Is life worth living? Decompressive craniectomy and the disability paradox

A good quality of life may mean many things to different people; however, a common assumption is that it is associated with good health, subjective well-being, and life satisfaction. 9 Health and happiness represent value judgments that are made on a day-to-day basis in medicine, where the former is taken to have significant implications for the latter and, at the extremes, to largely determine whether a life is worth living. Indeed, people go to great lengths to achieve good health through measures such as lifestyle changes, good diet, and exercise, implying that good health equates with happiness and that ill health and disability are associated with a poor quality of life and suffering. Many forward-looking concepts such as that of an advance directive about health care decisions, and choices about whether to undergo certain procedures, are predicated on that apparently simple contrast. owever, the reality is that patients' perceptions of personal health, well-being, and life satisfaction are often discordant with their objective health status. The disability paradox reflects the observation that many people with serious and persistent disabilities report a good or excellent quality of life, when to most observers they would appear to live in a very undesirable state. contemporary example has been demonstrated in the context of decompressive craniectomy. Over the past 2 de-