Is there such a thing as a life not worth living?
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7300.1481 (Published 16 June 2001) Cite this as: BMJ 2001;322:1481All rapid responses
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Because of limited health care funding, parents and caretakers of
children and others with chronic, critical, and confusing illnesses and
conditions quite often find themselves wrestling a silent executioner for
the very life of their patient.
When maintaining life at all--especially one sure to cost taxpayers
once a family exhausts health insurance and other resources--may bankrupt
a managed care group or even some branch of government, accountants are
not prayerfully pondering "quality of life" or moral issues.
Mothers may find themselves trying to outlast bureaucrats to provide
skilled nursing care in a home setting while cost accountants have doctors
telling the mother to "let go" and "free the child to dance with the
angels."
With advances in medicine, many more children live who once could not
have. Oooops, how much will their rescue and care cost? Technology
allows even the very ill to last a very long time IF it is made available.
But it costs plenty.
No so subtle tugs of war between the Cost of Life and one's Last
Breath are trumping genuine concerns for either the ill individual's or
his/her family's "quality of life." Anyone who thinks otherwise is a
dreamer although the study gave fairly short shrift to the economic
indicators.
Probably no nation can afford to save and forever ensure an ideal
"quality of life" for every person with whatever health problem. In many
ways, reading the well considered, researched, and written study
conclusion may leave one thinking there is infinitely more caring about
"quality of life" than those with "high maintenance" ill loved ones find
in the real world.
In America one state has already proposed making "medical
misrepresentation" a child abuse felony in order to (a) remove the child
from excessive government health care expense and (b) prosecute the mother
for exaggerating the problem however factually genuine. Translated: If
one labors to bring or return a child to health, ultimate recovery PROVES
the child was never ill and the mother should be jailed as a fraud.
As other states pick up on the idea the ghost of mythical "Munchausen
Syndrome by Proxy" will let more unwell children be jettisoned, removed
and adopted out, and their mothers nailed for financial fraud. It will be
recognized eventually that Cost of Care outweighs Life itself in many
official equations.
When it is possible for one or more doctors to disregard objective
physical findings of experienced and reputable phyicians--stating they are
imagined or are of no account as well as ignoring the long established
science of medical genetics--the fraud permitted along those lines by a
few doctors destroys any possible life quality for a child and family.
As too often "follow the money" is likely to be a, if not THE, major
determinant in life quality wherever one lives. Who, then, is empowered
to make choices on which life is not worth living, particularly on less
than healthy children having "a negative economic worth"?
Or have we had this argument throughout history already?
Barbara Bryan,
Communications Director
National Child Abuse Defense & Resource Center
Child/family advocate still awaiting the first study using accepted
scientific methodology to validate the theory of Munchausen Syndrome by
Proxy
Competing interests: No competing interests
Measuring quality of life within the context of death
EDITOR - Farsides and Dunlop present an interesting debate 1.
However, I think quality of life measures in the future have to consider
the meaning of death in relation to life. We need to ask additional
questions. That is, can we measure quality of life in relation to death
when we deem life not to be worth living?
First, is quality of life related to quality of death? That is, when
individuals or proxies (in the case of non-competent adults) believe that
a medical condition or health state (leading to suffering) is worse than
death, is their perception of death the termination of suffering?
Second, is quality of life related to preparation of death? Do people
perceive their quality of life to be better or worse if they are more
prepared to die? It is possible that some individuals who, as a result of
long-term or terminal illness, have prepared themselves for the end of
life may perceive their quality of life to be better than those who are
not prepared.
Third, we also have to take into account culture and religion to
effectively assess quality of life in this context, since death would have
different meanings depending on a person’s cultural and religious beliefs.
1. Measuring quality of life: Is there such a thing as a life not
worth living? BMJ 2001; 322:1481-1483 (16 June).
Competing interests: No competing interests