Health and the quality of life1

Thank you for the invitation to address the opening ceremony of your fourth Nursing Academic International Congress. It is a double pleasure for me. First, I welcome the opportunity to return to the academic environment and rekindle memories of the kinds of debates and discussions that ideally characterize this kind of setting. Secondly, I will always feel a debt of gratitude to the nursing profession. Not only did it provide me with a wife, but nurses throughout the years of my medical practice taught me almost as much as my more formal teachers. In addition, I recall with much pleasure receiving the Archon Award from your prestigious honor society last year. The fact that this is an academic congress has stimulated me to think more deeply about the topic that is the focus of your deliberations , and to perhaps be more philosophical than I would normally be. I was amazed at the amount of literature that surrounds the issue of quality of life and the number of research tools and constructs that have been developed (1). There is an International Society for the Quality of Life. I was particularly struck by the fact that the various efforts to quantify or measure quality of life frequently involved some health-related attribute. In general terms, the characteristics could be roughly divided into the internal and external factors. There were many excellent descriptions of the kind of physical and social environment that I consider among the external factors that contribute to life of good quality. Conversely, there were factors that related very much to the in-dividual's inner self. It is possible to imagine that there are some five main domains of quality of life: health and wellness, interpersonal relationships, community and home presence, personal growth and dignity, and self-esteem. The World Health Organization (WHO) defines quality of life as indi-viduals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. WHO has developed instruments to measure quality of life (2). It is perhaps intuitively obvious that health and life are inseparable and, therefore, that matters of health must enter into any conceptualization of quality of life. However, the ethical and policy dimensions of the relationship between health and the quality of life are not that straightforward. I suppose in simpler times there was no …