Health and the quality of life.

Abstract

Thank you for the invitation to address the openingceremony of your fourth Nursing Academic Inter-national Congress. It is a double pleasure for me.First, I welcome the opportunity to return to theacademic environment and rekindle memories ofthe kinds of debates and discussions that ideallycharacterize this kind of setting. Secondly, I will al-ways feel a debt of gratitude to the nursing profes-sion. Not only did it provide me with a wife, butnurses throughout the years of my medical practicetaught me almost as much as my more formalteachers. In addition, I recall with much pleasurereceiving the Archon Award from your prestigioushonor society last year. The fact that this is an aca-demic congress has stimulated me to think moredeeply about the topic that is the focus of your de-liberations, and to perhaps be more philosophicalthan I would normally be.I was amazed at the amount of literature thatsurrounds the issue of quality of life and the num-ber of research tools and constructs that have beendeveloped (1). There is an International Society forthe Quality of Life. I was particularly struck by thefact that the various efforts to quantify or measurequality of life frequently involved some health-related attribute. In general terms, the characteris-tics could be roughly divided into the internal andexternal factors. There were many excellent de-scriptions of the kind of physical and social envi-ronment that I consider among the external factorsthat contribute to life of good quality. Conversely,there were factors that related very much to the in-dividual’s inner self. It is possible to imagine thatthere are some five main domains of quality of life:health and wellness, interpersonal relationships,community and home presence, personal growthand dignity, and self-esteem. The World HealthOrganization (WHO) defines quality of life as indi-viduals’ perceptions of their position in life in thecontext of the culture and value systems in whichthey live and in relation to their goals, expectations,standards, and concerns. WHO has developed in-struments to measure quality of life (2). It is perhaps intuitively obvious that healthand life are inseparable and, therefore, that mattersof health must enter into any conceptualization ofquality of life. However, the ethical and policy di-mensions of the relationship between health andthe quality of life are not that straightforward. Isuppose in simpler times there was no question