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The concept of quality of life plays a key role in the modern medicine since it serves as a goal and gauge of treatment. The main trouble with it rests in that it belongs to the realm of “ought” wherefore empirical data studying “is” are of no help. There is thus a necessity to work with arguments borrowed from philosophy while philosophy has been dealing with this issue from its very beginning. This topic had, in ancient Greece, the name “eudaimonia,” and modern thinking rendered it usually as happiness or well-being. These words do not mirror the entire content, and the most appropriate equivalent of it would be the meaning of life worth pursuing by every human being. Yet the meaning of life is veiled by sundry paradoxes, and these paradoxes defy simple deﬁnition wherefore its application is rather tough. Moreover, the concept of quality of life must include also other factors like social, ﬁnancial, and natural environment as well as endowment determined by birth. In any way, this background must be taken into account whenever the concept of quality of life is focused on.
The contemporary medicine can hardly dispense with the term quality of life since it is the main goal and therefore the gist of its entire endeavor. This concept is more appropriate than health unless it is matching with it straightly. The main reservation to the notion of health itself is that health is mostly considered too narrow with regard to the present moment – momentarily. Future and past then often play a marginal role as if they were almost nothing. Yet any medical practice reveals that both former experience evaluated consecutively and expectations of all the sorts contribute fundamentally to the health status of the patient. In other words, aims as well as wounds must be taken into account seriously. Medicine therefore faces the challenge to make a switch: it should spread the meaning of the word health and to treat it as identical with quality of life at large.
Another trouble is that it is extremely difﬁcult to deﬁne quality of life so that it would ﬁt with concrete ordinary medical activity. Actually, this term labels rather a question than an answer, while to ﬁnd any answer is, for modern medicine, an endless task. Yet medicine is not alone. There are many other ﬁelds in which quality of life plays an important role as a gauge for operation in their agenda, i.e., sociology, psychology, economy, political and environmental sciences, etc. Experts have compiled many tests serving to evaluate the quality of life in particular ﬁelds. They are considered rendering of a norm that is then applied rather roughly and rashly as if it were sure what this norm amounts to.
Attitude like this requires in general and mainly in medicine some tweaks that would regard problems with criteria behind. How to anchor what ought to be? It is important everywhere and essential in medicine itself since medicine is led by them. No other discipline but philosophy is equipped for such an endeavor wherefore this question should be treated primarily by philosophical means.
The philosophical inquiry dealing with these issues is ethics, while in ethics one can distinguish two main branches. One of them is indeed meta-ethics that studies formal rules governing any thinking about moral topics, while the other one usually called normative should be transformed into bioethics: bioethics is not a mere application of some formerly designed philosophical stance but is a proper and original philosophical enterprise researching what the right quality of life would look like. It has ever been the ultimate philosophical mission, while no other discipline is endowed with instruments for pursuing such a goal.
The inquiry into quality of life must therefore remain within the philosophical realm, and the philosophical envoy to this sphere is just bioethics. Bioethics and no other discipline has an access to all the extreme conditions a human being might be exposed to and at the same time must ask how far these conditions still remain bearable in some way should be changed into a different state or exact ending of life. Of course, decisions like these require profound medical knowledge as well as experience and proper philosophical mastering of them. Therefore, one may assume that bioethics has a unique position within ethics while ethics as such, to be sure, has also its application as applied ethics in health care and medicine itself.
Yet these questions are far from being new. They were raised already in ancient times and the contemporary culture is now about to bring them around.
Arising Of The Concept
The notion of quality of life has a long history reaching back to the times of blossoming classical Greece, where this question concerning the good life became urgent and haunted people in various realms of social engagement starting with politicians and ending with philosophers. Philosophy actually has evolved to its heights in attempts to ﬁnd a solution of this arduous riddle as to how to live a good life (Nussbaum 1989). In fact, this progress was rather unique since in other religious cultures, any such query was soon debilitated by a holy authority who, either referring to a sacrosanct text or instructing the grumbler directly, rectiﬁed hesitators and so rid them of their niggles.
The reason of such a difference was that Greeks invented doubts and questions as a research tool – indeed, not just any questions but radical ones. The radical questions ask about universal and particularly one’s own assumptions so that nothing remains sure. Although craving after certainty, one is always prompted to leave it. If applied to life, one is to ponder about which style of life is appropriate. Examples of how the ancient Greeks investigated limits of what kind of life is acceptable can be found among tragedy composers who depicted even moral catastrophes while asking whether such catastrophes could be lived with (idem pp. 23–84).
