It is a standard position in healthcare ethics that quality of life is subjective. This shouldn’t be controversial as it is obvious that people are different, and have different personalities, experiences, backgrounds, and expectations.

We should be wary of making assumptions about the quality of life of others, especially if they have different lives, beliefs, and experiences than ours. It is important to remind ourselves that there are many ways individuals can be happy and have different definitions of what quality of life means to them.  

For example, an extrovert who loves being around people and belonging to many social clubs and organizations would think that an introvert who enjoys staying home reading or taking walks is really missing out on life and therefore probably has a low quality of life. Meanwhile, the introvert might think that the social butterfly who is always on the go is the one who is missing out on life as they can’t be happy alone with their thoughts.

Wealthy or upper-middle class individuals might think that those who are living in poverty cannot possibly have a good quality of life. Yet many who might be considered poor financially consider themselves to be well off in other ways and that they are kinder, more authentic, and less obsessed with status than the wealthy.

People living in large urban centers might believe that people living in remote rural areas must have poor solitary lives without culture or excitement, while rural dwellers might believe that a life in the big city with its crowds, traffic, stress and noise would be torture.

Society provides us with basic recipes for fulfilling lives, which usually involves a straight line from education to a career, to marriage, to children, to homeownership, and eventually retirement. It is therefore easy to assume that anyone who does not follow that path is somehow “missing out” and has a decreased quality of life.

Yet one cannot miss out on what one has never experienced. Not everyone feels the need to follow society’s plan for success and happiness. One can find fulfillment and quality of life in all sorts of different circumstances.

 Individuals can also adapt to tragic circumstances and learn to find different pleasures and comforts. We see this in our own lives as we age and our lives change. The quality of life for a small child is radically different than the quality of life of a teenager. The quality of life for an adult changes as they age and their circumstances, tastes and expectations change. Quality of life can often be situational and change according to the contexts.

Adaptability and Resilience

Humans are incredibly adaptive. Everyone who works in healthcare knows this. They can adapt to the most horrific situations and still find joy in simple basic pleasures which can take on a new meaning when they have lost many other pleasures and activities which they once took for granted.

Individuals can lose their jobs, their status, their spouses, their health, and their independence. Yet they can still find comfort, pleasure, and joy in many ways. For the elderly, it could be something as simple as being able to go outside and watch the sunrise another day, knowing that each day is precious because there will be so few of them. Being able to enjoy coffee, ice cream, watching a favorite familiar tv show or movie, listen to your favorite music, or have a visit from a family member or friend can be of immense comfort.

For those who have chronic illnesses and suffer discomfort or pain, being able to have these symptoms and pain alleviated by a caring healthcare worker can be the most important factor in providing quality of life. It is hard to enjoy life when you are constantly in pain. We should always focus on improving the quality of life when making harm/benefit decisions regarding specific clinical interventions.

We can’t experience the lives of others. We can, however, listen to them and try to understand them. We can also observe them and use empathy and imagination to try to appreciate what they are going through.

We should therefore be wary of judging the quality of life of others just as we would not want our quality of life judged by others.

David Campbell, PhD

Ethicist