest as a result of pneumonia. At the hospital she is placed on a respirator, but after two weeks does not regain consciousness.  A neurology consult reveals signs consistent with persistent vegetative state.

Adapted from Clinical Ethics, by Jonsen, Siegler, Winslade. (McGraw-Hill 1992)