The opposite concept reﬂected by philosophers was human thriving: thriving (eudaimonia), literally a good (eu) spirit (daimon), did sum up all the thoughts related to the ﬂourishing life while nothing else was worth following. In other words, thriving (eudaimonia) is not a good for anything else and is a good in itself: anything else can at best serve to it. In accordance with it, thriving (eudaimonia) was not an excellence (arété) in itself, since excellences (arétai) are always only means to some other goals, whereas this is the goal as such (EN 1097a30-1097b7).
Few words must be spent here with the meaning of the concept itself. All the attempts to translate the concept of thriving (eudaimonia) into modern languages are failing. Although the most common equivalent of it is happiness, happiness does not render the gist of thriving (eudaimonia) fully: there is also some reference to the future while the future breaks through the mere contentment and is open.
Even Aristotle already is hesitating about its proper content when he leaves it open, whether it is based more on excellence or fortune (EN 1099a33-1099b8), while there is beyond doubt that according to the general opinion of that time, the name (eudaimonia) is very close to another name (eutychia, tyché) with the meaning of luck (EE 1214a15-1214a25). Luck indeed refers to a chance behind it, but to put it as a whim of fate would be wrong; the lousy fate is always to some extent deserved as tragedies put it. On the other hand, good things occur not only as a merit but are often to some extent a gift. The most appropriate equivalent of the treated term in modern languages is just luck wherefore luck will be used in the text as it follows.
The scheme sketched above was treated by different thinkers differently, and philosophers asked about miscellaneous, sufﬁcient, and necessary conditions that must be met in order to achieve a successful life. For Socrates, the only condition of a good life was excellences themselves and nothing else, while all the excellences were included according to him in one: justice. Aristotle on the other hand, already under the inﬂuence of doctors (iatroi) and healers (iasoi), was aware that some tangible conditions like the choice of food and drink (diaita, diaitan, diaitasthai) or environmental hospitability (klima) also contribute to how well the life is led (Schiefsky 2005). The only question in this regard was for him how far these factors participate on thriving, although there was no doubt that they do not sufﬁce on their own.
The main factor shaping a good life was however the excellence of prudence or practical wisdom (fronésis) which was deﬁned by him as a competence to make proper decisions and conduct correctly in concrete, unique cases of the human lot (EN 1141b15-17). This capacity was treated later on under other names while the art of judgment (Urteilskraft) proposed by Immanuel Kant is the most important one. Those who are endowed with this capacity enjoy a good life in all the possible regards. Additionally, one may also ﬁnd in Aristotle an observation that the practical wisdom comes along with the proper goal wherefore those who pursue biased goals miss that capacity and consequently make many blunders (EN 1044a30-1144b1).
Both these very old discoveries are indeed worth keeping in mind by doctors themselves whose practice fundamentally depend on the art of judgment in concrete, unique moments of life. Yet this presumption is valid for everyone and therefore also for patients themselves. Many patients will avoid or recover from disease if they follow the right goal and develop the capacity to make pertinent decisions in every moment of life.
This basic scheme did change with the dawn of Christianity as an authentic Hellenistic phenomenon in all its traits: the whole New Testament is written in the common Greek (koiné) that was the language of that time and that underwent during the previous centuries some shifts. One of them was a replacement of the former “eudaimonia” by “makaria”; “makaria” or “makariotés” had originally almost the same meaning but appeared in a different context and hinted at a different approach to life (Russell 2012, chapter 2/1 pp. 36–64). While the notion of a good life in the classical time pursued some portion of delight while in some cases delight even prevailed, a profound switch occurred in the time of Gospels: Gospels no more extolled happiness of this kind and on the contrary startlingly praised the experience of persecution, poverty, meekness, mourning, hunger, and thirst (Mat 5:3–5:12, Luc 6:20–6:26).
