Theoretical Medicine and Bioethics

, Volume 26, Issue 4, pp 307–337 | Cite as

Quality of Life Considered as Well-Being: Views from Philosophy and Palliative Care Practice

  • Gert Olthuis
  • Wim Dekkers


The main measure of quality of life is well-being. The aim of this article is to compare insights about well-being from contemporary philosophy with the practice-related opinions of palliative care professionals. In the first part of the paper two philosophical theories on well-being are introduced: Sumner’s theory of authentic happiness and Griffin’s theory of prudential perfectionism. The second part presents opinions derived from interviews with 19 professional palliative caregivers. Both the well-being of patients and the well-being of the carers themselves are considered in this empirical exploration. In the third part the attention shifts from the description of “well-being” to prescriptions for the promotion of well-being. Our interview data are analysed in light of the theories of Sumner and Griffin for clues to the promotion of “well-being.” The analysis (1) underscores the subject-relativity of well-being, (2) points out that values that are considered important in every life still seem to be relevant (at least in palliative care practice), and (3) shows the importance of living a certain sort of life when aiming to enhance dying patients’ well-being.


covenant ethics life quality of palliative care philosophy professional–patient relationship well-being 


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  1. Annas, J. 2002Should Virtue Make You Happy?Jost, LawrenceShiner., Roger eds. Eudaimonia and Well-beingAcademic Printing and PublishingKelowna BC119Google Scholar
  2. Buijssen, H., Bruntink, R., Ploeg, H., Baar, F., Stoppelenburg, A. 2003A Good Ending, Good for All? Care for Carers Working in Palliative CareDe Stiel/TREDNijmegen/TilburgGoogle Scholar
  3. Byock, I 2003Rediscovering Community at the Core of the Human Condition and Social CovenantHastings Center Report33s40s41Google Scholar
  4. Deeken, J.F., Taylor, K.L., Mangan, P., Yabroff, K.R., Ingham, J.M. 2003Care for the Caregivers: A Review of Self-report Instruments Developed to Measure the Burden, Needs, and Quality of Life of Informal CaregiversJournal of Pain and Symptom Management26922953CrossRefPubMedGoogle Scholar
  5. Doyle, D.Hanks, G.Cherny, N.Calman, K. eds. 2003Oxford Textbook of Palliative Medicine 3rd edOxford University PressOxfordGoogle Scholar
  6. Emanuel, E.J., Emanuel, L.L 1998The Promise of a Good DeathThe Lancet351S21S29CrossRefGoogle Scholar
  7. Griffin, J 1986Well-Being: Its Meaning, Measurement and Moral ImportanceClarendon PressOxfordGoogle Scholar
  8. Hull, S.C., Taylor, H.A., Kass, N.E. 2001Qualitative MethodsSugarman, JeremySulmasy, Daniel eds. Methods in Medical EthicsGeorgetown University PressWashington146168Google Scholar
  9. Katz, R.S., Genevay, B. 2002Our Patients, Our Families, Ourselves: The Impact of the Professional’s Emotional Responses on End-of-life CareAmerican Behavioral Scientist46327339CrossRefGoogle Scholar
  10. Lawton, J 2000The Dying Process: Patient’s Experiences of Palliative CareRoutledgeLondonGoogle Scholar
  11. Luker, K.A., Austin, L., Caress, A., Hallett, C.E. 2000The Importance of ȁ8Knowing the Patient’: Community Nurses Constructions of Quality in Providing Palliative CareJournal of Advanced Nursing31775782CrossRefPubMedGoogle Scholar
  12. Martin, G.W 1998Empowerment of Dying Patients: The Strategies and Barriers to Patient AutonomyJournal of Advanced Nursing28737744CrossRefPubMedGoogle Scholar
  13. McCormick, T.R., Conley, B.J 1995Patients’ Perspectives on Dying and on the Care of Dying PatientsWestern Journal of Medicine163236243PubMedGoogle Scholar
  14. Meier, D.E., Back, A.L., Morrison, R.S. 2001The Inner Life of Physicians and Care of the Seriously IllJournal of the American Medical Association28630073014CrossRefPubMedGoogle Scholar
  15. Miles, M.B., Huberman, A.M. 1994Qualitative Data Analysis: An Expanded SourcebookSAGE PublicationsThousand OakesGoogle Scholar
  16. Musschenga, A.W 1997The Relation Between Concepts of Quality-of-Life, Health and HappinessThe Journal of Medicine and Philosophy221128PubMedGoogle Scholar
