Introduction to Clinical Ethics -5-

The Concept of "QOL" and the Bodily Situation

What is "a person's well-being"?

When we ask if a person is well or not, the question can be interpreted in two ways: if he lives his life well or if his situation is fine. The first interpretation refers to the person's attitude towards a particular situation, i.e. what he does or intends to do, or how he lives or intends to live in the given situation. The latter one, on the other hand, refers to his/her given situation or circumstance.

What results from the first interpretation of "a person's well-being"?

By "bodily situation", let us refer to the person's given medical situation. This situation is distinguished from other situations that the person might face, e.g. those concerning society, family, etc. "Health" and "disease", for instance, are terms that describe the bodily situation. Mental health also refers to the state of the person and therefore, is also part of the bodily situation.

The person's bodily situation is not evaluated in biomedical terms. Cancer itself, for instance, is neither good nor bad if judged only from the biological point of view. However, it is said to be bad for two reasons: first, it will result in distressing symptoms in the course of time and, second, it will shorten the patient's life. Correspondingly, the bodily situation of a person who has cancer is judged to be bad because of these predicted effects on the person, even if the person is not aware of his/her situation, or is not actually suffering from any distressing symptoms at present. Thus one's bodily situation is medically evaluated by estimating the impact that one's biological condition has on one's life as a human being, and this evaluation is based not only on one's actual present life, but also on one's predicted future life. Thus, we can define bodily situation in terms of the course of one's actual life, starting from the moment of evaluation .

In order to assess a person's life at a certain moment, we have been using the term "quality of life" (QOL). QOL, however, consists of many aspects, not all of which directly concern the bodily situation. For instance, one's quality of life is also made up of the quality of one's social and economical state, one's relationships with one's family and friends, the comfort of one's house, and other such situations that do not affect one's bodily situation, at least not directly. Therefore the question is, which aspects of one's QOL should we consider while evaluating one's bodily situation? To answer this question, we have to clarify the general concept of QOL.

I would say that a person's QOL is actually estimated according to the measure of his/her freedom or the actual choices that he or she has at the moment of estimation. For instance, pain and other distressing symptoms are bad because they hold the person against his will and restrict his or her chances of doing things freely. Psychological suffering (anxiety, depression, anger, etc.), physical disabilities and other factors that are negatively evaluated in the assessment of QOL are also bad for the same reason. Again, one's social circumstances might either enable one to do things freely or prevent one from doing them and therefore, it is also involved in one's QOL. To sum up,

QOL is a measure of the patient's actual freedom at the moment of estimation,

and we can define the condition of one's own body and mind that concerns one's freedom as "bodily QOL".

On the basis of the above conception of bodily QOL, we can conclude that one's bodily situation is estimated as the integrated sum of the freedom made possible by the condition of one's body and mind, from the moment of estimation until the time of death. Let "t1 " be the moment of estimation and "td " be the time of death. Then, the relationship between the bodily situation and QOL can be expressed as follows:

The value of a person's bodily situation at t1 is the integrated sum of the person's bodily QOL that is and will be actualized in the course of time from t1 on until td.

If you prefer a mathematical formulation,
let "B(t)" be the estimated value of the bodily situation at a moment "t" and "Q(t)" be the value of the bodily quality of life at "t".

B(t) = t1 td Q(t)dt

Thus the longer the life span and the higher the QOL at every moment, the better his present bodily situation is.

QOL, i.e. the individual's freedom, at a given moment can be estimated publicly and not privately, though it is mainly estimated on the basis of the patient's self-evaluation. Also the bodily situation at a given moment is estimated in terms of the patient's freedom, though it is valued by means of medical and therefore scientific inspection.

update: 15/August/2003



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