Actually, the sense of it was rather enigmatic and bafﬂing to the contemporary spectators and audience wherefore its interpretation slipped into thrawn medieval notions, according to which any pleasure is postponed to the time after resurrection as a reward for repentant and sinless people. Yet pondering with regard to the question as to what the good life would be did not evaporate altogether in the medieval culture and found its expression in the form of “regimina sanitatis.” “Regimina sanitatis” (Wachinger 2001; Lejeune 1942 pp. 168–182) were treatises worked out particularly by famed physicians on demand of wealthy individuals, noblemen, or some clerics of a higher rank. These documents contained lists of ediﬁcations and recommendations that depicted proper style of life.
This feudal legacy acquired a new breath with the coming of renaissance that returned to the antique approach and stressed thriving in earthly life, be it anything. From this time on, the concept of “vita beata” became again central not only for philosophers but also for theologians as well as ordinary people. On this background evolved protestant ethics that stressed modesty and chastity in those who enjoy the blessing of God and who therefore postpone jolly and merry-making consumption in favor of future weal. With regard to such a deferral, ordinary work was no longer a curse and became rather an integral component of a good life. This turn has totally changed the concept of good life so that even any present notion can hardly omit it.
Yet even this standard of a diligent life met its limits when the former certainty about redemption crabwise vanished. With the progressive alienation due to the globalized world, craving of people after some value in front of them came forth: to live without any goal is not endurable wherefore this gap requires fulﬁllment almost at any price.
The wording “meaning” and “meaning of life” coined for the ﬁrst time by Leo Tolstoy (Tolstoy 1983) has taken root in this regard and has become an entrenched concept in modern philosophy usually ranked to the existential branch. This existential approach revived philosophy and made it again closer to the human life, by the way, due to its emphasis on ﬁction literature (Soren Kierkegaard, Fyodor Dostoyevsky, Karl Jaspers, Martin Heidegger, Albert Camus, Jean-Paul Sartre). Medical terms and sickness issues appear in their texts quite often.
Without a notion of meaning, it is not possible to discuss the modern question of quality of life, but reﬂections on this concept have also another source, and this source is rather earthly. Its background is of course philosophical and concerns the ethical concept of utilitarianism that assesses morality, according to the consequences the concrete deed brings about. The main tenet of this approach requires promoting the capability of achieving happiness for the majority of people. These thinkers (Jeremy Bentham, John Stuart Mill) had naturally a model of happiness in mind by which they assumingly grasp the gist of luck (eudaimonia) as it was understood by the ancient people. The proper content was however still rather hedonistic than anything else. Although some attempts were made to tweak this bias (Henry Sidgwick, George Moore, Richard Brandt), its propensity toward comparison of outcomes prompts to simplify happiness as a measurable quantity-like pleasure.
This framework served well to politicians who struggled for having some gauge of welfare of a given population. Actually, the term was coined already after the First World War but spread only after the Second World War when some economists (Galbraith 1958) and some politicians (1964 Lyndon Johnson, 1972 Willy Brandt) found that mere calculation of revenues does not sufﬁce. Instead of “afﬂuent” society or society of “plenty,” they started to operate with the concept of “quality of life,” rendering the goal of their endeavor.
Sociologists adopted this term later on and, in contrast to economical experts, accounted for other indicators apart from the sole ﬁnancial ones. These additional indicators include environmental factors, habitation, capacities, family, social position, security, and last but not least the state of health rated from both objective and subjective vantage points.
Further inquiries moved naturally closer to psychology (Aaron Antonovsky) and medicine as such (WHO: Ottawa Charter, Healthy Cities Project), while the outcomes of treatment is now mostly assessed by the quality of life of patients with regard to the treatment itself and its aftermath. Although the concept is rather complex and interdisciplinary, manifold tests are proposed so that they can measure the quality of life of various groups of sick or vulnerable people (children, elderly, handicapped, and particularly oncological patients).
The concept of quality of life is, as displayed above, rather interdisciplinary and vague so that any deﬁnition of it does not yield easily. The contemporary manner of treating the quality of life is focused more on subsistence than existence of the human being. However, an accent should be put on mental competence, simply because the free will plays a key role in making choices about the course of life, but also in psychosomatic impact on health itself on the one hand and on the other hand in rating life at any particular moment as well as at large. Yet some decent level of welfare has always been presumed by some philosopher from the time of ancient Greece on.
