THE QUALITY OF LIFE
The growing interest in what is commonly referred to as “the quality of life” has its source in two relatively recent developments. The first is the prosperity and leisure of Western society, the second concern about the ability of medicine to keep people alive. These are diverse sources of worry united by the desire to make life as satisfying as possible.
Primitive hunters who lived in caves collapsed in exhaustion at the end of the day. They were happy to be alive and took little interest in measuring that satisfaction. Even in relatively recent times, so long as they had to work from dawn to dusk to earn a living, people lacked energy for reflection on the level of their happiness. Although philosophers have shown interest in the nature of the good life from an early stage in human history, ordinary people and governments have not puzzled over what constitutes an adequate quality of human existence until recently. Examining one’s life requires leisure, prosperity and a taste for abstract thinking.
The second source of interest in quality of life issues derives from the vast advances of medicine. Ventilators, feeding tubes and an astonishing array of drugs now enable physicians to keep their patients alive for long periods of time. The world record among humans for living as a biological organism, without consciousness and self-awareness, in what is called “a persistent vegetative state,” now stands at over thirty-six years. A good many people, in great pain or suffering from a terminal illness, feel that they don’t want to live without joy and meaning. This raises difficult problems about honoring the desires of people to be allowed and perhaps even to be helped to die. Although assisting the death of individuals is illegal in most states, we tend to assess the appropriateness of requesting such aid on the basis of the quality of life patients are still able to enjoy.
A few decades ago, the Canadian government funded initiatives attempting to develop measures of the quality of life. Because that quality has significant subjective elements, it is very difficult to capture it in objective terms. Nevertheless, the Canadian researchers tried and came up with some clever ideas. They reasoned that telephones and paved roads tend to make life better, so we should be able to measure human satisfaction by the miles of pavement and the number of receivers per thousand of population. Thinking that citizens of a highly militarized nation are unlikely to be happy, they compared the total population of countries with the number of those in uniform: according to this idea, an increase in military personnel would be matched by a decrease in the quality of life.
Would it not be nice if life were so simple? Unfortunately, such objective considerations do not yield access to complex realities; they are not direct measures of happy living. Email, for example, greatly speeded up communication among people, but at the price of hurry, unnecessary messaging and frightful triviality. Increase in the military may portend unhappiness, yet many people report that the excitement and intensity of living during the Second World War made those years unforgettable. No blessing is unmixed. It is not enough to find factors that contribute to happiness; we must also explore their side effects and attendant costs.
The distinction of having developed an account of ideally complete happiness belongs to Aristotle. He believed that to be happy, people must live in a stable, prosperous society, surrounded by friends and at peace with themselves and their neighbors. They must hail from loving families, enjoy the benefits of sound upbringing and have their emotional needs met. It is essential to have a good temperament, money and even a measure of good looks; broke, nasty and ugly people find it difficult to attract a mate. Further, one must be lucky to avoid ruinous events such as premature death by disease or accident.
Aristotle’s idyllic conception of richly fulfilled life is thoroughly conventional. Some societies operate without family structures, others eschew stability. We all know cultures in which mates are selected by parents, and subcultures in which money has no value. But, more important, does the absence of any one qualifying condition of happiness leave our lives in shambles? This possibility is easiest to see in relation to luck: a grievous accident can disable or destroy us. But a lack of good upbringing can be readily offset by moralizing efforts or self-enforced decency. Aristotle does not order the features of happiness in terms of importance or efficacy; it seems as if he wanted the presence of all before he would declare anyone happy.
The most devastating problem for this view derives from a peculiarity of human nature. People who have everything going for them know how to render themselves unhappy. They complain that life is too easy and that they lack a challenge. Of course, the world is full of things to fix; it is never difficult to work for improvement or adopt a cause. But such strenuous activities seem unattractive to people who grew up with everything provided. So, paradoxically, individuals who should be the happiest on Aristotle’s account end up as miserable lost souls.
