'Quantity, Quality and Balance'

CAERS Substack Article #6

‘QUANTITY, QUALITY AND BALANCE’

CAERS SUBSTACK ARTICLE #6

Vous trouverez la version française de cet article ici.

In previous articles we have explored values, ideas that we use to explain why certain things matter to us, and science, a process of criticism and conjecture that we use to understand the universe better.

Values tend to be more qualitative in nature; it can be difficult to measure values. We may rank them, but those rankings may not be absolute and it may be difficult to explain our rankings. On the other hand, science tends to be more quantitative; we can measure aspects of the universe sometimes to great exactitude. Because of that, science makes it easier to compare and rank things.

So, which is more important, things that we can measure well or things we cannot measure so well? Or are they both equally important?

The left side of our brain, the left cerebral hemisphere, is the more logical, quantitative half of our brain. The right side is our more intuitive, qualitative side. It is said that with logic we explain, but it is through intuition that we discover.

Nowhere is the contrast between values and science more evident than at the end of life. Do we want to live as long as we can, or would we be prepared to sacrifice length of life if doing so allowed for a qualitatively better dying experience and death?

To some degree, that has been a focus of the pandemic, though we may not realize it. A century ago, pneumonia was called ‘the old man’s friend’, because in the big scheme of life, and death, it was one of the more tolerable ways to exit this world. In other words, when near the end of life, many chose not to accept treatment for pneumonia and instead succumb to it even though treatment might have extended their lives for a short period. Of course, life was rather different then. People often lived on farms and were exposed to the natural process of death on a daily basis. Even in cities, elderly relatives often lived, and died, with their families, so their families intimately witnessed the demise of their elders. And wakes were held in the family home where they had died.

Today, many people have never witnessed the death of an animal, let alone a human, especially a close relative. We are less familiar with the dying process. Over the last two years, we have been able to quantify the number of people who have died from COVID and their ages and other vital statistics. But we struggle a little more, perhaps, when dealing with the qualitative aspects: What was their quality of life prior to acquiring COVID, and was it deteriorating and how quickly? Did they die peacefully? Might COVID have been the modern day ‘old man’s friend’?

These are tough questions because they are qualitative in nature. Although answers don’t come easily, the answers matter a lot, at least as much as the quantitative ones. Have we felt comfortable asking them and attempting to answer them?

Perhaps if we were more familiar with death, and more comfortable discussing it, we might have approached the pandemic differently. Maybe we would have been better at trying to balance the quantitative length of life with the qualitative aspects of both life and death. It is even possible that we might have tried to balance the desire to prevent all deaths from COVID, even in those already near the end of life, with the qualitative harm done to others who would not get seriously sick from the virus but who would instead suffer from the measures instituted to prevent every death from COVID at all costs. After all, we know that mental illness, child abuse, substance abuse, suicides, childhood developmental delay, financial stress, and many others, were made qualitatively worse during the pandemic because of many of the measures implemented.

It may be worth reflecting on these issues of quantity of life, and quality of life and death. It is likely in the careful and sober balancing of the two that we will find a deeper meaning for our lives, and the solace we seek when it comes to our own mortality.

J. Barry Engelhardt MD (retired) MHSc (bioethics)

CAERS Health Intake Facilitator