Already Greeks had troubles with deﬁning the equivalent of the concept of quality of life, which was just luck (eudaimonia) and which dwarfed in front of them as an ultimate end. Although it was a shared value for the whole people, the most acute formulations came from one of the last classical thinkers – Aristotle. Aristotle proposed a deﬁnition of eudaimonia as eu zén kai eu prattein, i.e., living well and doing well (EN 1095a19, 1098b21). This notion apparently differs from the common translation of the term “happiness” in some basic traits.
Our contemporary understanding of “happiness” arouses in us more or less hedonic associations of pleasure. Moreover, another attempt to render luck (eudaimonia) as well-being is too close to subjective wellness and welfare in objective terms that remind us of something snug, which is again against Aristotle’s thinking. Then, for Aristotle and for other Greeks too, someone can be considered lucky (eudaimón, eudaimonikos) only after her/his death. The reason is plain: during life, people may always commit something wicked and thus spoil everything including what positive they have done in the past. It is in sharp contrast to our approach that suggests enjoying every moment of life – to treat happiness otherwise would be foolish for us. In addition, our grasp of happiness bears more or less passive meaning of experience of something, whereas Aristotle conversely pointed out activity of an accurate way: not just working generally but working for the polis. Political life and involvement with it was considered by all the Greeks an ultimate fulﬁllment of life for any free citizen.
At this point, Aristotle is split. He varyingly puts forth either contemplative life (bios theoretikos) in some texts or active life (bios praktikos) in relationships with other people in other texts while his legacy has imposed this hesitation on us. Neither Christianity has resolved this riddle. Does labora or ora deserve more liking? What is more venerable: familiarity with truth or boost of weal?
This question is more metaethical than ethical in the sense that one cannot propose a deﬁnite and all-embracing answer. It however does not mean that no solution could be found. The main reservation with the demand on solution is that it has ambitions to become a universal tenet for all. Yet such a yearning is from the ground aberrant since the “ought” here regards every single person differently and thus no general rule can be offered.
The proportion of knowing and being is in each individual case distinct, and everyone is to wrestle with comprehension of her/his unique mixture of both. This uniqueness is essential in this as well as in many other cases and to deal with it requires a particular skill. To be sure, already Aristotle had this conviction when he held that for achieving luck (eudaimonia), a person must be endowed with some dispositions while the foremost one in this regard is just prudence or practical wisdom (fronésis) that, though so important for practical issues, belongs somewhat startlingly to ﬁve intellectual (dianoetiké) excellences of the soul. It is indeed always difﬁcult to make judgment of its output since outcomes seemingly bad in some future instant may turn out later on to be good and conversely.
Assessment of how this capacity works and whence whether one’s life is thriving or thwarted is also difﬁcult due to other factors. Particularly, it remains open what should be stressed more: the objective worth of life or subjective feeling about it. Putting emphasis on the subjective pole of the term turns it out to be devoid of rules wherefore too arbitrary and even wanton, whereas emphasis on the objective pole prompts individuals to be dragged by society and its norms even against their own wishes.
It has been averred that rendering luck (eudaimonia) as happiness fails while it is patent that a more appropriate equivalent of the term would be meaning of life. This notion is however again rather elusive: modern philosophy attempted to bestow on the term meaning a meaning in the framework of both analytical and continental tradition, but some nebulosity remains. Actually, it is rather difﬁcult and awkward to account for it.
There is certainly a cognitive portion of its gist, and one can only conjecture what it refers to while the most ﬁtting candidate is justice in the sense of equity as well as equality with regard to other people. People languish deeply whenever being abased and humiliated by the community they belong to: then the meaning of life wanes and the quality of life dramatically falls down. One’s own life, on the other hand, has quality and meaning if she or he enjoys acknowledgment by others. This motive drives us quite often even to sacriﬁce many other dear things (Taylor 1997 pp. 98–131).
Yet the emotional charge still seems to prevail in the concept of meaning wherefore meaning is to be ranked to the realm of values. Values are always emotionally loaded and prime movers of the soul. The ultimate drive is thus never purely rational; rationality only instrumentally serves them as David Hume noticed while it has never been confuted after him (Hume 1978 pp. 413–418). The emotional experience can be divided further into two separate realms, and these realms are rendered as bliss and hope.