EXTERNAL CONDITIONS OF HAPPINESS
This shows that even all the conditions supposedly necessary for happiness are insufficient to bring it about. Next, we need to ask if a high quality of life really requires all these external conditions. People have led good lives in turbulent times and without friends. Individuals who devote themselves to the service of God need not be smart and good looking to be satisfied. Although we think that money occupies a privileged position in the search for happiness, winning the lottery guaranties lifelong pleasure just as little as does a monk’s vow of poverty. We can conclude that happiness has no list of prerequisites: it can flower anywhere and under the most untoward conditions.
In trying to understand the nature of happiness, the most important consideration is not what circumstances promise the greatest apparent benefits, but what is valued most highly by the humans involved. What seems wonderful to scientists and bureaucrats may be of no interest to ordinary people. Quality of life must, therefore, be examined on the basis of the subjective valuations of individuals. A person who spends every free minute smoking and playing cards cannot be declared to have an inferior quality of life unless he doesn’t enjoy those activities. The socially worthwhile must not be confused with the individually satisfying.
CHOICE OF VALUES
The moment we introduce individual preferences into the assessment of quality of lives, objective measurement becomes impossible. Human beings are so diverse in their choices that one goes begging in the search for something—anything—that everybody prizes. Even the great magnets of food, sex and companionship fail to capture the devotion of everyone: people go on hunger strikes, lose interest in conquest and copulation, and head to the mountains to assure their privacy. We can make better estimates of the quality of life by how many of their wants people satisfy and how completely than by making judgments about the quality and appropriateness of their desires.
One way to explore the quality of life is, accordingly, to study the satisfaction of people with their existence. But almost immediately, the subtlety and adaptability of human nature come to the fore, because seeing if people get what they like is not the end of the story. It is, of course, very important that we have at least some of our desires satisfied, but if our wants are outrageous or difficult to meet, we can surprise even ourselves by changing them and learning to settle for the possible. If the world does not permit us to get what we like, we can take revenge by liking what we get. This has been a powerful defense of people against disappointment: stoics and deeply religious Christians have long known how to be satisfied with what nature or the Lord was willing to provide.
If there is anything unique about humans, it is their orneriness. We are not easily satisfied; in fact, many people reject good times that can be easily achieved. We want challenges, difficulties in the way of fulfillment, and if the world does not provide them, we are prepared to help it out. No one has to climb Mt. Everest or win the Tour-de-France, yet there are individuals who cannot feel complete without at least trying. The obstacles we place in the way of delight can be astonishing: we strain the human frame to the breaking point by jumping out of airplanes, going on Crusades and denying ourselves the pleasures of sex.
Cats do not allow anything to interfere with their peaceful slumbers. Some humans, by contrast, do not permit themselves to feel good unless they put in a solid day of work at what they don’t enjoy. This points to the involuted depths of human nature and demonstrates the folly of supposing that pleasure or enjoyment is the only condition we value. Individuals who stand in a complex relation to themselves can, as the great American philosopher Josiah Royce said, come to hate their loves and love their hates. Such internal struggles may be thought to point to an unhappy consciousness, but even here we must be careful not to underestimate the satisfactions of moral struggle and suffering.
The simplest helpful way to think about the quality of people’s lives is in terms of the activities they want and are able to perform. One important and persistent tradition views this coincidence of desire and ability as the very heart of freedom. Although humans can get used to lives of sharply limited liberty and a few may even welcome external control that makes choice largely unnecessary, most of us find that the freedom of doing what we want greatly enhances the quality of our days. Our desires need not be refined, unusual or noble; what matters is that we be able to do what we want as, where, when and how we desire.
This approach is reinforced by a look at growing old. The burgeoning competence of children is replaced by the broad freedom of adults to do, within limits, what they wish. The long decline we call aging consists of the gradual loss of abilities: little by little, the easy becomes difficult and the difficult impossible. Even desires shrivel and what once seemed urgent slips from sight and survives only as a vague memory. Those unwilling to accept the loss suffer intensely, but even people who face the inevitable calmly see their horizons narrow and their options disappear. “Closing concerns,” as some languages refer to the process, leave the elderly with ever fewer activities to enjoy, each of which requires ever more effort.