  17. Nordenfelt, L 1993Quality of Life, Health and HappinessAshgateAldershot, UK, Burlington, VTGoogle Scholar
  18. Nordenfelt, L 1999IntroductionEthical Theory and Moral Practice2310CrossRefGoogle Scholar
  19. Olthuis, G., Dekkers, W. 2003Medical Education, Palliative Care and Moral Attitude: Some Objectives and Future PerspectivesMedical Education37928933CrossRefPubMedGoogle Scholar
  20. Pearlman, R.A., Miles, S.H., Arnold, R.M. 1993Contributions of Empirical Research to Medical EthicsTheoretical Medicine14197210CrossRefPubMedGoogle Scholar
  21. Ramirez, A., Addington-Hall, J., Richards, M. 1998ABC of Palliative Care: The CarersBritish Medical Journal316208211PubMedGoogle Scholar
  22. Richardson, J 2002Health Promotion in Palliative Care: The Patients’ Perception of Therapeutic Interaction with the Palliative Nurse in the Primary Care SettingJournal of Advanced Nursing40432440CrossRefPubMedGoogle Scholar
  23. Sandman, L 2001A Good Death: On the Value of Death and DyingActa Philosophica GothoburgensiaGöteborgGoogle Scholar
  24. Sandøe, P 1999Quality of Life – Three Competing ViewsEthical Theory and Moral Practice21123CrossRefPubMedGoogle Scholar
  25. Schermer, M 2001The Different Faces of Autonomy: A Study on Patient Autonomy in Ethical Theory and Hospital PracticeDissertation University of AmsterdamAmsterdamGoogle Scholar
  26. Schermer, M 2003In Search of 'The Good Life’ for Demented ElderlyMedicine, Health Care and Philosophy63544Google Scholar
  27. Sherman, D.W 1999End-of-life Care: Challenges and Opportunities for Health Care ProfessionalsThe Hospice Journal14109121CrossRefPubMedGoogle Scholar
  28. Singer, P.A., Martin, D.K., Kelner, M. 1999Quality End-of-life Care. Patients’ PerspectivesJournal of the American Medical Association281163168CrossRefPubMedGoogle Scholar
  29. Steinhauser, K.E., Christakis, N.A., Clipp, E.C., McNeilly, M., McIntyre, L., Tulsky, J.A. 2000Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care ProvidersJournal of the American Medical Association28424762482CrossRefPubMedGoogle Scholar
  30. Sulmasy, D.P., Sugarman, J. 2001The Many Methods of Medical Ethics (Or, Thirteen Ways of Looking at a Blackbird)Sugarman, JeremySulmasy, Daniel eds. Methods in Medical EthicsGeorgetown University PressWashington318Google Scholar
  31. Sumner, L.W. 2002Happiness Now and ThenJost, LawrenceShiner, Roger eds. Eudaimonia and Well-BeingAcademic Printing and PublishingKelowna BC2139Google Scholar
  32. Sumner, L.W 1996Welfare, Happiness, and EthicsOxford University PressOxfordGoogle Scholar
  33. Twycross, R.G 1987Quality Before Quantity – A Note of CautionPalliative Medicine16572Google Scholar
  34. Varelius, J 2003Autonomy, Subject-Relativity, and Subjective and Objective Theories of Well-Being in BioethicsTheoretical Medicine24363379CrossRefGoogle Scholar
  35. Vig, E.K., Pearlman, R.A. 2004Good and Bad Dying from the Perspective of Terminally Ill MenArchives of Internal Medicine164977981CrossRefPubMedGoogle Scholar
  36. Walters, G 2004Is There Such a Thing as a Good Death?”Palliative Medicine18 (2000) 404–408CrossRefGoogle Scholar
  37. Wenrich, M.D., J.R. Curtis, D.M. Ambrozy, J.D. Carline, S.E. Shannon, and P.G. Ramsey. “Dying Patients’ Need for Emotional Support and Personalized Care from Physicians: Perspectives of Patients with Terminal Illness, Families, and Health Care Providers.” Journal of Pain and Symptom Management 25 (2003): 236–246Google Scholar
  38. Wilson, D.M 2000End-of-Life Care Preferences of Canadian Senior Citizens with Caregiving ExperienceJournal of Advanced Nursing3114161421CrossRefPubMedGoogle Scholar
  39. World Health Organization. “Palliative Care.” [cited (2004) Jan 12]. Available from: URL:
  40. Yurk, R., Morgan, D., Franey, S., Stebner, J.B., Lansky, D. 2002Understanding the Continuum of Palliative Care for Patients and Their CaregiversJournal of Pain and Symptom Management24459470CrossRefPubMedGoogle Scholar
  41. Zimmerman, C. 2004Denial of Impending Death: A Discourse Analysis of the Palliative Care LiteratureSocial Science and Medicine5917691780CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Department of Ethics, Philosophy and History of Medicine (232)Radboud University, Nijmegen Medical CentreNijmegenThe Netherlands

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