Hope is essential in the sense that deprivation of it leads to despair and menace by suicide. Troublesome is that there are also false hopes and these hopes can wreck easily; the name of such a lapse is the syndrome of burnout. However, the dimension of hope in itself does not ﬁt the life of a high quality. Quality of life also necessarily needs some kind of bliss or satisfaction: the mere ascetic life of postponing every pleasure to the future would be dreary. At least temporarily, prosperous life needs some degree of gladness. Of course, conversely, the mere pleasure without any expectation in the future would be as mentioned above, despairing because of its emptiness.
Thus, bliss rid of hope as well as hope rid of bliss is ruining the quality of life. Every person has a proper ratio of these two dimensions and when any of these dimensions wither, the person suffers. Quality of life again depends on the concrete proportion of these two dimensions and to hit at the right mixture indeed requires prudential choice (fronésis) that is therefore urgently important for living well.
Those who are endowed with this capacity of common sense enjoy a double advantage. Particularly, they make mostly appropriate decisions in concrete cases of their lives wherefore they succeed in avoiding pernicious ends: in a way, it is a skill of prophetic anticipation. Additionally, common sense as a sound reason exerts some impact on the body wherefore the body has better chances to be sound as well; these psychosomatic relations have its root in the fact that the mind represents supreme regulations and regulations working well keep the system as a whole in concord.
Potential to reach a high quality of life is high in such people. However, liaisons between mind and body are not that tight. Of course, patients endure diseases (e.g., genetic ones) often contrary to their pure hearts and the other way round. Then, the question arises how to cope with this doom. Here again prudence or practical wisdom (fronésis) may play a key role in that it helps patients to ﬁnd a new equilibrium due to coping with their handicap and in spite of it. There may thus happen that someone has a malady in a classical sense and thrives nonetheless. Should such people be considered sick or healthy?
Health in the deﬁnition of WHO as “the state of complete physical, mental and social well-being.. .” would be, under these conditions, a fanciful dream since no single person would ever enjoy it. In medicine, doctors need something more tangible, and the notion that healthy is the one who manages to live with his/her handicap a life of high quality is an adequate option for it.
The modern health care therefore operates with the concept of “health-related quality of life” that summarizes inquiries into the junction between the quality of life and health in the classical terms. Traditional vocabulary of medicine appears to be too narrow for judgments about the results of treatment: it is necessary, for example, to square up with conﬂicting values like health itself and length of life (Callahan and Hanson 1999). Which of these two values should override the other one? Is it more covetable to live long in wretched conditions or to relish comfort and die soon? If one takes into account also the double bind of mind-body in the sense that one inﬂuences the other in both directions, assumption that health can be studied separately ﬂounders.
Therefore, one may propose that “health-related quality of life” is an extension either of quality of life to health or health to quality of life. In any way, the contemporary medicine has taken over this concept and works with it.
Consequences For Bioethics
The previous considerations hinted at the moral facet of the quality of life several times and now it is urgent to tackle it more thoroughly. Among crucial ethical questions with regard to it, one of them exceeds others: is it good to mark good (quality of) life or luck (eidaimonia) as an ethical value or not?
The pro and con arguments are as follows: if the quality of life contributes to the moral value of human beings or their dignity, then those who are worse off miss some dignity and are exposed, at least in some cases, to the thread of possible extermination.
Indignation must be apparently aroused by it in everyone: all the human beings are equipped with equal dignity, and distinguishing people according to the quality of their lives would be nothing but discrimination of some of them.
Yet if dignity is unalterably ﬁxed on the same level for everyone, then endeavoring after anything goes necessarily in vain. Medical improvements would be then mere enhancement that delivers only some more pleasure without any moral charge. Can morality be dispatched in this way?
Indeed not. There is another exigent question, a question of enhancement in behind, but it exceeds this topic and cannot be inquired into here, although some arguments put forth here with regard to the quality of life might be useful for enhancement as well.
How should this puzzle be treated? The proper moral attitude rests in distribution of moral judgment between doctors and patients: patients are entitled to ponder about and choose the quality of their life up to them, while doctors are forbidden to encroach upon goals of their patients even though they seem fatuous to them; the realm of medical agenda is restricted to means only.
One of the consequences this tenet has for medicine is that all the patients should be treated in the same way, be they lucky or lousy – the quality of their life itself is a criterion only for them and should be irrelevant to doctors as to vigor of their effort. Summarizing it brieﬂy, one may take it so that the goals of doctors are the means of their patients and the goals of patients are a taboo for medicine at large.
