Intended for healthcare professionals


Measuring quality of life

BMJ 2016; 354 doi: (Published 16 August 2016) Cite this as: BMJ 2016;354:i3816
  1. Anthony Cohn, consultant paediatrician
  1. Department of Paediatrics , Watford General Hospital, Watford WD18 0HB, UK
  1. anthony.cohn{at}

In medicine, especially in life or death situations, we are advised to take a patient’s quality of life into account when deciding to offer or withhold treatment. The GMC wisely advises us not to rely on our own judgment but to consult widely before reaching our conclusion. As with many moral choices I find that as I get older, the answers become less certain.

For many years I viewed quality of life in two dimensions, one measuring physical ability and the other intellectual or cognitive ability. Drawing a simple axis made plotting a graph of somebody’s quality and therefore “value” fairly straightforward and easy to calculate. On several occasions, I used this figure to suggest withdrawal of care for sick premature babies or to justify avoiding intensive treatments for children with multiple disabilities. I was reassured that these decisions often met with general consent, but now I realise that my position may have silenced any dissenting voices.

Having listened to and seen families who look after such children, I realise that this is too simplistic. I now think that, as humans, we have a third dimension which might be called our “humanity” or, for religious people, the soul. Unfortunately this is difficult to measure and that makes judging the quality of somebody else’s life even more difficult. A person may have little physical or obvious cognitive ability but still have immense humanity; in my new three dimensional world, their total volume is incalculable. Alternatively somebody with high levels of physical and cognitive ability may score low on the humanity scale and so, although having a large cross sectional area, may be quite literally two dimensional.

I would like to apologise to those children and their families for whom I have been a two dimensional doctor.


  • Competing interests: I have read and understood the BMJ Group policy on conflict of interest and have no relevant interests to declare.

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