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Quality of Life Judgments

I want to clarify some issues with the Andrea Clark case. If Andrea Clark communicated she was ready to have the ventilator removed or to discontinue dialysis, it should be done. It is within her moral purview to make that request. If she is unable to make that request, then the question should fall to the guardian entrusted with making these decisions for her when she is incapacitated. There is no moral dilemma if either Ms. Clark or her designated guardian opt to discontinue life support. The moral complexity arises when Ms. Clark's desire is to remain on life support and a hospital committee disagrees because they have made a quality-of-life assessment and found Ms. Clark's life "without meaning".

William May explains why quality-of-life assessments are inappropriate for determining who should live and who should die in his book Catholic Bioethics and the Gift of Human Life:

"Quality of Life" judgments are inescapably arbitrary and unjust. Different authors assign different qualities that one needs to possess "meaningful" life, and the same authors at times list different qualities in different apologias for their position. More significantly, the qualities alleged to make life worthwhile (intelligence, ability to respond to stimuli, awareness of others, etc.) all admit of enormous differences in degree. But some cutoff point has to be assigned, above which the quality of life is "meaningful" and below which it is not so that death can be mercifully administered. Such cutoff points are arbitrarily asserted, with different authors assigning different "weight" to different factors and different degrees of ability within the chosen criteria. It is evident that this way of determining who should live and who should die is utterly arbitrary and unjust."

It is an evil arrogance that allows an individual to presume his assessment of the worthiness of another's life is more valid than this other individual's own assement of the meaningfulness of his own life.


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