Matti Häyry

Measuring the quality of life: Why, how and what?

In this paper three questions concerning quality of life in medicine and health care are analysed and discussed: the motives for measuring the quality of life, the methods used in assessing it, and the definition of the concept. The purposes of the study are to find an ethically acceptable motive for measuring the quality of life; to identify the methodological advantages and disadvantages of the most prevalent current methods of measurement; and to present an approach towards measuring and defining the quality of life which evades the difficulties encountered and discussed. The analysis comprises measurements both in the clinical situation concerning individual patients and in research concerning whole populations.Three motives are found for evaluating the quality of human life: allocation of scarce medical resources, facilitating clinical decision making, and assisting patients towards autonomous decision making. It is argued that the third alternative is the only one which does not evoke ethical problems.As for the methods of evaluation, several prevalent alternatives are presented, ranging from scales of physical performance to more subtle psychological questionnaires. Clinical questionnaires are found to fail to provide a scientific foundation for universally measuring the quality of life.Finally, the question of definition is tackled. The classical distinction between need-based and want-based theories of human happiness is presented and discussed. The view is introduced and defended that neither of these approaches can be universally preferred to the other. The difficulty with the need approach is that it denies the subjective aspects of human life; whereas the problem of the want approach is that it tends to ignore some of the objective realities of the human existence.In conclusion, it is argued that the choice of methods as well as definitions should be left to the competent patients themselves — who are entitled, if they so wish, to surrender the judgement to the medical personnel. Technical factors as well as the requirements of respect for autonomy and informed consent support this conclusion.

Genetic Ignorance, Moral Obligations and Social Duties

In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kants concept of autonomy and Aristotles notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mills ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.

Genetic information, rights, and autonomy.

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide a firmer basis for ethical guidelinesand policies in this field.

Liberal utilitarianism and applied ethics

Preface Introduction 1. Utilitarianism and the British Tradition 2. The Development of Modern Utilitarianism 3. From Classical to Liberal Utilitarianism 4. Ethical Theory and Practice Summary and Conclusions Notes Further Readings Bibliography Index

Philosophical Arguments for and Against Human Reproductive Cloning

Can philosophers come up with persuasive reasons to allow or ban human reproductive cloning? Yes. Can philosophers agree, locally and temporarily, which practices related to cloning should be condoned and which should be rejected? Some of them can. Can philosophers reproduce universally convincing arguments for or against different kinds of human cloning? No. This paper analyses some of the main arguments presented by philosophers in the cloning debate, and some of the most important objections against them. The clashes between the schools of thought suggest that philosophers cannot be trusted to provide the public authorities, or the general public, a unified, universally applicable view of the morality of human reproductive cloning.

Prescribing cannabis: freedom, autonomy, and values

In many Western jurisdictions cannabis, unlike most other psychoactive drugs, cannot be prescribed to patients even in cases where medical professionals believe that it would ease the patient’s pain or anxiety. The reasons for this prohibition are mostly ideological, although medical and moral arguments have been formulated to support it. In this paper, it is argued that freedom, properly understood, provides a sound ethical reason to allow the use of cannabis in medicine. Scientific facts, appeals to harm and autonomy, and considerations of symbolic value cannot consistently justify prohibitions.

If you must make babies, then at least make the best babies you can?

This article provides an overview of the reasons why people should or should not have children, and of two attempts to define what we can do to make sure that the lives of the children we have are as good as they can be. It is suggested that the answers to these questions are more complex than we tend to think, and that rational arguments can be found to support many mutually conflicting reproductive policies.

A defense of ethical relativism.

Relativism is usually a derogatory word in philosophical bioethics in the West. If people make the mistake of trying to understand radically “different” points of view, an accusation of relativism is quickly forthcoming. But why should this be an accusation? My aim in this paper is to demonstrate that it should not.

Considerable Life Extension and Three Views on the Meaning of Life

Picture this. You are having your regular medical checkup, when, all of a sudden, the physician turns to you and says: “Oh, did I remember to mention that you can now live forever?” You look at the doctor enquiringly and she goes on: “Well, it’s not actual immortality, you know, but they’ve invented this treatment—I don’t have the full details—that stops aging, getting physically older. It might not be for everyone, but you seem to be a suitable candidate. You could still die of accidents and illness, of course, but they’ve calculated that with care and any luck you should live to be a thousand, as opposed to the hundred or so that you would now have. And in a millennium, techniques will advance further, so there could be more in store for you after that.”

Cloning, naturalness and personhood

Since the invention of recombinant-DNA techniques in the 1970s, the development of modern biotechnology has presented a constant challenge to our views of ourselves as natural and moral beings. Somatic cell therapies, which cure diseases only in those individuals who are actually being treated, are the least problematic form of medical genetics, as they can easily be seen as no more than a new method of doing what physicians have always done in their professional capacity, namely removing illness and relieving suffering. Germ-line gene therapy, which is expected to rectify hereditary disorders both in patients themselves and in their descendants, has been viewed with more suspicion, because more permanent changes in the human constitution over generations are involved. The project to map the human genome has also caused concern, mainly since it can be applied to eugenic purposes — for the alleged improvement of humankind. But for the last two decades the most serious moral doubts about genetics have been related to cloning or, to be more precise, to the production of children by copying the genetic makeup of living individuals.