Should quality of life ever be a factor in medical ethics?

[SRoper]

I was in a recent conversation where some were advocating that we should take quality of life into consideration when making decisions about whether to withhold treatment from a newborn. At the time I dismissed quality of life as something to consider, but then I thought about the following scenario. Suppose someone is dying of cancer and it is believed that chemotherapy will only delay death for two months. Is it a morally justifiable decision for the patient to decide to end treatment so that the time he has left would be more enjoyable? If yes, is this not allowing quality of life into the discussion?

 

[Cheshire Cat]

It is noteworthy that in the latter scenerio, it seems that the patient could make an informed decision for himself. In the former case, it would be us making the decision for the newborn. Anyway, quality of life is often subjective and based on an individual level. A condition might seem like hell for one person, and the next may be perfectly happy with it. Quality of life should definitely be considered, but I think it would have to be a very extreme case/condition that would warrant ending the life of a newborn.

 

[Davidius]

It is noteworthy that in the latter scenerio, it seems that the patient could make an informed decision for himself. In the former case, it would be us making the decision for the newborn. Anyway, quality of life is often subjective and based on an individual level. A condition might seem like hell for one person, and the next may be perfectly happy with it. Quality of life should definitely be considered, but I think it would have to be a very extreme case/condition that would warrant ending the life of a newborn.

The adult is making a decision on his own and choosing to forgo treatment is not the same thing as euthanasia.

 

[Jim Johnston]

I was in a recent conversation where some were advocating that we should take quality of life into consideration when making decisions about whether to withhold treatment from a newborn. At the time I dismissed quality of life as something to consider, but then I thought about the following scenario. Suppose someone is dying of cancer and it is believed that chemotherapy will only delay death for two months. Is it a morally justifiable decision for the patient to decide to end treatment so that the time he has left would be more enjoyable? If yes, is this not allowing quality of life into the discussion?

First, I'd agree with the distinction Caleb drew. And, "withholding treatment" is vague. The situation would need to be spelled out. Should we keep offering CPR, even if without the infant would definately die the second we stopped?

Next, is the context and irreligious one? Some have persuasively argue that death and being dead is worse than having life, even one marked by suffering. That is, it is better to live, in any form, than to be dead. Many atheists have argued this way (cf. J.M. Fischer, The Metaphysics of Death, Stanford, 1993). In that book atheist Thomas Nagel quipped: "Dying wouldn't be so bad, if it weren't followed by death." (Also see the book for the break down of terms. Dying is that time before death. Being dead is that time after death. Death is the state in between. Philosophers are funny.)

If Christian theism is the context of the discussion, some would argue that we should not act as Lord over the time of our death. That our suffering has been ordained by God as a means of sanctification. That God put us in this situation *for our good.* It could be discipline from our Father. What's two months of suffering when facing ever lasting life? Should the martyrs who knew they were going to their certain (and quite painful!) death have drank hemlock knowing that they were going to die soon anyway? Have their remaining time be "more enjoyable?" Is there no analogy between suffering for your Lord as a martyr or as a cancer victim? Can we show the non-believer the value of a Christian worldview by how we suffer compared to how the pagan in the next room suffers?

I'd also add that while I take suffering to be an evil, I take death to be a greater evil. Jesus didn't just suffer, and then heal from thas suffering; he died, and then rose from the dead. The last, and greatest, enemy is death. Indeed, Adam and Eve were promised death if the disobeyed, not just suffering. Thus in the above instance I'd say that it is a greater evi to end your life than to suffer.

That people don't want to die is humorously illustrated in this funny story by an anonymous writer. I think the point is subtle but profound:

A very old Jewish man called his wife to bed. "I am going to die. Please call a priest -- I wish to convert to Catholicism." His wife responded with shock and disbelief, reminding her husband that they had been devout Jews all their lives. "I know, dear," he said, "but isn't it better that one of them should die than one of us?" --Anonymous.

(I also acknowledge that there are many subtilties, distinctions, and fine lines to be made in this debate. There are many types of Euthenasia, e.g., LST and PAS types. I also ackowledge that many pro-life ethicists would not agree fully with everything I've said. The suffering argument could be strengthened. I don't mean to imply that we should never seek to relieve or illeviate all forms of uffering. So, the above is my general take on the matter, but I'd also agree that we should take such questions on a case-by-case basis.)

 

[No Longer A Libertine]

I'm pro life at all costs and instances, abortion is never an option in my mind,period.

As far as euthanasia, a conscious being is not free to make this decision and be free from the guilt of murder.

Pulling the plug on a person who is brain dead and would cease to breath without the machine is a grey area to me, it is tempting to justify letting them go especially if all the machine is doing is prolonging suffering with no hope of recuperation.

 

[Pergamum]

If one is brain dead, then they are dead...it wouldn't be mercy killing.


Quality of life is very subjective. Most suicides could be justified if perceived quality of life is lacking.


However, in a terminal case where pain relieving meds could be taken, then the aim would not be to shorten one's life but to relieve pain. Thus, the principle of double effect would be in use and the action of taking meds to relieve pain (with the unintended consequence of shorterning one's life) would be permissible.