In this paper three questions concerning quality of life in medicine and health care are analysed and discussed: the motives for measuring the quality of life, the methods used in assessing it, and the definition of the concept. The purposes of the study are to find an ethically acceptable motive for measuring the quality of life; to identify the methodological advantages and disadvantages of the most prevalent current methods of measurement; and to present an approach towards measuring and defining the quality of life which evades the difficulties encountered and discussed. The analysis comprises measurements both in the clinical situation concerning individual patients and in research concerning whole populations.
Three motives are found for evaluating the quality of human life: allocation of scarce medical resources, facilitating clinical decision making, and assisting patients towards autonomous decision making. It is argued that the third alternative is the only one which does not evoke ethical problems.
As for the methods of evaluation, several prevalent alternatives are presented, ranging from scales of physical performance to more subtle psychological questionnaires. Clinical questionnaires are found to fail to provide a scientific foundation for universally measuring the quality of life.
Finally, the question of definition is tackled. The classical distinction between need-based and want-based theories of human happiness is presented and discussed. The view is introduced and defended that neither of these approaches can be universally preferred to the other. The difficulty with the need approach is that it denies the subjective aspects of human life; whereas the problem of the want approach is that it tends to ignore some of the objective realities of the human existence.
In conclusion, it is argued that the choice of methods as well as definitions should be left to the competent patients themselves — who are entitled, if they so wish, to surrender the judgement to the medical personnel. Technical factors as well as the requirements of respect for autonomy and informed consent support this conclusion.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Clark A, Fallowfield LJ. Quality of life measurements in patients with malignant disease: a review. J R Soc Med 1986;79:165–9.
Daughton DM, Fix AJ, Kass I, Bell CW, Patil KD. Maximum oxygen consumption and the ADAPT quality-of-life scale. Arch Phys Med Rehabil 1982;63:620–2.
Hörnquist JO. The concept of quality of life. Scand J Soc Med 1982;10:57–61.
Siegrist J, Junge A. Conceptual and methodological problems in research on the quality of life in clinical medicine. Soc Sci Med 1989;29:463–8.
Harris J. QALYfying the value of life. J Med Ethics 1987;13:117–23.
Lohr KN, Ware JE Jr, eds. Proceedings of the advances in health assessment conference. J Chronic Dis 1987;40 (Suppl 1).
Neuhausser D. Advances in health status assessment: conference proceedings. Med Care 1989;27 (Suppl).
Callahan D. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster, 1987.
Daniels N. Am I My Parents' Keeper? New York: Oxford University Press, 1988.
Häyry M, Häyry H. Health care as a right, fairness and medical resources. Bioethics 1990;4:1–21.
Carr-Hill RA. Assumptions of the QALY procedure. Soc Sci Med 1989;29:469–77.
Williams A. The economics of coronary artery bypass grafting. Br Med J 1985;291:326–9.
Duff RS, Campbell AGM. Moral and ethical dilemmas in the special-care nursery. N Engl J Med 1973;289:890–4.
Shaw A. Dilemmas of ‘informed consent’ in children. N Engl J Med 1973;289:885–90.
Kirby MD. Informed consent: what does it mean? J Med Ethics 1983;9:69–75.
Gillon R. Consent. Br Med J 1985;291:1700–1.
Hakama M, Holli K. Millainen on oikea rintasyövän hoito? Duodecim 1990;106:907–9.
Kuhse H. The Sanctity-of-Life Doctrine in Medicine: A Critique. Oxford: Oxford University Press, 1987.
Clark B. Whose Life Is It Anyway? London: Samuel French Ltd, 1978.
Fayers PM, Jones DR. Measuring and analysing quality of life in cancer clinical trials: a review. Stat Med 1983;2:429–46.
Drettner B, Ahlbom A. Quality of life and state of health for patients with cancer in the head and neck. Acta Otolaryngol 1983;96:307–14.
Haes JCJM de, Knippenberg FCE van. The quality of life of cancer patients: a review of the literature. Soc Sci Med 1985;20:809–17.
Priestman TJ, Baum M. Evaluation of quality of life in patients receiving treatment for advanced breast cancer. Lancet 1976;i:899–901.
Spitzer WO, Dobson AJ, Hall J, et al. The QL-index. J Chronic Dis 1981;34:585–97.
Heinrich RL, Schag CC, Ganz PA. Living with cancer: the cancer inventory of problem situations. J Clin Psychol 1984;40:972–80.
Morrow GR, Chiarello RJ, Derogatis LR. A new scale for assessing patients' psychosocial adjustment to medical illness. Psychol Med 1978;8:605–10.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70.
Campbell A, Converse PE, Rodgers WL. Quality of American Life Perceptions, Evaluations and Satisfaction. New York: Russell Sage Foundation, 1976.
Lanham RJ, DiGiannantonio AF. Quality-of-life in cancer patients. Oncology 1988;45:1–7.
Torrance GW. Measurement of health state activities for economic appraisal: a review. Journal of Health Economics 1986;5:1–30.
Wright SJ. Age, Sex and Health: A Summary of the Findings from the York Health Evaluation Survey. York: University of York, 1986.
Pörn I. An equilibrium model of health. In: Nordenfelt L, Lindahl BIB, eds. Health, Disease, and Causal Explanations in Medicine. Dordrecht: D Reidel Publishing Co, 1984:3–9.
Nordenfelt L. On the circle of health. In: Nordenfelt L, Lindahl BIB, eds. Health, Disease, and Causal Explanations in Medicine. Dordrecht: D Reidel Publishing Co, 1984:15–23.
Nordenfelt L. On the Nature of Health: An Action-Theoretic Approach. Dordrecht: D Reidel Publishing Co, 1987.
More T. Utopia. London: Chatto & Windus Publishers, 1908.
Calman KC. Quality of life in cancer patients — an hypothesis. J Med Ethics 1984;10:124–7.
Rights and permissions
About this article
Cite this article
Häyry, M. Measuring the quality of life: Why, how and what?. Theor Med Bioeth 12, 97–116 (1991). https://doi.org/10.1007/BF00489791
- patient self-determination
- quality adjusted life years
- quality of life
- value of life