Yet this taboo is pervious in some way. Any doctor has a duty to attempt to understand patient’s intentions simply because these intentions must be always held in regard. Assuming autonomy merely formally without ﬁlling up its content would be not only deriding but also an offense. Informed consent thus requires knowledge of what the patient wishes. There is therefore a necessity to converse with patients about their notion of quality of life.
In addition, argumentation about what the concept of quality of life might refer to is necessary too, not just with concrete patients themselves but with other health experts and managers. The reason is that any system of health care must make a decision about scarce resource allocation and about the decent minimum of care for everyone. Yet the quality of life depends not only on the level of medical treatment but also on other factors as mentioned above wherefore there is urgency to discuss the appropriate quality of life with other experts and in the last with democratic representatives. Representatives however express opinions of the public, and the public is therefore the last authority that judges on the quality of life for all.
In other words, the patient is split. On the one hand, as a citizen, he discusses his concept of the quality of life with all other people. On the other hand, he pronounces his wishes as to the quality of life to the doctor while the doctor must, according to the possibilities, obey them.
The doctor thus has to take seriously primacy of the notion of quality of life on the patient’s side, which is non-utilitarian in its nature and which will be in the center of all the other considerations. Contrary to it, the utilitarian stance (Jeremy Bentham, John Stuart Mill) falls to the medical staff as well as to the public at large. However, this concept is much more empirical than ethical since criteria of the quality of life arise from negotiations wherefore exceed philosophical tools: their character is political in the full sense of the word.
On this more or less political background, also ethical issues are to be inquired into. The quality or meaning of life is an ultimate intrinsic and therefore not an extrinsic value, a value that is served to by everything else and that in itself does not serve to any other thing. The content is however rather enigmatic in several ways. The main ones will be referred to below.
The general question of ethics is what one ought to do. Many answers have been proposed in the past centuries while they were commonly too abstract and with regard to the concrete life failed. Although already Aristotle at the beginning warned that reality deﬁes general rules and therefore requires exceptions (epieikia) from them (EN 1137b12, 1137b26, 1143a20, 1143a31), almost all the philosophers after him were tempted to sketch ethics so that it would hinge on tenets being more or less stiff.
Yet every tenet is sully in that any other tenet might appear to be conﬂicting with it. The nature of tenets is thus burdened with a paradox, and this paradox is rooted very deeply. It therefore seems to go wrong face to face with the quality of life and requires some other way out. It therefore remains open whether the quality of life has rather cognitive or emotional, subjective or objective, or active or passive background. Should one rely more on hope, bliss, or anything else?
The only solution is to ﬁnd the proper balance between both weights. To grasp the right proportion depends on prudence or practical wisdom (fronésis) as a competence to make accurate decisions in concrete, unique cases while this capacity warrants some quality of life (EN 1140a24- 1145a11). However, it is not switching necessity into assets. There is something positive in deciding things tangibly while the reason rests in that it satisﬁes the demand on ethics to set what ought to be done. One should not be bafﬂed by presumption that concrete thinking is common and easy. The opposite is true – it is very rare. Both disposition and education prompt people to remain stuck in abstract cliché simply because already the language as it is has no single word with reference to something unique.
Discussions on ethical anchoring of the quality of life are not however exhausted by this. To aver that one is to make accurate decisions, additional annoying questions crop up and start to haunt those who keep it. Which decision is accurate enough and how can one distinguish it from the false ones? Is there any criterion for it? The deﬁnition remains relativistic what makes the situation rather bleak. The only option might be to judge about good and bad thereafter. Merely by backward assessing deeds, one can conclude which of them have turned out to be successful and ﬁne.
Yet when should one tackle it? The next hour, week, month, year, or later? How much time must elapse before one can set about it? Any positive (negative) conclusion in some moment may prove negative (positive) in the next moment and so forth. The only serious position would be therefore to choose in advance the goal while the goal in the case of being good is what bestows upon us prudence or practical wisdom (fronésis) as Aristotle held it (EN 1144a7-1144a9). One therefore should take into account and consider rather posterior than anterior goals, while the goal at the end of ages would be the most appropriate one.
Such a goal is almost eschatological, and eschatological aim could be considered identical to deontological duty so that the whole conundrum of morality might be resolved. Surprisingly, confusion about what the ﬁnal goal and consequently the quality of life would remain.
