Quality of Life: A Deconstruction for Clinicians

Abstract

Quality of life has been an issue in medical research for more than twenty years1, and many authorities now regard it as a key measurement in clinical trials2,3. Yet the concept remains controversial. In the clinical world, scepticism is exemplified by a comment by Wulff in the JRSM: ‘Scientists may use rating scales and visual analogue scales to measure pain, and they may even invent scoring systems quantifying types of handicaps; but when they talk about measuring quality of life they have gone too far’4. This statement reflects a two-world model of medicine and of human experience in which objective facts are clearly distinguished from subjective values4,5. It can be seen as a reaction to the World Health Organization's concept of health and of quality of life that invites us to mix facts and values non-systematically: ‘Quality of life is defined as an individual's perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations and standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment’6.

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