What is the Quality of Life? A Euphemism for Euthanasia
In my medical training in the 1980's the term quality of life was often used when a patient's case was discussed and an illness was becoming increasingly difficult to treat or care for. It was assumed that if a patient's quality of life was poor, then the decision to continue pursuing aggressive treatment needed to be re-evaluated. Even as a Christian physician, with no training or teaching in ethics, I adopted this quality of life approach to decide on treatments. It seemed that most of my colleagues based treatment decisions on what quality of life we judged the patient to have given a particular disease or condition. Everyday, nurses and doctors in long term care facilities use "quality of life" arguments to decide why they shouldn't pursue a treatment or remedy in a "difficult case." Quite frankly, it is much easier and cheaper to do nothing for a patient, than to carefully palliate a condition providing adequate pain control and comfort measures without shortening the life of a patient.
Part of our society's acceptance of the "quality of life" paradigm lies in the failure to face or embrace suffering. We are taught to end suffering at all costs and now, in Oregon, that translates into taking the life of a person to "end their suffering." Modern society has no theology to handle suffering and hence suffering is considered the enemy and must be vanquished at all costs. As a practitioner of the healing arts, I am obligated to relieve suffering to the best of my ability but I also acknowledge that all life ultimately involves some degree of suffering. As John Paul 2 reminds us, Jesus not only redeemed us by His suffering but He redeemed suffering itself, so that suffering is not without value if united with Christ's suffering. (Col 1:24)
It was not until my conversion to Catholicism and my exposure to Catholic medical ethics that I started to see the pernicious aspect of this quality of life argument. Catholic theology teaches that Life itself is a good, because God created life. Therefore, it is not up to me to make a judgment of whether the quality of someone's life is "good." During the late 1930's in Europe, handicapped, mentally retarded and ill people were judged to have a poor quality of life and became the target of Nazi Germany's euthanasia program. (along with Jews, Catholic priests, gypsies and homosexuals) The photo above was the graves of victims of euthanasia in Austria during 1941. They were "defective" German citizens or the incurably ill.
Without firm guidelines and teaching in Christian ethics, even well meaning Christian health professionals can be caught up in the quality of life approach to health care. I considered myself a devout Christian physician but had no training in the Christian approach to medical ethics in health care. I am thankful for the wealth of information available to me in the Church and have availed myself of our diocesan ethics specialist at times for consultations. I no longer feel like I am "flying by the seat of my pants" when attempting to navigate complex medical/ethical decisions for the frail elderly population I care for.
"Even when not motivated by a selfish refusal to be burdened with the life of someone who is suffering, euthanasia must be called a false mercy, and indeed a disturbing "perversion" of mercy. True "compassion" leads to sharing another's pain; it does not kill the person whose suffering we cannot bear. Moreover, the act of euthanasia appears all the more perverse if it is carried out by those, like relatives, who are supposed to treat a family member with patience and love, or by those, such as doctors, who by virtue of their specific profession are supposed to care for the sick person even in the most painful terminal stages." - The Gospel of Life, #66 - John Paul II, 1995
Sources of Medical Ethics
Catholic Medical Association
Evangelium Vitae/The Gospel of Life
National Catholic Bioethics Center
Priests For Life