What is Your Definition of Quality of Life?

Not to stir a controversy here or anything. Yet, I like to hear from you on what is your definition of a need and a want is.

Typically, I like to think of a need as what we need to sustain life: basic food, clothing, shelter, etc. I do this to show people that we have a lot more choices in life and budgeting than we realize. I look at the issue as what does a person need to eat to sustain life? Basically, it is beans, rice and some fruits and vegetables. What is it for housing? For many, this may mean an apartment or house. For others, it may be a tent or a car. As a society, we debate the minimal standard of living that we should help others with to maintain a minimal standard for quality of life. So we set the bar between what is a need and what is a want that may be a little higher than basic need to sustain life based on our definition of quality of life.

Quality of life is interesting to define because every one has a different definition. Thus, I write this for people to think about their quality of life. For some, the first words that come up may be based on having a space to live in a safe neighborhood. For others, it may be having enough to eat so people do not go hungry at night. Others may say it is to be happy and to be able to enjoy life.

So I thought that it may be easier to define if it from a life and death perspective (medical care). However, as I thought about it, hoping to find a clear answer to blog about, the gray area became even grayer. Recently, my grandfather in-law passed away after a stroke. He had been having health problems for the last few years, so it was probably his time to go. However, after the stroke, he was maintained by life support systems and his daughters had to decide whether to continue life support. Years ago, there would not be a decision if life support was a need or a want because there would not be any an option. Now, with all our technological improvements, the level of health care that is a need versus a want has become grayer.

There is the argument that if we have the technology to help the patient and if the patient may be able to have some quality to life after the procedure, that we should employ it, no matter the cost. There is a debate on what is quality of life that I do not want to get into here. So let’s assume, their quality of life is considered “normal” life with no health problems for the reason that brought the patient to the hospitals (yet there could be pre-existing conditions). This argument is probably an easier one to make to use the life-saving medical procedure for a 5 year old patient than it is for a 95 year old patient that probably only had a few months or years to live at most due to his pre-existing conditions. It also probably makes a difference if the procedure is a simple on or a complicated one that will take many medical professionals to take care of the patient and thus raising its costs.

Hold it. I know that some readers are questioning what does cost have to do with saving a life? Money should not be an object when we are talking about a human being with a soul. Yet, if we assume that every one in health care (pharmacies, hospitals and companies making health care equipment) are not in it for the money (no profit motives), then the cost of health care is equivalent how many hours a doctor and nurse have to work and how much the medical supplies and use of the equipment costs. Now, it may seem reasonable to save a life no matter what the cost, especially if we have the time and money to do it. However, there comes a point where “no matter what the cost” means that the medical staff can not go home because they need to take care of the overload of patients on life support measures for months and years at a time. The question is should we factor in how this affects the quality of life for the medical professionals who are working 80 hours weeks, years at a time, and can not see their family? Is it worth them giving up their quality of life (time with children and family) to support someone who may or may not live and with no certainty, if they live, for how long (maybe 1 day, 2 years or 5 years)? And, what if that patient would probably be in a coma the entire time?

Doesn’t this bring up an interesting medical debate?

If you think that the current medical staff can not get stretched so thin that they are working all the time, consider the debate over residents working a standard 80 hour work week a few years ago. Part of the reason they worked so long was done to help them learn everything that they needed to know in their few years as a resident which is hard to do if they just work 9 to 5 without seeing a critical patient from start to finish. Yet, the long hours from residents also helped a hospital to be able to keep its doors open to patients that the staff could not do without an extra set of hands. Think about how the waiting lists of patients waiting for surgeries in other countries who decide to come to the U.S. or other countries like India because they do not want to remain on a waiting list for several months before it is their turn. Also, many of our hospitals are running at 95% to 100% capacity already with the growing needs of baby boomers waiting to hit our medical facilities in just a few years.

I do not mean this to be a question on whether we should have universal health care in the U.S. or if the price of health care is too high. We can save that for later. Rather, I ask to raise a question for readers on what is quality of life and where the minimal line should be drawn. In particular, if you could to make a decision today to work 2 additional years (60+ hours a week) to afford to live an additional 2 years beyond where your life would currently end via the assistance of advanced medical care, would you do it?

It may be an easier question to ask if you made it at the end of your life, if you had to decide to have a surgery to extend your life because it is a life or death decision. It is easier if you did not have to pay for it and harder if you when you need to pay for it and work harder and longer to do it ahead of time.

No matter what health system we have (government pay, company pay or patient pay), it ends up costing us as a tax payer, consumer or directly as a patient, one way or another. Thus, in a sense we are paying for it now.

For myself, I would want to live a balanced life today rather than work extra on a consistent basis, giving up time with my family, to afford to pay the few extra years at the end of my life. However, I do enjoy the benefits that our health care systems provide. Thus, my wife and I work to afford basic health insurance to have the opportunity to have a normal life after a car crash. However, there is a line we have talked about on where to cut off life support based on the prognosis of quality of life.

This is going to become an important issue for our politicians and voters to decide on as our baby boomers reach their 70’s and 80’s. Before, we automatically paid for health care because we had many people working to support Medicare for a few elderly. Thus, costs did not really factor into the decision, too much. In the future, we will have to pay for their health care with a few workers supporting each elderly patient on Medicare. It may seem easy to say pay for health care no matter what the cost. Yet, even if we did use money to pay for health care, there may be a point where the health care needed strains the resources we have available.

Thus, for me, the current political discussion on health care should not only be if we keep the system we have or go to a universal health care system but also should be how to clarify our expectations on what is quality of life. It is one thing to discuss how to extend our quality of life if cost was not a factor. However, it is another decision when we are the ones paying for it whether it as taxpayers or directly as the patient or whether we consider the doctors and nurses who may be the ones expected to do more for less (which has already been going on with Medicare cost cutting measures).

This also raises other questions as consumers on how we make purchases to help our quality of life especially if it means working longer in a job we do not enjoy. Where do we draw the line on working harder (especially if it is in a job we do not like) or making by with less?

Again, I do not mean to raise an argument on whether insurance companies, drug companies or hospitals are greedy or not. I meant it for a philosophical debate on if your quality of life is measured more on quantity (length of life) or quality (doing more of what we want in the time we have, even if it means a shorter life).

I know most people would like to have quality of life mean sitting on a beach sipping a margarita (instead of working), yet who would be at the hospital taking care of the sun burns and skin cancer?

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