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Gauging What 'Quality of Life' Means

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Vatican Conference Considers Ethical Principles

ROME, MARCH 6, 2005 (Zenit) - The much-bandied term "quality of life" was the theme of the annual meeting of the Pontifical Academy for Life. The Feb. 21-23 general assembly of the Vatican body brought together Church dignitaries, along with experts in medicine and bioethics, to reflect on the subject of "Quality of Life and the Ethics of Health."

In his presentation, the president of the academy, Bishop Elio Sgreccia, observed that the terms "quality of life" and "health" have become a sort of absolute, "to be pursued to the point of a sort of divinization of health."

The terms, he noted, reflect a strong influence of the utilitarian philosophy so widespread in English-speaking societies. This has led to a widespread belief that "the human being who does not possess the desired minimal 'quality' does not deserve to be kept alive -- hence, the proposal of eugenic parameters for the purpose of selecting those who do deserve to be accepted or kept alive and those who are to be abandoned or suppressed via euthanasia."

Trying to understand what the concept quality of life means was dealt with by A. Gómez-Lobo, professor of metaphysics and moral philosophy at Georgetown University, Washington, D.C. The idea that lives can be judged according to their quality goes back to the ancient Greek philosophers, he noted.

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It is a concept that covers diverse dimensions of life, but in the area of health the expectation of a low quality of life has become a standard rationalization to justify euthanasia, Gómez-Lobo explained. However, claiming to benefit a person by intentionally killing someone with a low quality of life is "deeply wrong," he argued.

A person suffering from health problems "is still enjoying the basic good of life, a good that is distinct from any evil the person may be undergoing," the professor said. Moreover, for an external observer to judge that the patient is a life "not worth living" is "an intolerable presumption," he added.

The prohibition against killing an innocent person, Gómez-Lobo continued, is based on respect for the dignity of the person, "and human dignity is logically independent of, and not reducible to, the quality of a person's life because dignity is an intrinsic property that does not admit of degrees." In fact, he added, "The suffering and the weak have a special claim on us." And the quality of life of the patient should not affect this obligation.

"Vegetative state"

The question of what to do with persons who are in a vegetative state was addressed by Gian Luigi Gigli and Mariarosaria Valente. They are, respectively, the president of the World Federation of Catholic Medical Associations, and director of the Department of Neurosciences at the Santa Maria della Misericordia hospital in Udine, Italy.

In analyzing the current situation they observed in a statement: "Faith in the omnipotent power of technology of being able to ameliorate the quality of life and lack of moral principles combine together." This technological approach considers every action ethical if it is the result of free choice, and every action legitimate if it is socially useful.

Regarding the vegetative state they explained: "This condition is still affected by important clinical uncertainties, leading to frequent misdiagnosis." It is difficult to distinguish between the vegetative state, and the persistent, also called permanent, vegetative state. In the latter case no recovery is expected, but the point of division between the two is not clear. They added that there are well-documented cases of patients who have recovered consciousness even after the criteria for permanence have been met.

So-called right-to-die advocates argue that once a vegetative state is diagnosed as permanent there should be a presumption against assisted feeding. In addition, the provision of food and water is redefined as a medical treatment, rather than the provision of basic needs. "According to this view, the ensuing death by dehydration and starvation should be regarded as a natural death," Gigli and Valente wrote.

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However, they explain, in this situation patients do not die because of the vegetative state, but of malnutrition and renal failure. "The outcome (death) is fully intended."

The two explain that understanding how we have arrived to intending the death of someone in this state is linked to considerations about the quality of life. Often, in measuring the quality of life, the concept is reduced to the ability to produce and to be useful. It follows, then, that using health resources for people who cannot return to a productive life is considered wasteful.

The withdrawal of nutrition and water from persons in the permanent vegetative state can lead to a dangerous attitude in the medical profession, Gigli and Valente warned. "Withdrawal of nutrition and hydration could be the key to open the still strong existing barriers which oppose the legalization of euthanasia in the majority of countries," they added. As well, in the long term, having doctors hastening death could destroy the relationship of trust between patient and physician.

The newborn

Another set of questions regards the quality of life for newborn babies. This was dealt with in the paper presented by Patricio Ventura-Juncá, director of the Center for Bioethics of the pontifical University of Santiago, Chile.

Newborn babies are highly vulnerable as well as quite incapable of evaluating their situation or expressing preferences. In the last few decades, neonatal care has made enormous strides, explained Ventura-Juncá. Many of the immature functions of prematurely born infants can be temporarily replaced by mechanical means. But the ethical problem that exists is judging whether to withhold or withdraw treatment.

She explained that many parents have difficulty in understanding the medical information they are given and to make a decision. In general, however, parents are more in favor of intervening to save the infant than are health care professionals. In this situation the opinion and the values of the doctor in charge have a great influence on the parents.

The situation of persons suffering from mental handicaps was addressed by professor Wanda Poltawska, a psychiatrist from the school of theology of the University of Krakow, Poland. "A human being is always human irrespective of the stage of his or her physical or mental development," she stated.

Families burdened with a mentally diseased person are often divided over the best way to cope with this problem. In order to affront the burden, family members need a deep understanding of the sense of suffering.

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In deciding what to do when confronted with this situation Poltawska stated: "The life of a human being, its beginning and its end are in the hands of the Creator -- when we try to manipulate human conception or human death we transgress our authority."

Handicapped persons are a challenge to society, she added, and our own value as persons can be assessed by examining our attitudes toward the ill, the old and the disabled.

In a letter dated Feb. 19, directed to Bishop Sgreccia on the occasion of the congress, John Paul II drew attention to "the essential quality that distinguishes every human creature as that of being made in the image and likeness of the Creator himself" (No. 3).

This dignity and quality of the person "endures through every moment of life, from the very moment of conception until natural death," the Pope stated. "Consequently, the human person should be recognized and respected in any condition of health, infirmity or disability."