Quality of Life: Secular Ethics
Summary
Quality of Life is a secular ethical principle stating that human life only has value if it allows the person to enjoy a meaningful, autonomous existence. Unlike the religious Sanctity of Life (which says life is valuable in itself), Quality of Life argues that life's worth depends on whether it contains more happiness than suffering, more autonomy than dependence, more dignity than degradation. Peter Singer, a preference utilitarian, is the leading philosopher arguing that the Sanctity of Life doctrine is outdated Christian ideology that should be replaced by Quality of Life principles. Singer argues that a person with severe disability, terminal illness, or unrelenting pain has the right to choose death because their life has become so compromised that continuing it serves no purpose. Quality of Life is linked to Autonomy—the principle that people should be free to make decisions about their own bodies and lives. However, critics argue that once we start judging whose life is "worth living," we risk devaluing disabled, elderly, and vulnerable people.
Detailed Explanation
What is "Quality of Life"?
Definition
The principle that a human life has instrumental (not intrinsic) value—its worth depends on what the person can do, experience, and enjoy. A life is valuable if it allows happiness, autonomy, relationships, and meaningful activity.
Key Components of Quality of Life
Physical health
Freedom from pain, access to medical care.
Mental health
Psychological well-being, contentment, engagement with life.
Autonomy
The ability to make choices about your life.
Relationships
Connections with loved ones.
Meaningful activity
Work, hobbies, spiritual pursuits.
Independence
The ability to care for yourself and function.
When these are absent or severely diminished, Quality of Life is poor.
Intrinsic vs. Instrumental Value
Intrinsic Value (Sanctity of Life)
- Life is valuable in itself, just because it is human life.
- No conditions needed; a person in a coma has the same value as a healthy person.
Instrumental Value (Quality of Life)
- Life is valuable for what it allows you to do and experience.
- A life with no consciousness, no ability to relate to others, and no possibility of pleasure has little or no value.
Peter Singer's Quality of Life Commandments
Singer's Argument
Singer is a preference utilitarian. He argues that what makes killing normally wrong is that it frustrates the victim's preference to continue living.
But: If someone prefers to die (because quality of life is poor), then killing them respects their preference rather than violating it.
Singer's Five Quality of Life Commandments
1. Recognize that the worth of human life varies—not all lives have equal value.
2. Take responsibility for your decisions—consider how they affect others.
3. Accept that a life can be so compromised it is not worth living—especially with terminal illness or severe disability.
4. Make quality of life decisions based on the individual's circumstances, not abstract principles.
5. Value autonomy—respect the person's choice about their own death.
Autonomy and Quality of Life
The Autonomy Principle
Humans should be free to make informed, voluntary decisions about their own bodies and lives.
Applied to Euthanasia
If a competent, informed person requests euthanasia, their autonomy should be respected.
Why This Matters
- Forcing someone to live against their will treats them as an object (violating Kant's second formula of humanity).
- Respecting their choice honors their personhood and self-determination.
Subjective vs. Objective Quality of Life
Subjective Quality of Life
- How the person themselves rates their quality of life.
- Their own values and preferences determine whether life is worth living.
- Example: A person with severe arthritis might say: "My quality of life is poor—I can't do what I love."
Objective Quality of Life
- An external assessment based on measurable facts (health, function, relationships).
- A doctor or observer judges whether life meets minimum standards.
- Example: A doctor observes: "The patient has these capabilities, therefore quality of life is adequate."
For Euthanasia Decisions
Subjective is usually considered more important—if the patient believes their quality of life is unacceptable, that matters more than an external judgment.
Strengths of the Quality of Life Approach
1. Respects Autonomy
People should have the right to make decisions about their own bodies and lives. Forcing someone to live in agony against their wishes violates their fundamental freedom.
2. Recognizes Individual Differences
Not everyone has the same values about what makes life worth living. Objective criteria (like "persistent consciousness") can't capture everyone's preferences. Quality of Life allows for individual judgment.
3. Responds to Modern Medical Capacity
We can now keep people alive in conditions unimaginable when the Sanctity of Life doctrine was developed. Persistent vegetative state (PVS), extreme dementia, terminal suffering—these modern scenarios weren't addressed by ancient religious texts.
4. Avoids Torture
Forcing someone to endure unrelenting pain violates the principle of compassion. If we truly love someone, we should respect their wish to die with dignity.
