Methodological and ethical problems of assessing the quality of life - Bioethics

Methodological and ethical issues of assessing the quality of life

The problem of assessing the quality of life faces serious methodological difficulties. In particular, the researchers' claim that the QALY scale can serve as a universal measurement system for various health conditions is criticized from many angles.

The QALY scale is a kind of uniform measure of medical utility for different people and different diseases - just as in the past I. Bentham tried to create a single measurement system for pleasure or happiness. Obviously, a high generality of this scale is achieved by significant, often rather artificial modifications of empirical data, and is accompanied by a loss of important information, which is more successfully expressed with the help of specialized tools. In this regard, they raise serious doubts about its adequacy for solving many scientific and practical problems.

For example, the literature points out that there is no evidence that estimates that determine the value of QALY for certain pathological conditions will correspond to the real judgments expressed by patients suffering from these conditions.

Difficulties in clarifying the notion of the quality of life are related not only to its subjectivity, but also to the fact that it can be viewed from different perspectives: the notion of what is a "good quality of life" at the given treatment, can strongly differ at patients and medical community. It is difficult to expect that these discrepancies can be overcome in some acceptable way.

There are also ethical problems in measuring the quality of life. This is due to the fact that the quality of life, being an appraisal concept, assumes a certain system of values ​​(including, perhaps, hidden). As a result, the conclusion about this or that medical technology (which can become the basis for making political decisions) depends on some value system, which may itself not be perfect.

The adopted political decisions, in turn, are capable of bringing certain negative consequences for certain social groups: for example, to become the basis for an unfair distribution of resources. In the literature, it has been repeatedly pointed out that the QALY scale actually contains in itself the latent prejudices of modern society with all its discriminatory tendencies (inequality by sex, age, health status, rejection of people with incurable disability, etc.).

In other words, the life of a person with a low quality of life is regarded as less valuable, as a result of which public health resources are redistributed in favor of other categories of people. Here we return to the previous problem of the value of life.

In this case, life as a value is viewed in a purely utilitarian perspective - as a value from the standpoint of the possibility of achieving an increase in social utility with minimal economic costs.

As a result, decision-making in the health care system on the basis of only a utilitarian approach (maximizing utility for the maximum number of people) leads to inequality, redistributes resources in favor of those who are easier to achieve a gain in utility, and denies medical care to those for whom it is more difficult and it is more expensive to relieve suffering and improve the quality of life.

The matter is complicated by the fact that in some Western countries the assessment of medical technologies using the QALY scale is established by law.

Thus, the task of assessing the quality of life related to health still has many unresolved problems and requires further work. Nevertheless, it can be confidently asserted that the quality of life has become one of the new fundamental categories of medicine, along with such categories as health and disease, norm and pathology. The concept of quality of life in modern health care is the most important way to clarify the notion of the patient's good and the purposes of medicine, as well as the way to evaluate medical interventions that take into account not only the clinical perspective, but also the patient's point of view.

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