If we add to this diminished world the anxieties of ill health and the debilitation of chronic pain, it becomes intelligible why some people want to die. That, at least, is one thing they can choose to do, partly in desperation and partly as a last affirmation of their power. An existence of painful inactivity and tortured waiting for death is understandably not acceptable to people who have once been vital participants in the drama of life. This gives us a vivid idea of what an intolerably low quality of life might be like. Although there are multiple forms of and reasons for unhappiness, keeping our eyes fixed on the painful end of our sojourn reveals, by contrast, what counts as high quality of life.
ACTION AND ENJOYMENT
The lesson we learn from this is something most of us know already, even if not explicitly. Life is good when we can do what we enjoy doing and the results (if we aim at any outcome beyond the doing itself) are favorable. The actions that please us and what we achieve by them differ widely: human nature permits much variety. But, typically, there is both action and enjoyment; for the most part, without them, life lacks luster and significance.
There are two forms of existence that seem acceptable to people without the presence of both conditions. The first lacks enjoyment, the second action. Many people engage in daily rounds of activities without taking pleasure in the busy-ness or in what is achieved. Individuals in dead-end jobs, in positions where they don’t control their labor and in circumstances where their contribution remains unappreciated tend to feel that their lives lack redeeming value. Even for them, however, a bit of delight shines through the drab everyday. There is pleasure in doing the job and doing it well even if it earns no rewards. And we must not overlook the satisfaction competence provides, along with the enjoyment of comfortable habits. All in all, people in such positions are happier than they seem and say—and perhaps even than they know. At the very least, the claim of the famous American author, Thoreau, that “most people live lives of quiet desperation” does not apply to them.
As they age, some people learn to take delight in the activities of others. When they themselves can hardly move, grandparents rejoice in their grandchildren running the marathon. The vicarious pleasure in what others do can lifts one’s spirits by the recognition that the joy of the world has not come to an end with the waning of our powers. Just as we live through the exploits of athletes and explorers, so we imagine ourselves in the positions of the beautiful and famous. Too much imaginative identification can be harmful for the young; it interferes with their own activities. But when nothing is left beyond appreciation and the hungry eye, observing life can give people the sense that they are still in the fray.
SELF-KNOWLEDGE AND ACQUIESCENCE
Human nature has a striking defense mechanism against unhappiness. The old advice to “accept it and make the most of it” is exactly what we follow, often unconsciously. Few people are permanently unhappy with their bodies and fewer still grieve over not being a mathematical genius. We learn to play the cards we have been dealt because being upset over not having been born a Rockefeller ruins one’s life. So we forget our faults and deficits and go about our lives as though they didn’t matter. This is the way people in jail survive their terrible confinement and quadriplegics embrace their heartrending limits. Obviously this is not an argument for imposing burdens on ourselves and others; it is better if some of the elements of happiness are ready at hand. But this wonderful defense mechanism offers hope that, even under severely adverse conditions, a good quality of life remains possible.
Philosophers from the earliest times have insisted on the importance of knowing oneself. This was supposed to enable us to gain a clear picture of what is good for us and guide us to actions that promote both public morality and private happiness. Such knowledge may, in fact, be of some use in leading a good life, but we find that increased levels of information are not always accompanied by more intense satisfactions.
This is particularly true in relation to knowledge of our level of happiness. At some of the most satisfying moments of life, we lack explicit knowledge of just how happy we are, and the beginning of inquiry is at once the disappearance of delight. It may be best to enjoy and leave it at that; why create problems where none exists? This strategy is especially appropriate because valid comparisons of qualities of life are notoriously difficult, and perhaps impossible, to obtain. Obviously, we know the difference between delight and the depths of depression, but efforts to tell whether my current troubles are more or less severe than the ones that beset me eight years ago yield questionable results. In making such judgments, we must keep in mind that the difficulties that beset us tend to seem the worst ever and the present moment of happiness fades by comparison with the mythical distant past.
