Perspectives in Biology and Medicine

QUALITY OF LIFE: AN IDEOLOGICAL CRITIQUE MATTHEW EDLUND* and LAURENCE R. TANCREDIf "Quality of life" is a more complex phrase than it first appears. It conjures up pleasant notions of how we ourselves want to be and how we want to live. It has generated an enormous literature and become the object of a great deal of academic attention [1, 2]. Unfortunately it is a term whose definition is extremely difficult [3]. Its uses vary from individual to individual, though each in turn rarely discloses what is meant by the phrase. As a concept, quality oflife is open to a myriad ofideological uses, as well as potential abuses. It is the purpose of this paper to illustrate the multiplicity of meanings of the phrase "quality of life" as reflected in matters of health policy. To accomplish this, we first need to consider ideological analysis from a historical perspective. It will then be shown how to use it in explicating the ideology of quality of life and of its antecedent, the concept of sanctity of life. To perform this type of ideological analysis, we have to understand one underlying idea: that knowledge, like metals, manufactured goods, and products, is a type of commodity. It is created, often in planned fashion, and then bought and sold, sometimes in the market, more commonly in the quasi marketplace of politics and ideas. Who creates, who sells, who buys, and what their underlying motivations are, are as open to analysis as any other commodity [4]. Yet it is hard to immediately sense knowledge as a material good, to see ideology as anything more than a curious expression of mind. "Quality of life" is just one such product. It first appears as a worthy concept useful in the justification of health care services. But to understand it, we must ask further questions: who is talking about quality of life? what sort ofquality is being specified? defined by whom? for whom? decided by whom? One must consider the different social and economic ?Assistant professor of psychiatry, University of Texas Health Science Center, Houston, Texas 77225. tKraft Eidman Professor of Medicine and the Law, University of Texas Health Science Center, Houston, Texas 77225.©1985 by The University of Chicago. AU rights reserved. 0031-5982/85/2804-0447$01.00 Perspectives in Biology and Medicine, 28, 4 ¦ Summer 1985 \ 591 groups who use the phrase, when they use it, how they use it, and, finally, why they use it. History ofIdeology as a Concept It is not surprising that the word ideology itself has become host to a panoply of avowed, and not so avowed, ideological meanings. The modern , pejorative meaning of the term ideology we owe to Napoleon himself . In the early eighteenth century a group of French philosophers led by de Tracy eschewed traditional metaphysics and attempted to base their own speculations more on anthropological and psychological description and evidence. When he discovered these philosophers opposed to his own, imperial desires, Napoleon labeled them "ideologists," and the label stuck [5]. The pejorative sense of the term ideology continued with Marx, who, with the concept oifalches Bewusstein (false consciousness) and works like The German Ideology, attempted to skewer the liberal bourgeois ideas of his time. Since that time, ideology has often been used by Marxists and other thinkers to describe positions other than their own—positions that are, by implication, less correct. The clearer the truth of one's own suppositions, the more clearly "ideological" the character of the thought of one's opponent. The full view of the world as inherently ideological had to await the Frankfurt school of sociology, a group of German sociologists of the 1920s and 1930s titularly headed by Horkheimer and Adorno. The Frankfurt school took national civilizations as the major units ofanalysis. One of its further assumptions was the general interrelatedness of all phases ofdaily life—economic, political, social, cultural, and ideological. The Frankfurt school was particularly important not only in describing the inherently ideological nature of social thought but in highlighting the importance ofideology. People act in life for economic and social reasons, yet they also act because of ideas, ideas that may reflect obliquely or even work counter to their...