Quality of life is the third topic that must be reviewed to analyze a problem in clinical ethics. The idea of quality of life is difficult to define. However, it is often raised in complex cases and must be addressed. This chapter is devoted to explaining the concept of quality of life, analyzing its implications for clinical decisions, and suggesting certain distinctions and cautions that should be observed in 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.
The Ethical Principle of Beneficence as Satisfaction
No single ethical principle predominates in this discussion of quality of life. Both principles that we have discussed in the prior topics, namely, Beneficence and Respect for Autonomy, are relevant to this topic. However, we may select one particular aspect of the Principle of Beneficence as most relevant to this discussion about Quality of Life. In Chapter One, we limited the very broad idea of Beneficence to one of its implications, namely, as a moral principle that directs persons to help others in need. In medicine that need arises from deficits in health, and the actions are those that correct those deficits and support the patient. In this topic, we focus on another aspect of the Principle of Beneficence, namely, acting 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 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.
Beauchamp TL, Childress JM. Utilitarianism. In: Beauchamp TL, Childress JF, eds. Principles of Biomedical Ethics. 6th ed. New York, NY: Oxford University Press; 2009:336–343.
Meaning of Quality of Life
When defined as a state of satisfaction, 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. In recent years, efforts have been made to develop measures of quality of life that can be used to give some empirical basis to this value judgment and to evaluate outcomes of clinical interventions. ...