Lewenskwaliteit in biomediese konteks : filosofies-etiese ondersoek
Thesis (MPhil (Philosophy))--University of Stellenbosch, 2006.
ENGLISH ABSTRACT: Every individual has a mental image of what a ‘good’ life entails. Whether this idea of a good life is based on hedonist, preference satisfaction or ideal theories, or a combination of these theories, it forms the underlying framework that indicates and measures how well or how poorly we are doing. The smaller the discrepancy between these suppositions we nurture and our real circumstances, the greater the degree of wellbeing and satisfaction we experience. This satisfaction with our lives can be indicated on objective and subjective scales, and these serve as a direct reflection of our quality of life. In addition to self experienced quality of life, quality of life is also seen as the aim of health care. However, as the World Health Organization (WHO) sketches an almost utopian view of health, the field is deemed to be so wide that it includes man in his totality. This state of total psychological, physical and social welfare is further seen as a primary or basic necessity to which everyone is entitled. Human welfare, or quality of life, viewed from a healthcare perspective, serves as the criterion for substantiating, informing and guiding health care. Not only are choices regarding the type and degree of intervention in the therapeutic situation guided by this, but quality of life is also regarded as the single cut-off point for determining whether continued existence would be better or worse than not existing at all. A further outcome of quality of life is the use of QALYs (quality-adjusted life years) and TTO (Time trade-off). These instruments are designed to determine the net efficiency of therapeutic intervention by combining two dimensions, namely quality and quantity of life. Quality of life and [healthy] lifespan are therefore combined in a single framework of value assessment, and this framework is applied as the main criterion for allocating limited resources. This application of quality of life has been adjusted to serve as the main measure for determining the value of a life. In this study quality of life will critically be investigated with the focus on self experienced quality of life; quality of life as the aim of health care; and quality of life as the determining factor to place a value on a human life. The study indicates that the concept of quality of life had to undergo a natural and unavoidable development and expansion to keep pace with the changed medical ethos of our times. The writer indicates that the transformation of quality of life as the aim of healthcare to quality of life as the factor for determining the value of a life is currently ethically unacceptable in its application. Finally, a more acceptable development that includes referred competition and social responsibility is suggested.