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Tydskrif vir Geesteswetenskappe

On-line version ISSN 2224-7912

Tydskr. geesteswet. vol.48 n.3 Pretoria  2008

 

Is die sorg om lewenskwaliteit die moeite werd?

 

Is the concern with quality of life worthwhile?

 

 

Anton A. van Niekerk

Sentrum vir Toegepaste Etiek Departement Filosofie Universiteit van Stellenbosch. aavn@sun.ac.za

 

 


OPSOMMING

In hierdie artikel word die sorg om lewenskwaliteit aan 'n kritiese analise onderwerp. Aandag word geskenk aan hoe hierdie sorg opduik in bio-etiese diskussies soos die Terry Schiavo-geval. Aandag word geskenk aan die wyse waarop die begrip "quality adapted life years" (QALY's) inhoud gee aan die begrip lewenskwaliteit, en aan hoe dit gebruik word om besluite oor toegang tot, byvoorbeeld, intensiewe eenhede te fasiliteer. David Benatar se argument dat om te lewe, is om skade op te doen, en dat dit daarom beter is vir alle lewe om te verdwyn, word aan 'n kritiese analise onderwerp. Uiteindelik kom die skrywer tot die gevolgtrekking dat, vanweë die vervlietende en onstabiele betekenisse wat mense geneig is om aan die begrip "lewenskwaliteit" te heg, dit futiel is om deurslaggewende inhoud aan dié begrip te probeer gee. Dit is van veel meer waarde om ons sorge te maak oor die begrip "lewensin" as "lewenskwaliteit". Dit word aangetoon dat die lewens van mense waaroor daar weinig twyfel is dat hule lewens veel sin gehad het, in die meeste gevalle min lewenskwaliteit gehad het. 'n Argument word gekonstrueer wat aantoon dat 'n sinvolle lewe 'n lewe is wat juis min gesteur is oor kwaliteit en wat in hoofsaak bestaan uit die beskikbaarstelling van sigself aan die belange van ander.

Trefwoorde: Lewenskwaliteit, lewensin, kwaliteitsaangepaste lewensjare (QALY's), David Benatar, Pollyanna beginsel, Karl Popper, utilitarisme, Terry Schiavo, Richard Dawkins, asimmetrie van pyn en plesier


ABSTRACT

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.

Key words: 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


 

Full text available only in PDF format.

 

BIBLIOGRAFIE

Benatar, D. 2006. Better never to have been: the harm of coming into existence. Oxford: Clarendon Press.         [ Links ]

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Matlin, M.W. & Stang, D.J. 1978. The Pollyanna Principle: Selectivity in Language, Memory and Thought, Cambridge MA: Schenkman Publishing Company.         [ Links ]

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Popper, K. 1945b. The open society and its enemies, volume 2. London: Routledge & Kegan Paul.         [ Links ]

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Rachels, J. 2007. The elements of moral philosophy. Boston: McGraw-Hill.         [ Links ]

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Van Niekerk, A.A. 2005a. 'n Reg om te lewe of 'n reg om te sterwe? Terri Schiavo se lot laat die wêreld dink, Rapport (Perspektief), 3 April 2005: 2        [ Links ]

Van Niekerk, A.A. 2005b. Teodisee en misterie: oor God, kwaad en lyding, Ned. Geref. Teologiese Tydskrif, 46 (3+4): 609-622.         [ Links ]

Van Niekerk, A.A. 2005c. Geloof sonder sekerhede: besinning vir eietydse gelowiges. Wellington: Lux Verbi.         [ Links ]

