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Technical advances based on unprecedented levels of energy use brought a new phenomenon of mass consumption as well as many obvious gains in the typical quality of life. However, they have not substantially reduced economic inequality. They also introduced new risks (ranging from car accidents to nuclear weapons) and some worrisome environmental changes, especially the possibility of relatively rapid global warming.

Previous chapters have reviewed measurements that focus on specific aspects of health. This chapter reviews broad-ranging measures of general health and health-related quality of life. It opens with a discussion of the evolution of the quality of life concept and of its different definitions. It then reviews twenty-six measurement scales that are designed for clinical use, for use in social surveys or in epidemiological studies.

This chapter addresses two questions. First, is there anything wrong with deliberately creating a child with a disability (such as deafness)? Second, what is the proper role of child welfare considerations in reproductive decision-making? The chapter concludes that child welfare arguments do have a role, but one that is more limited and less decisive than is commonly assumed. One reason for this is that the idea of harm only applies in very extreme cases, cases where the person created has a life that is so awful that she would be ‘better off dead’. Another is that the relationship between disability and quality of life is more complicated and less direct than is sometimes thought. For these reasons (amongst others) the chapter concludes that a general legal prohibition on selecting for disability is unwarranted, or at least cannot be justified on child welfare grounds alone.

This chapter discusses how the way services are currently focused reflects the values associated with particular perceptions of quality. It offers an alternative way to understand quality of life and care from the person with dementia's perspective. The chapter builds on existing work and offers an approach that locates quality in the relationships people have with those around them, and in the society in which they live, as an alternative to an efficiency-based and individualistic way of assessing services.

This chapter investigates the potentially conflicting interest of quality of life. It considers whether the right to life continues to offer protection for incompetent patients with negligible quality of life and then proceeds to consider the requirements of the right if its protection is applicable. The person/human distinction is rejected in the context of human rights law. The key issue in withdrawal of life-sustaining treatment is not whether the right to life is applicable (for, in respect of a not yet brain dead human being, it will always be applicable) but rather what steps will be reasonable for the state to take in order to preserve the individual’s life. In determining this, the other rights of the patient must be taken into account, including of particular relevance the right to be free from degrading treatment and the right to privacy and autonomy.

Many of our distinctively human social traits are interwoven with simulational propensities. A stroll through simulation-related topics includes the psychological underpinnings of social bonds, our fascination with fiction, and the relevance of simulation and empathy to moral theory. The “chameleon effect”, which involves unconscious mimicry of facial expressions, postures, and mannerisms, promotes cohesion and liking within a group. Enactment imagination and empathy lie at the core of our experience of fiction. Emotional empathy, i.e., affective contagion, is a crucial determinant of the quality of life, and high-level empathy, or perspective taking, plays a critical role in moral motivation and moral principles, especially universalization principles like the golden rule.

This chapter begins with a discussion of the need to re-vision political mobilization and interest group activity through the lens provided by politicized urban neighborhoods. The scholarly emphasis on formal organization, resource mobilization, and policy strategies often obscures low-income residents' active political engagement with a full range of quality-of-life issues, from graffiti, vandalism, and illegal billboard advertisements to aggressive drug dealing, hate crimes, and gun violence. The chapter details the interest group environment on the crime issue in two large urban locales, Philadelphia and Pittsburgh. At the urban level—unlike the state and national levels—this chapter reveals a stunning array of broadly focused citizen groups that are active and regular participants in crime control politics. These groups range from formal organizations, such as long-standing community councils, to informal and new organizations formed in the aftermath of tragic, violent crimes. They interact with lawmakers through legislative hearings but also through a wide range of informal contacts. In contrast, police and prosecutors are more limited in their interaction with legislators, which shifts problem definitions and policy frames away from punishing offenders and toward broader social problems facing high-crime communities.

Each of the four chapters of Part I of the book synthesizes one aspect that must be specified in the operationalization of the capability approach, then proposes a framework for doing so. The issue of this second chapter is how one ‘specifies’ the dimensions of valuable functioning or capability. Martha Nussbaum's work on central human capabilities and John Finnis's work on basic human reasons for action are both presented, and then alternative accounts of universal human needs and values are briefly considered. The theoretical conception of basic human values that has been developed by Finnis is proposed as being a conception that enables and requires participatory dialogue in application, has objective foundations, and can also coherently engage with and be refined by the large and growing empirical literatures on happiness, subjective well‐being, quality of life indicators, and views of the poor—which have not been well‐integrated with poverty reduction approaches. This conception can also mesh well with methodological literatures on participation, and be used by persons with diverse philosophical approaches and opinions. Ends with a table listing the dimensions of human development from 39 different disciplines.

