Q. Please help me understand why, in cases of near death, the Church does not get aboard with the concept of “quality of life” insofar as decisions about extraordinary means need to be made.
A. This is a question I have discussed on several occasions, but it keeps recurring.
First, what does “quality of life” specifically mean? Doesn’t it signify whatever the person(s) using it means? (In an earlier column, published in 1992, I compared the phrase roughly to the word “confidential,” which certainly can have varied meanings. For example, consider the phrase, “Your inquiry will be kept confidential.”)
Even more fundamentally, however, “quality of life,” while definitely one factor in assessing extraordinary medical means, is neither the sole factor nor the principal factor.
The paramount factor is not “quality of life,” but rather, “sanctity of life.”
Hence, one should be alert to the use of the phrase. As ethicist Professor Joseph Boyle once put it, “many people… are deeply suspicious of the use of this expression, and with good reason. The term has a history and a set of connotations which, to say the least, are suspect. The expression entered medical parlance in a clearly ideological context…”
For some (too many, I think), the concept of “quality of life” is used to measure the personal dignity of a patient in her or his suffering. This is especially true of the disabled, the elderly, the chronically sick or feeble, and the emotionally or mentally challenged. Anyone who has even skimmed the relevant literature about persons so afflicted should first know that each and every human being is unique, precious and unrepeatable. Hence, each and every human being has the right to life, liberty and the pursuit of happiness. No human being may trample or even diminish these rights; contrary thinking is at the heart of what Pope John Paul II labeled as “the culture of death.”
One of the best moral summaries of the “quality of life” problem is offered by Dr. William E. May, who has long merited a place among America’s leading bioethicists. In his Catholic Bioethics and the Gift of Life (OSV, 2000), he emphasizes that the phrase is ambiguous; in fact, “the same authors at times list different qualities in different apologias for their position.” Complicating the subject further, qualities thought to make life worthwhile or better (e.g., intelligence, ability to respond to stimuli, awareness, etc.) “admit of enormous differences in degree.” Also, observers have varied “cutoff margins,” as to when life becomes less “meaningful” (whatever this means). And such a “cutoff point has to be assigned, above which the quality of life is ‘meaningful’…” Such limitations, he adds, “are arbitrarily asserted, with different authors assigning different ‘weight’ to different factors and different degrees of ability…” Hence, the process here of “judging” life or death becomes “utterly arbitrary and unjust.”
On the other hand, relying on the sanctity of life is always meaningful and just.
Pope John Paul II’s insistence that every human being is unique, precious and unrepeatable is crucial to the “sanctity of life priority” over the “quality of life” premiss. Regardless of all other considerations, the human being is never to be viewed merely as an “it” – as a nameless though numbered object. On the contrary, the human being is of incalculable worth before God the Creator, and consequently must always be viewed as a person, with unalienable rights. The Jewish Existentialist philosopher, Martin Buber, rightly emphasized that a human being is a “Thou,” not an “it,” and has to be viewed as essentially a “Thou.” Both Karol Wojtyla, the Ethician of Lublin, who became Pope, and Martin Buber offer the contemporary world an easily understandable ethical foundation in behalf of one’s relationship to other human beings. Pope John Paul provided this argument in, for example, two epoch-making books as well as several papal encyclicals. Martin Buber, of course, gave us the truly great book, Ich und Du (I and Thou).