5. Aligns with Secular Ethics
In diverse societies, not everyone shares religious beliefs about the sanctity of life. Quality of Life provides a common ethical ground based on autonomy and well-being.
Criticisms of the Quality of Life Approach
1. "The Slippery Slope" / "Dangerous Precedent"
Once we start judging whose life is "worth living," where do we draw the line? Today, we permit euthanasia for the terminally ill who request it. Tomorrow, we might permit it for the severely disabled. Eventually, we might permit it for the depressed, the elderly, the economically dependent.
Historical Warning: Nazi Germany used "quality of life" arguments to justify killing disabled people, the mentally ill, and eventually genociding entire groups.
2. Devalues Disabled People
If life's value depends on health/autonomy/function, people with disabilities are implicitly considered "not worth living". Disabled people report that society's ableism (prejudice against disability) often makes their life difficult—not the disability itself. When someone with a disability requests euthanasia, is it because their life is genuinely intolerable, or because society fails to support them?
3. Abandons Intrinsic Human Dignity
Quality of Life says life is only valuable if it meets certain conditions. But this implies that some lives have no value—that some people are not worth keeping alive. All human beings have intrinsic dignity just by being human. To suggest otherwise is to treat humans as disposable objects.
4. "Who Decides?" Problem
Even accepting Quality of Life, who judges whether quality is acceptable? The patient alone (subjective)—but what if they're depressed and making a rash decision? Doctors (objective)—but doctors may impose their values on patients. Society (consensus)—but which society? Standards vary by culture.
5. Conflates "Poor Quality" with "Not Worth Living"
Many people with serious illness, disability, or old age report low quality of life but still want to live. Just because someone's quality of life is poor doesn't mean they think it's not worth living. We shouldn't assume that low quality of life = legitimate reason for euthanasia.
6. Creates Pressure on Vulnerable People
If euthanasia is permitted based on Quality of Life, vulnerable people might feel pressure to die to reduce burden on family or society. An elderly person might request euthanasia not because they think life is worthless, but because they don't want to burden their children. Was the decision truly autonomous if made under social/family pressure?
Scholarly Perspectives
Peter Singer
"The sanctity of life is a doctrine based on outdated religious views. In a secular society where many citizens do not hold religious beliefs, quality of life is a more appropriate principle. A life has value insofar as it permits the individual to experience happiness, exercise autonomy, and engage in meaningful relationships and activities. When these are severely compromised by terminal illness or disability, it is not wrong—it may even be compassionate—to assist someone to die."
Singer's fundamental critique of the Sanctity of Life doctrine and his case for replacing it with Quality of Life as the basis for euthanasia ethics.
Medical Ethics Literature
"The quality of life appropriate to life-sustaining treatment decisions should assess how the conditions of the patient's life affect the value of that life to that patient. What matters is the individual's informed, voluntary preferences about their own existence."
This emphasizes that quality of life judgments should be subjective (based on the person's own values) rather than objective (based on medical criteria). This protects autonomy.
Key Takeaways
Instrumental Value
Life is valuable for what it allows (happiness, autonomy, relationships), not valuable in itself like Sanctity of Life claims.
Peter Singer
Leading preference utilitarian arguing that respecting someone's preference to die (when quality is poor) is more ethical than forcing them to live.
Autonomy Central
If someone competently chooses to die, their autonomy should be respected rather than overridden by religious doctrine.
Subjective Assessment
The patient's own view of their quality of life matters most—objective medical criteria can'tcapture individual values.
Slippery Slope Risk
Critics warn that judging whose life is "worth living" risks devaluing disabled, elderly, and vulnerable people (Nazi Germany example).
Ableism Problem
Disabled people may request euthanasia due to social injustice (lack of support, accessibility) rather than genuine intolerable suffering.
Quick Reference: Sanctity vs. Quality of Life
| Aspect | Sanctity of Life | Quality of Life |
|---|---|---|
| Value of life | Intrinsic (valuable in itself) | Instrumental (valuable for what it allows) |
| Based on | Religious doctrine (Imago Dei) | Secular utilitarian philosophy |
| Euthanasia | Never justified (Strong) or rarely justified (Weak) | Justified when quality poor and person requests it |
| Core principle | Life is sacred; only God decides | Autonomy; person decides their own value |
| Protects | The most vulnerable (doesn't judge worth) | Individual freedom and suffering reduction |
| Risks | Prolonged suffering in unlivable conditions | Devaluing disabled/elderly; pressure to die |