This is an interesting question Doctor D found in a discussion going on at the Serenity Now Hospital blog.
Quality of Life is the concept that medical care should focus not just on the number of days our patients live but the amount of meaningful and fulfilling health within those days. Patients will often sacrifice length of life for improved quality of life. Some patients also decide that in the face of a life-threatening illness they will not have further treatment once their quality of life falls below a certain level.
Reflecting on quality of life helps doctors recognize the humanity of their patients. It helps us realize that that longer life isn't always better. At its best, quality of life allows the patient to decide how they approach illness and disability, while the doctors respectfully relinquish control to the patient's wishes.
Doctor D believes that quality of life cannot be determined apart from the patient's personal values and preferences. Many doctors, however, make quality of life judgements about their patients. Often physicians embrace the concept of quality of life without acknowledging that it is a personal decision that belongs to the patient not them.
On the post "Compassionate Death?" Doc Sensitive relates the story of an attending that decided not to treat an elderly man with dementia due to the attending's belief the man had no quality of life. The attending allowed the patient to die comfortably and untreated without ever trying to find out the old man's desires or contact the man's family. Doc Sensitive wonders if this was the right way to handle this patient?
The discussion after the post is also interesting. (Doctor D threw his 2 cents worth into the conversation too--It's the 3rd comment down.)
What do you think? Would you be comfortable with a doctor making a quality of life decision for you if you couldn't speak for yourself? Do you think Doctors are the right people to be making quality of life decisions? Do accounts like this make you more likely to get a living will or discuss your wishes with your family?
Doctor D will be back soon with more answers to your questions.