Quality of life is the third topic that must be reviewed in order to understand any problem in clinical ethics. Although the idea of quality of life is difficult to define, it is often raised in complex cases and must be addressed. This chapter explains the concept of quality of life, analyzes its implications for clinical decisions, and suggests certain distinctions and cautions that should be observed when discussing this concept in clinical care. The chapter also reviews in detail an area of clinical care in which quality-of-life considerations often loom large, namely, end-of-life care, including termination of life support and physician-assisted dying.
3.0.1 The Ethical Principle of Beneficence as Satisfaction
The two ethical principles discussed in the previous topics, namely, beneficence and respect for autonomy, are relevant to this topic. In Topic One, we focused on one implication of the very broad idea of beneficence, namely, as a moral principle that directs persons to help others in need. Medical indications comprise the actions that aim to meet the needs of patients. In this topic, we focus on another aspect of the principle of beneficence, namely, the duty to act in ways that bring satisfaction to other persons. Many moral philosophers have taken satisfaction or happiness as a significant element of beneficence. We propose that it is particularly relevant to clinical decisions. One significant feature of all medical interventions is the aim to produce a state of satisfaction for the patient who has sought treatment. He or she is not only made well, but feels well. Quality of life, then, refers to that degree of satisfaction that people experience and value about their lives as a whole, and in its particular aspects, such as physical and psychological health. The ethical dimensions of any case in clinical medicine must include not only appropriateness of interventions (beneficence as help) and respect for the patient’s preferences (autonomy) but also the improvement of quality of life (beneficence as satisfaction). When medical care fails to do so, ethical problems will arise, as this topic will demonstrate.
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3.0.2 Meaning of Quality of Life
Quality of life as a state of satisfaction 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. Efforts have been made to develop measures of quality of life that can be used to give some empirical dimension to this value judgment and to evaluate outcomes of clinical interventions. Such measures usually list a variety of physical functions, such as mobility, performance of activities of daily living, absence or presence of pain, social interaction, and mental acuity. Scales are devised to rate the range of performance and satisfaction with these aspects of living. ...