Tydskrif vir Geesteswetenskappe
On-line version ISSN 2224-7912
VAN NIEKERK, Anton A.. Is the concern with quality of life worthwhile?. Tydskr. geesteswet. [online]. 2008, vol.48, n.3, pp. 326-337. ISSN 2224-7912.
This article investigates the question as to whether the concern with "quality of life" is worthwhile. It is well known that quality of life issues are quite prominent in the field of Bioethics, where it normally crops up in situations where questions concerning possible euthanasia or physician assisted suicide are raised. The Terry Schiavo affair is a case in point. In health care management, quality of life issues are often related to calculations of so-called QALY's or "quality adapted life years". QALY's are indicative of a blatantly utilitarian management tool in health care systems, as formulated by Thompson: "QALY's provide a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. When combined with the cost of providing the interventions, cost-utility ratios result; these indicate the additional costs required to generate a year of perfect health (one QALY). Comparisons can be made between interventions, and priorities can be established based on those interventions that are relatively inexpensive (low cost per QALY) and those that are relatively expensive (high cost per QALY)" (as quoted by Rapley 2003: 143). QALY's and related concepts that are utilised to establish "quality of life" and the extent to which such notions can help us to make difficult decisions in the clinical setting, are briefly discussed. It is then pointed out that, in terms of the acceptance of the so-called "Pollyanna Principle", people are often under the impression that their lives have more worth than is actually the case. Quality of life is no necessity in view of the evolutionary requirements of human survival. This is one of the reasons why the search for political policy in terms of concerns about "the general/public interest" constitutes problems, as has been argued by Karl Popper. The notion of "the general interest" presupposes that people can indeed agree on a standard of life quality that is acceptable to all, and that is highly debatable. The author also discusses aspects of David Benatar's recent book Better never to have been, in which it is argued that existence is always a harm and that the extinction of sentient life is, consequently, the only moral desideratum. Attention is paid to Benatar's argument in connection with the alleged "asymmetry of (the presence and absence) of pain and pleasure", and the way Benatar adapts traditional utilitarianism in this respect. This leads to a stance on abortion that is "pro death", in contradistinction to the more well-known "pro-life" stance. The author's conclusion is that the concern for quality of life is, in the end, quite futile; it is impossible to expect that consensus on the requirements of life quality could ever be found, mainly because the content bestowed on this concept is so very subjective. It is much more prudent to concern oneself with the question, not about the quality of life, but rather of the meaning of life. A meaningful life is one with a plot or a focus that can be reconstructed in a narrative - a narrative not always construed by the author of a life, but often by other people, for example descendants of the person. Examples of lives that must, without doubt, be regarded as very meaningful, though often devoid of much quality, are discussed in the article. Specific examples include Julius Caesar, Winston Churchill, Franklin D Roosevelt and Nelson Mandela. An argument is developed which claims that the quest for meaning in life is directly proportional to the extent to which one's life is devoted, not to one's own interests, but to the interests of others.
Keywords : Quality of life; meaning of life; quality adapted life years (QALY's); David Benatar; Pollyanna Principle; Karl Popper; Utilitarianism; Terry Schiavo; Richard Dawkins; asymmetry of pain and pleasure.