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1 Vgl. oor hierdie gebeure Van Niekerk 2005a.
2 Ek maak in my bespreking van QALY 's onder andere gebruik van gedeeltes van die ongepubliseerde MPhil-tesis van my student Maritza Breitenbach (2006).
3 Ek het elders gehandel oor die vraag wat dit beteken om gelukkig te wees. Vgl. Van Niekerk 2003.
4 Vergelyk ook die volgende passasie uit Dawkins: "A gene travels intact from grandparent to grandchild passing straight through the intermediate generation without being merged with other genes...a gene...does not grow senile; it is no more likely to die when it is a million years old than when it is only a hundred...The genes are the immortals, or rather, they are defined as genetic entities that come close to deserving the title. We, the individual survival machines in the world, can expect to live a few more decades. But the genes in the world have an expectation of life that must be measured not in decades but in thousands and millions of years" (Dawkins 1989: 34).
5 Vir 'n bondige dog helder verduideliking van die hooftrekke van utilitarisme, vgl. Rachels 2007: 89-116.
6 Ek verduidelik hierdie argument, ook met verwysing na die oorspronklike bronne, meer uitvoerig in Van Niekerk 2005b: 614-615.
7 Benatar ondersoek so 'n moontlikheid in sy boek en kom tot die gevolgtrekking dat so 'n Rawlsiaanse onderhandeling altyd en noodwendig moet uitloop op die gevolgtrekking dat menslike lewe nie behoort voort te gaan nie; vgl. Benatar 2006: 178-181. In 'n kritiese bespreking van Benatar se boek wys Len Doyle egter daarop dat dit goed voorstelbaar is dat 'n Rawlsiaanse onderhandeling tot 'n ander gevolgtrekking kan kom. Dit sou naamlik verwag kon word dat die moontlike wêrelde wat die gevolg van so 'n onderhandeling is "worlds [sou kon wees] about which it could rationally be argued that, compared with Benatar's paradise of oblivion, the potential harms of existence might be accepted as being worth the potential benefits, including the harm of experiencing the absence of such benefits... Original negotiators might design a world in which they would be willing to be born that might have the following characteristics: a dramatic excess of benefit over harm; a range of goods and services which, when experienced, would make most harms seem secondary; a wide spectrum of effectively enforced positive and negative freedoms that are always exercised in the interest of the least well-off" (Doyal 2007: 574). Daarom: "the issue that faces Benatar is whether or not his analysis is flexible enough for original negotiators rationally to decide in any circumstances approximating actual human existence that his view is false and that they rather would prefer to exist rather than never experience anything" (Doyal 2007: 575).
8 Vir verdere kritiese besprekings van die utilitarisme, vg. Rachels 2007: 103-116; De Roubaix 2005: 72-153, Williams 1985:74-78 en 1988, en Brody 1983: 21-22.
9 Burke wys in sy boek oor Popper daarop dat die vereiste van probleemoplossing aan die wortel van sowel Popper se filosofiese as politieke denke lê. Vgl. Burke 1983: 1-37.
10 Vir Popper se politieke filosofie, vgl. Popper 1945a en 1945b, asook Bryan Magee se bespreking hiervan in Magee 1973: 74-107.
11 Ek sluit in dié verband aan by wat Alasdair MacIntyre die "narrative order of a single human life" noem as hy dit het oor die "core conception of a virtuous life". Vgl. MacIntyre 1981: 174, 190-209.
12 Ek het hierdie aanspraak in veel meer besonderhede uitgewerk in my 2005c: 96-116.

 

 

Anton van Niekerk is professor in en voorsitter van die Departement Filosofie en direkteur van die Sentrum vir Toegepaste Etiek aan die Universiteit van Stellenbosch. Hy spesialiseer veral op die terreine van die Bio-etiek, Godsdiensfilosofie en Filosofie van die Menswetenskappe, en is 'n (deur die NNS) B-geëvalueerde navorser. Hy is die skrywer, mede-skrywer en redakteur van 17 boeke en meer as 100 vakwetenskaplike artikels en boekhoofstukke. Onder sy bekendste boeke tel Rasionaliteit en relativisme: op soek na 'n rasionaliteitsmodel vir die menswetenskappe (1992), Geloof sonder sekerhede: besinning vir eietydse gelowiges (2005) en Ethics and AIDS in Africa: the challenge to our thinking (2005). Hy het die US se Kanseliersmedalje in 1980 en die Stalsprys vir Filosofie in 1995 verower. Hy is voorsitter van die Direksie van die Ethics Institute of South Africa (EthicSA), 'n lid van die Etiekkomitee van die Mediese Navorsingsraad en 'n direkteur van die International Association of Bioethics. Hy was ook voorheen President van die Wysgerige Vereniging van Suider-Afrika, redakteur van die South African Journal of Philosophy en lid van die Raad van die Universiteit van Stellenbosch. Hy het ongeveer 40 referate by internasionale vakkongresse gelewer, en was tot op hede die studieleier van 51 voltooide magistertesisse en promotor van 13 voltooide doktorale proefskrifte.

Anton van Niekerk is professor and chair of the Philosophy Department and director of the Centre for Applied Ethics at the University of Stellenbosch. He specializes in the fields of Bioethics, Philosophy of Religion and Philosophy of the Human Sciences. He is the author, co-author and editor of 17 books and more than 100 peer reviewed journal articles and book chapters. He holds a B-rating as researcher by the NRF. Amongst his best known books are Rasionaliteit en relativisme (Rationality and relativism) (1992), Geloof sonder sekerhede: besinning vir eietydse gelowiges (Faith without certainties: reflection for modern-day believers) (2005) and Ethics and AIDS in Africa: the challenge to our thinking (2005). He was awarded the Chancellor's Medal of Stellenbosch University in 1980 and the Stals Prize for Philosophy in 1995. He is chairperson of the Board of the Ethics Institute of South Africa (EthicSA), member of the Ethics Committee of the Medical Research Council and a director of the International Association of Bioethics (IAB). He is a former President of the Philosophical Society of Southern Africa, a former editor of the South African Journal of Philosophy and a former member of the council of the University of Stellenbosch. He has delivered some 40 papers at international conferences and has supervised 51 completed masters and 13 completed doctoral dissertations.

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