This chapter lends some clarity to the discussion of quality of life in heart failure (HF). To do so, it explores definitions of quality of life, outlines the literature on the effect of HF on quality of life, and ends by summarizing what is known about the effect of interventions on quality of life in persons with HF. The common dimensions of quality of life in all the models reviewed are physical, emotional, and social function. The chapter further discusses the impact of HF on each of these dimensions. The physical dimension includes biological issues or illness characteristics, symptoms, and functional status. The emotional dimension includes the psychological response to HF. Social functioning includes sociodemographic factors, including cultural and environmental aspects. Some evidence suggests that optimal medical therapy and perhaps disease management can improve quality of life, but many of the studies are limited by a failure to define the construct and measure it in its complexity.

This chapter discusses the implications of the palliative care models on the quality of life and psychological well being of terminally ill patients. Experimental and descriptive studies that evaluated the model of palliative care and used quality of life as an outcome are considered. The term ‘quality of life’ includes the measures to assess the quality of life as well as the measures of pain control, symptom control, and general well being. The chapter does not include discussions on the development of research instruments geared to measure the quality of life, or the impact of palliative care on the quality of life and bereavement of relatives and families, or the implications of palliative care for non-terminally ill patients. However, it does include reviews of assessment tools, the concept of quality of life and its methods of assessment, and the role of care-givers in assessing the quality of life of the patients. Included as well are comparative studies of the palliative care practices and their impact on the quality of life of patients in the US and UK.

Engaging the non-identity problem, this chapter begins by showing that it is possible to be harmed by being brought into existence. In the process, a distinction is drawn between two quality of life judgements — ‘a life worth starting’ and ‘a life worth continuing’. The chapter argues that coming into existence is always a harm. An asymmetry between pleasure and pain (and between benefit and harm more generally) is described and defended. Although the good things in one's life make one's life go better than it otherwise would have gone, one could not have been deprived by their absence if one had not existed. However, by coming into existence one does suffer harm.

This chapter discusses the quality issues found in palliative and supportive care. It distinguishes the two main areas that are important for palliative care: ‘quality of life’ of patients and their carers and ‘quality of care’ delivered by services. Some of the issues of quality discussed in this chapter include the theoretical considerations on measuring quality and the aspects of quality that are considered ‘right’.

This chapter examines the issues that arise for policing nightlife scenes. It begins with an episode from one of the special meetings that the police occasionally hold at the precinct for bar owners, at which owners receive tips from officers on how to reduce quality-of-life complaints from residents and prevent crime in their bars. To enhance the quality of life in downtown neighborhoods and provide a sense of safety on streets, leaders of postindustrial cities have enacted policing strategies that target “broken windows,” or signs of public disorder. This meeting and other initiatives signify the New York Police Department's effort to curb quality-of-life complaints (e.g., noise, litter, and damage from revelers) as well as crimes inside and outside bars by making specific owners responsible for the structural conditions of dense nightlife scenes and targeting those who are “bad” and irresponsible.

Quality of life measurement within the medical context takes a very different approach from that adopted by the social sciences. Within medicine, the construct is referred to as health-related quality of life (HRQOL) which relies heavily on measuring symptoms of ill-health. Within the social sciences, quality of life is conceptualized as a global construct, positive in nature, encompassing, but not limited by health. This chapter contrasts these two views. It is evident that these are serious issues concerning measurement of HRQOL, to the extent that the instruments may not be regarded as valid measures of quality of life as the term is generally understood. The global measures of subjective well-being, while valid and theoretically embedded, are also limited by their relative insensitivity to medical health. The reason for this insensitivity is proposed to be a homeostatic system that normally maintains subjective quality of life within a narrow positive range.

This chapter examines whether the concept of quality of life has been helpful in the field of palliative care, evaluating whether there exists a shared and common concept of quality of life between physicians, patients, and their families. It discusses the possible means of assessing the quality of life through measurement or through the provisions of qualitative information on specific treatments, and also discusses whether the improvement of life in the palliative setting affects the manner of decision making of the individuals and patients involved. The chapter also considers the capacity of palliative care to improve the quality of life more than the conventional services and alternative models of treatment it offers. It also evaluates the alternative aim of palliative care if quality of life is rejected as the main objective of palliation.

Palliative care providers who wish to evaluate the full impact of their care must measure changes in quality of life (QOL) as well as improvements in areas specifically targeted by particular interventions such as pain and depression. Since palliative care considers the family as the unit of care, patient QOL, family member QOL, and the QOL of the family unit are all primary outcomes of palliative care. This chapter suggests that the best indicator of the quality of whole-person care is the QOL of the care recipient. The importance of measuring QOL has been widely recognized in the health care literature in the last two decades. Unfortunately, this has led to a great pressure to measure QOL at all phases of cancer and HIV disease, even though the measures are not adequately developed to show primary outcomes.