Abstract
In the context of end of life care utilitarianism’s focus on the positive and negative consequences of actions and omissions offers a powerful ethical guide. Whilst many writing on this topic and from this point of view has tended to focus on various kinds of euthanasia this chapter concerns the connection between good and bad care and right and wrong action. Within palliative and end of life care, such thinking allows the concept of ‘quality of life’ to come to the fore as something that can guide ethical and practical decision-making. To adequately estimate the role that the concept ‘quality of life’ can play in ethical decision-making this article offers a taxonomy of four standards used to assess quality of life, provides a critical overview of various standard objections raised against the concept of ‘quality of life’, and discusses the Quality Adjusted Life Year (QALY) which is one of the best known methods to measure quality of life. The topic of utility aggregation, central to utilitarian thinking, is laid out in its intrapersonal and interpersonal dimension. The chapter concludes with a consideration of three important areas of application that pose different questions and problems for utilitarian decision-making within end of life care. Starting with decisions concerning the practice of continuous sedation, the chapter considers decisions to withdraw or withhold care that can be due to a lack of patient consent, i.e. the patient’s refusal of treatment, but can also be justified by appealing to the futility of available treatment options.
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Notes
- 1.
An antinatalistic position ascribing a negative value to birth is for example advocated by Benatar 2006.
- 2.
The taxonomy of distinctions (1) to (4) follows Quante 2014, 33–36.
- 3.
For the following explanations and the typology of five arguments against quality of life-considerations conf. Ach et al. 2000, 126–134.
- 4.
For the replacement of “sanctity of human life” by the value of “quality of life” in health care and decision making conf. Koch 2000.
- 5.
This ethically impermissible discrimination covers two varieties: (i) the eugenic selection at the beginning of life and (ii) age discrimination at the end of life.
- 6.
Conf. Nord 1999 as regards the question of who is to determine the value of a certain health state.
- 7.
On intrapersonal justice also conf. Quante 2010, 51.
- 8.
The knowledge component is constitutive for the doctrine of double effect (conf. Quante 2016, 175).
- 9.
Conf. also Mashour 2010.
- 10.
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Mooren, N., Quante, M. (2020). Utilitarianism and Care at the End of Life. In: Emmerich, N., Mallia, P., Gordijn, B., Pistoia, F. (eds) Contemporary European Perspectives on the Ethics of End of Life Care. Philosophy and Medicine, vol 136. Springer, Cham. https://doi.org/10.1007/978-3-030-40033-0_3
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