Some ethical considerations concerning the “quality of life as a guidance in assigning health resources

Abstract

Managing scarce resources is a troublesome problem common to all human activities. Dealing with health resources is particularly difficult because people are directly involved. The key issue in correctly assigning health resources is finding consistent criteria to support the right decisions.

During the last few years, the so called “quality of life” has become an increasingly popular concept, although its use has many ethical drawbacks. This speech tries to outline a few ethical issues that arise when we try to use “quality of life” as a decision criterion to evenily dstribute scarce health resources.

All “quality of life” measures have severe methodological fallbacks although intensive research is being carried out to achieve proper statistical tools to deal with this new kind of data. Adding the term quality to the term life becomes quite confusing. In the end, one would think that since there is such thing like a low quality life, life is not worth living and there is no point on preserving it.

Ontologically speaking, a human being is substance, while quality is just one of its multiple accidents, not a goal in itself. The essential principle: “all human beings are equally respectable” can not overseen. Unfortunately this principle alone does not solve the problem of managing scarce health resources.

From the macroeconomist point of view, cost-utility studies help decision making, but we must bear in mind that economist should serve people and the contrary shows itself as absolutely perverse. Quality of life measures also have a small impact in everyday clinical decision making. In this context, the whole dimension of the patient who seeks assistance should be taken into account, not just a bare measure of the quality of his life.

The quality of life is an ambiguous term. It can be easily used against human rights and dignity. Many authors have already pointed out the problems surrounding its practical uses. Therefore, the “quality of life” should not be used alone as if it was the only objective criterion avalaible. We must bear in mind that caring for people is hard and can not be standardised with algorithmic paths, no matter how sophisticated they might be.