The following was published in the Sept.-Oct. 2009 issue of MCCL News.
Why the elderly, disabled should not be discriminated against
By Paul Stark
When health care is rationed, it usually is done according to a "quality-of-life" ethic that now dominates the field of bioethics and much of American culture. People who are disabled, elderly, sick or mentally incapacitated—whose quality of life is considered poor—are denied care in favor of younger or healthier patients.
"The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities," writes Princeton ethicist Peter Singer in a recent argument for rationing health care. "[S]aving one teenager is equivalent to saving 14 85-year-olds." The use of quality-adjusted life-years (QALYs) in health care decisions puts such thinking into practice.
The quality-of-life view measures the worth of a human being by features of his or her life. These may include the ability to function in ordinary tasks, participate in community, have friendships and familial relationships, appreciate beauty, exercise rational faculties and experience happiness. On this perspective, there is such a thing as a "life not worth living" or a life without meaning.
The same kind of thinking is used to disregard the lives of unborn children. Bioethicists who support abortion argue that a human being must acquire certain qualities in order to become a rights-bearing "person" deserving of respect—and unborn humans, who are at a very early stage of their development, fail to meet those criteria.
So at both the beginning and end of life, humans beings are valued according to characteristics that some humans have and others do not. This contrasts with the pro-life view, or what is sometimes called the sanctity-of-life or equality-of-life ethic, which holds that human beings are valuable in themselves—not for their acquired properties or abilities—and are therefore equal in fundamental dignity and rights.
The quality-of-life view does not withstand scrutiny. Here's why.
First, proposed quality-of-life criteria seem largely subjective. Who is to say when life is not worthwhile? Many of those with a "poor" quality of life may (and do) lead admirable and very meaningful lives.
Second, all quality-of-life criteria come in degrees—abilities, happiness, cognitive functions, etc. If one's personhood (i.e., worth, dignity, right to life) depends on quality-of-life criteria, then personhood also is a matter of degree. That is, some people are more valuable than others, and some have "more" of a right to life than others.
Say that my friend is a happy, healthy, normal college student, but I'm just a bit happier or perhaps even a bit more self-aware and appreciative of life. It would follow, on the quality-of-life ethic, that my friend has a life less worth living than mine. And each quality-of-life "setback," whether financial, health-related or otherwise, would put him one step closer to rational suicide. This is radically contrary to our intuitive notion of human equality and the dignity of human life, irrespective of circumstances.
Third, quality-of-life criteria tend to exclude some human beings who we all agree are valuable persons with worthwhile lives. Newborn babies may not yet be self-aware, and reversibly comatose patients are not even conscious. Neither can have a good "quality of life" as it is usually defined, but almost no one argues that they are not persons deserving care.
It is true that newborn babies and reversibly comatose patients will soon be able to function in the proper way and have a good quality of life; their current state is only temporary. But in order to say that they are persons, despite their present inability to function as such, we must ground their personhood in something other than those functions. Namely, they are persons because they are human beings, who by nature have the inherent capacity to develop certain abilities, whether those abilities are immediately exercisable or not.
And this means that all disabled or elderly patients—not just the reversibly comatose—are deserving of full moral respect and protection by virtue of their membership in the human family. Those with an allegedly poor "quality of life" should not be discriminated against in the provision of care and treatment.