Report by H.E. Mons. Elio Sgreccia on the occasion of the General Assembly of the Pontifical Academy For Life on the theme:
"Quality of Life and the Ethics of Health"
February 21-23, 2005
Today, to evoke these two terms, quality of life and health, is equivalent to focusing public opinion on something more than a political programme; it is almost like invoking "absolutes", the greatest or even the only forms of good, to be pursued to the point of a sort of divinization of health.
On the other hand, there are some who bring light to bear on the emergence of new illnesses (those due to so-called "well-being") and the abysmal injustice that is being created between the well-off and those excluded from their table, which is evident within the individual health-care sectors and also in the perspective of globalization.
Quality of life: magic words
The words or message, "quality of life", which first appeared in a political document (a speech by United States President Johnson, who succeeded John Kennedy as President), permeated Western cultures as a political and financial ideal deemed sound for peaceful, powerful societies, capable of producing the means not only to satisfy their basic needs but also those that aspired to "well-being": social security, health care, the enjoyment of their wealth, the improvement of the ecological environment and the satisfaction of a certain number of desires. After satisfying their needs, people affirmed the urge to satisfy their desires; however, these have no predetermined limit.
This message converged with the utilitarian philosophy widespread in English-speaking societies. Elaborated by the philosopher J. Bentham, it has been renewed in our day by other philosophers (such as P. Singer, in a sensist and materialist conception) to become an ideal: ethical good must produce pleasure and eliminate pain. The political programme based on the quality-of-life concept thus becomes an ethical obligation.
This change gave rise in turn to a corollary: the human being who does not possess the desired minimal "quality" does not deserve to be kept alive, hence, the proposal of eugenic parameters for the purpose of selecting those who do deserve to be accepted or kept alive and those who are to be abandoned or suppressed via euthanasia.
Self-awareness and the capacity for relating, that is, the "signa personae", without which the person himself would not exist, have often been proposed among the features that connote the minimum quality of a life held to be worth living. This is how it is, for example, in neo-contractual thought.
Such an ideal conception of "quality of life" thus inevitably challenges the more traditional concept of the "sanctity of life", misinterpreted as biological vitalism. This has also given rise to contraceptive programmes: happiness means few, for quantity is the enemy of quality.
Health as well-being for all
In the meantime, the complementary concept of "health" had also received a utopian and hedonistic impulse, since it was defined by the World Health Organization (Preamble of the Constitution, 22 July 1946) as a state of "complete physical, mental and social well-being, not merely... as the absence of disease or infirmity". In another document published by the same Organization, health is described as "the physical and mental well-being necessary to live a life that is enjoyable, productive and rich in meaning".
Such an ideal consequently impels society to plan "health for all", even "free of charge".
It was soon noted, however, that financial resources are insufficient, even for the most developed countries; so health programmes have been downsized in order to face the problem of the "allocation of resources for health care". This is a key theme for the economy, for medicine and for all societies.
Obviously, some people are considering reducing expenditures on the hospital "businesses", obliging them to revise the system of admitting patients. Others seek to identify and define "needless expenses". For example, might "needless expenses" be the sums spent on the terminally ill? And this is a recognizable incentive to the legalization of euthanasia.
The consequences of this cultural process in the concept of health have brought to the limelight the opposite of what had been proposed: a culture that does not accept self-control, sacrifice or hardship, not even in things that are paradoxically harmful to health; the rejection of the element of "responsibility" for lifestyles; the overwhelming desire to eliminate the concepts of disease, pain and death.
The miserable conditions, in terms of health and well-being, of the developing continents and countries should also be remembered. In many areas of Africa and Asia, for example, health service has been reduced to the minimum due to the total lack of organized health care, doctors and medicines, and has led to the interruption of therapeutic treatment. The Pontifical Academy for Life also focused on this aspect during its General Assembly.
However, the relators and participants were also asked the straightforward question: what concept of "quality of life" and what ideal of "health" are compatible with cultural and historical realism and further, with Christian anthropology?
We are convinced that the winning solution will consist in working out a new, critical and positive perspective that approves the non-reductionist concept of the human being (for this is the crux of the matter), a concept that respects the unchangeable and equal dignity of every human person as a creature of God, from conception until natural death; a perspective that will refer to the fundamental value of life and respect for the principle of ethical responsibility and will consider the human being in the perspective of spiritual life, open to transcendence.
The 18 reports and 12 announcements that comprised the General Assembly certainly made a valuable contribution to rethinking the principles underpinning the society of "well-being", social justice and the vision of the human being.
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