The comparison of the quality of life of different people is even more fraught with danger. Each of us carries an impenetrable tower (or dungeon) of privacy in our souls: sometimes, information about the internal mood and private intentions of people must be pieced together from flimsy evidence. In this enterprise, even the attentive person finds it easy to go wrong. Individuals can overact in displaying joy and sadness; others may mean to mislead in order to hide their real feelings. People with a “poker face,” habitual complainers and those who actually do not know what they think or how they feel about certain events leave us in the dark about their internal climate.
Of what value, then, is knowledge for increasing happiness? It can give us much-needed information about what we like, the means for achieving our goals and the limits of our power. Babies have little knowledge of the world; they have to learn what hurts and what pleases. The experimentation this requires survives our early years: adults and even the elderly travel, eat new foods and try activities they have never done before. In this continuous process of discovery, we come face to face with what we cannot do. Knowing what we like is important, but no more so than knowing what we cannot obtain or achieve, no matter how much we would like it. Knowledge of our likes and limits, in turn, can stimulate the imagination to develop new ideas of how best to attain our ends.
Knowing our aims, our means of achieving them and the vast land of futility that lies beyond our limits makes life as much of a success as it is reasonable to expect. But even here, we lack certainty. Victory can turn into bitter disappointment and trusted methods of operation may not work. Worst of all perhaps, overwrought self-confidence can deceive us about our limits and convert minor triumphs into a grand but hopeless quest. Under the best of circumstances, happiness is not guaranteed. If it occurs, it is a combination of sunny temperament, hard work and luck. We can certainly contribute to its attainment by concerted effort. But it is unclear how far we can control our attitude to life, and luck is altogether beyond our power.
HAPPINESS AND DEATH
These reflections make it clear that happiness is an individual matter dependent largely on what people value and how they assess their situation. The subjective factors make it impossible to develop a grand theory of what makes people happy. The very condition that satisfies some individuals may well be ruinous to the quality of life of others. Even highly trained psychologists and psychiatrists must ground their advice in the desires and preferences of their clients. The Declaration of Independence has it right in referring to the pursuit of happiness; neither the government nor divine intervention itself can provide anything beyond some of the wherewithal associated with fulfillment.
There is, nevertheless, one feature of happiness that, though by no means universal, enjoys broad currency among people who claim to have a high quality of life. The dynamic nature of happiness shows itself in the dissatisfaction of individuals who have attained everything. Having it all or having seen each of one’s efforts crowned with success is not nearly as satisfying as being on a roll but not quite where we want to be. At some charmed moments, things fall into place and everything promises success. At such exhilarating times, happiness appears as the favorable process of fulfilling our purposes. We swim in the midst of these events, managing to convert into reality what we want or hope for and creating the impression that nature and society obey our call.
To have done it all already would take the striving and the growing control out of the picture. Because we are in love with activity, what satisfies is the combination of achievement and new effort, the ever incomplete process of mastering the flow of events. With luck, this quest for felicitous action ends only at death. This may be the reason why Aristotle said that we are not to consider a person happy until the end; there are too many contingencies that may cause disaster or at least disrupt satisfaction.
The topic of the quality of death is often overlooked in discussions of the quality of life. But the two are inseparably connected. Dying is a process that may take a long time and cast a shadow over a significant portion of existence. Some cancers and Lou Gehrig’s disease, among countless other maladies, involve a slow deterioration of the body, leaving sufferers with the daily horror of contemplating a failed life and subsequent demise. The pain and frustration are difficult to imagine; the anxiety ruins everything. It should come as no surprise that some people pray for release or take matters in their own hands and commit suicide.
Under favorable circumstances, a good life is possible. A good death must be an integral part of this life. It can take many forms, one of which consists of a rapid and painless exit from this world, caused by a devastating stroke or heart attack. The ideal is for this to occur late in life when purposes have been attained and the energy has run out. A quick death does not detract from the quality of life; on the contrary, it guards against the shadows devouring the good times we once had.
 The text was sent by the author on July 21, 2017. Berlin Forum wish to thank John Lachs for giving us the permission to publish it on our www.