How should one think about the quality of life in the last? The trouble is that the quality of life as a goal is in its nature again paradoxical and the main paradoxical clash rests in that it can be neither merely approached nor attained at any moment of life.
If attaining some particular goal, one starts to ask which other goal is worth pursuing, and when making a switch like this several times, one certainly discovers her or his straying in a circle wherefore her or his effort becomes totally wasted. If on the contrary one is aware that the goal can never be reached, she or he certainly relinquishes it and starts to dawdle since her or his effort would be wasted too. In both cases then, one is threatened by falling into despair that may end up in a suicide, while suicide is just the opposite of a high quality of life.
Which lesson can one take from this remark? Indeed, the quality of life is a volatile value with propensity to vanish if one strives after it too forcibly – actually, quality of life is something that should be kept in one’s mind only marginally while pursuing something earthly. The awareness of the quality of life is rather a mere feeling in the background, but it is a feeling of crucial signiﬁcance wherefore there is no chance to abandon it. This statement refers to inquiries carried out by some phenomenologists like Martin Heidegger or Hans-Georg Gadamer who stressed the background mood (Stimmung) which reveals the unreiﬁable meaning and which represents a horizon of experience at large.
What thus might be the proper target of interest that is so permeated by emotions so much? A very simple solution comes up. The essential feature of life that is considered valuable by all the people is just a network of sound relationships to other people. Breaching these relationships with the consequence of alienation severely disrupts one’s own quality of life and in extreme cases is not bearable at all. Those who on the other hand build up liaisons with their neighbors thoroughly and on mutual trust, thrive. In other words, one can conclude that trust on both sides as being trusted and trusting others makes life marvelous. The importance of “I-though” relationship has been stressed by some philosophers (Soren Kierkegaard, Ferdinand Ebner, Martin Buber) and conﬁrmed by some empirical data (particularly coherence and social capital exerts a strong impact on health; Rocco and Suhrcke 2012).
Facing these assumptions, differences between being and knowing seem to be less sharp since knowing is only marginally obtaining abstract information about the world; the gist of recognition is recognition of other free beings or of the meaning they manifest in their conduct or production. Comprehension of this sort is investigated by hermeneutics and due to hermeneutics as a skill, one is able to spot what the other human being thinks (Grondin 1997). Then everyone has a chance to reach through understanding someone else, also understanding one’s own self: the self thus establishes her or his being due to the knowledge of others and knowledge indeed depends on being too (George Herbert Mead). Those who tangle languish (Mead 1934).
There is therefore a possibility to propose one general feature of life if it is regarded having high quality and it is just integration within a network of excellent interpersonal relationships while it can be considered a universal goal from the ethical vantage point.
The quality of life is a broad, interdisciplinary concept stumbling on obstacles when it is to be delimited. Elimination of its sociological, economical, and ecological facets is never feasible, nor is it feasible in the case of its appropriation by medicine, although some simpliﬁcation is gained. Bodily health becomes here a dominating factor while there is still another dimension that plays a key role in it. This dimension of interpersonal relationships is essential for bioethics and for ethics at large while they fundamentally contribute also to health as such.
To live life thriving in all regards depends on the capacity to make ﬁtting choices in concrete cases, i.e., on the excellence of prudence or practical wisdom ( fronésis), while modern neurology and neuroethics have in addition proved that this ability has much to do with frontal lobe functions of the brain (Fuster 2008). In other words, the impact is mutual: frontal lobes are the structure necessary for prudence, and prudence can inﬂuence indirectly through behavior and directly through psychosomatic relations the state of the brain. The quality of life thus has a very close relation to the body.
The quality of life is measured in the modern medicine by miscellaneous tools while an explicit or implicit notion of it is always presumed as a gauge that decides about whether patients are getting better or worse. Yet this intuitive stance is a profound failure since these notions are based on mere hunches rid of conceptual clarity: clariﬁcation is urgently needed wherefore philosophy must be critical about it.
In this sense, medicine is split and hobbles on since on the one hand, it relies on mere intuition and on the other hand, it is based on exact and rational scientiﬁc procedures: evidence-based medicine on the level of what is and fuzzy feelings about what ought to be contrast too sharply. Any further testing of the quality of life must be therefore marshaled in the manner that would be boosted by philosophy and bioethics in particular.
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