Health Status, Quality of Life, and the Individual

FROM time to time, a terrible event happens to someone, and yet the survivor finds herself or himself better off. Through injury, a person is rendered paraplegic, or even quadriplegic; cancer strikes, requiring debilitating chemotherapy and raising the specter of a shortened life. The person suffering the calamity transcends the suffering and loss and finds new meaning in life. Living becomes a richer, more satisfying experience and, in extreme instances, people feel that they never really appreciated life until their tragedy. See also p 619. If one had to rate the quality of life of a quadriplegic whose life experience is dominated by well-being and joy, what would one say? In this issue ofJAMA, Gill and Feinstein1take the philosophical position that only the individual can rate quality of life, and if the individual says that it is excellent, that is what it is. From this perspective, they