Is die sorg om lewenskwaliteit die moeite werd?

Van Niekerk, Anton, A. (2008-09)

CITATION: Van Niekerk, A. A. 2008. Is die sorg om lewenskwaliteit die moeite werd. Tydskrif vir Geesteswetenskappe, 48(3):326-337.

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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.

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.

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