‘Quality of Life’ Ethics

A basic definition of ‘quality of life’ consists of defining life-which in humans generally implies a continuation of heartbeat and breathing as minimum criteria and quality-which in reference to life seems to refer to what some consider to be other important, extra essential characteristics or attributes of life. Characteristics that are external to life itself. With the term ‘quality of life’ we are defining and judging life as needing these other essential attributes in order to say that person really has life. Albert Jonsen and his co-authors write, “In general, the phrase (‘quality of life’) expresses a value judgment: the experience of living, as a whole or in some aspect, is judged to be ‘good’ or ‘bad’, ‘better’ or ‘worse.’”[rs19,p.88] [rs23,p.27] Medical decisions, including those involving life and death issues, are based on judgments that consider all the characteristics of the situation of a patient’s medical condition and existence. Each one of these multiple and varied ‘quality of life’ characteristics can certainly be a factor in medical treatment and decision making, but it becomes an ethical problem when they are used as the factor in the decision to end someone’s life by acts of omission or commission (“they are too old”, they are too young”, they are poor”, “treating them will be too costly”, “their life won’t be as good as it could be”, “they are too sick”, etc.).

Life (having life) simply is or is not; it is a total gift not brought about by us. It is really the medical aspects surrounding medical conditions that help direct us on how to treat the various medical circumstances the patient finds himself in. For example, if I told you my 17-year-old son had a heart valve defect that needed surgery or he will die; you would probably say to fix it. If I told you he was a sickly Down’s syndrome child with an IQ of 50 would you still say fix it? If it were my sickly dad aged 85? Paul Ramsey argues that “we need only to determine which treatment is medically indicated to know which treatment is obligatory…a ‘quality-of-life’ approach wrongly shifts the focus from whether treatments are beneficial to patients to whether patients’ lives are beneficial to them” (or to us, i.e. a burden!).[rs18,pp.215-16] In providing medical care we should not be morally deciding whether this life (any life) is good or bad, but should be objectively discerning the medical factors surrounding that life, then offering treatment that best helps that person.

When we take the audacious step of deciding that a life is ‘bad’ and helping to eliminate that divine gift of life, we have ethically moved way beyond treatment decisions concerning simply the medical aspects. We have moved to the decision to eliminate life itself (kill by omission or commission). The problem with the concept of whether life is of a good or bad ‘quality’ is that it is based on peoples’ differing (subjective) judgments. Should a baby born deaf and blind (thus unlikely to be able to speak) be allowed to survive or should it be ‘allowed’ to die (killed by omission)? The Nazis and Peter Singer of Princeton feel society should be allowed to make that decision. Of course, by such reasoning, the world would have been deprived of Helen Keller. Genetic diagnoses can now be made in early pregnancy by villous sampling and babies with problems can then be discovered, diagnosed, and eliminated prior to birth (aborted). Mother Teresa responded in various ways to questions on life; but often pointed out the errors of man’s self-assuredness on who should live or not live. One of my favorite responses of hers is her reply to a pointed question as to why her all-loving God had not produced someone to find a cure for HIV/Aids. She facetiously replied, “He did, but you aborted her!”

Various schemes of criteria for ‘objectively’ making medical decisions on what is a ‘quality’ or ‘livable’ life have been devised to try and objectify actions that can be taken to withdraw support for or eliminate life. After all, if objective criteria on what is a poor quality of life can be established, then elimination of that life (by omission or commission) can supposedly proceed without criticism that the death was brought about in a subjective manner. What is a ‘quality’ or ‘livable’ life would then appear to have only ‘objective’ components, despite those components being arrived at by the subjective decisions of men. The Royal Dutch Medical Association set ‘guidelines’ in 1990 for killing incompetent people including infants. For pediatric patients a ‘livable life’ criterion was devised with these factors 1. Expected suffering (including emotional), 2. Potential to live independently, 3. The child’s life expectancy.[rs23,p.63] In our very financially oriented, secular world there is even a cost-benefit financial scheme offering us criteria to help us decide who should be treated and who should not![rs23,pp.293-318] Once put in place and remaining in place awhile, these ‘objective’ criteria would then become the standard. Those disagreeing would then appear to be the ones having a subjective agenda.

When you move away from the dignity and sanctity of the personhood of human life itself, then you move quickly into subjective rationalizations of who is not quite human. Not really human (and thus able to be eliminated) becomes: the ‘vegetative’ state person, the unwanted embryo, the old and very sick, the killer, the child molester, the Down’s syndrome person, or anyone else who becomes not fully human in someone else’s eyes. Mother Teresa summed it up before the United Nations when she said that as long as abortion continued in the world there would never be peace. She was referring to the subjective-ness of deciding who is really human by using as an example the decision that an embryo is not quite human and saying that if we could find a reason to kill it, then (paraphrasing her), “I can find a reason to kill you and you can find one to kill me”. Rationalizations that support ‘quality of life’ judgments cause us to morally err in thinking that it is ok to make God’s gift of life humanly expendable. Equality of life is a better phrase for promoting a respect for the dignity of the divinely given gift of life. It would help eliminate bigotry, bias, and moral error in our decisions concerning life or death issues.

Note: See Reference Pages (Quality of Life-Ethics) on this subject to view specific references cited above.

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