<Vita biologica>and<vita biographica>in medicine

Abstract

This paper is a report of philosophical investigation in the field of medicine, where the author is now trying to cultivate the field of clinical ethics with physicians and nurses.
Traditionally prolongation of the patient's life had priority over other aims of medicine, i. e., the quantity of life had been the main value. Recently the other aspect of life, i. e., the quality of life, has been introduced, among others, in palliative care, and it has become a standard view that pain control should be chosen even when it may hasten the patient's death. This does not mean, however, that euthanasia as the intentional choice of death could ethically be chosen in some cases. The usual view in palliative medicine is that there is difference between intentionally hastening death for the sake of terminating the patient's suffering, and reluctantly permitting it when the life is foreseen to be shortened by the treatment chosen for the sake of palliation.
The usual view also allows withdrawing, and also withholding, life-prolonging treatments when they become the source of more suffering than benefit. But there is a problem with this view: the purpose of withdrawing them cannot be improving, nor maintaining, the quality of life, but not postponing death any further, which seems to be the same as hastening death. This is the problem that the author investigaties in this paper by considering some cases of clinical ethics.
In the couse of the investigation, the author rejects the common understanding that the prolongation of life and the quality of life concerns two aspects of the same life, and claims that with the introduction of the latter a new conception of life has been imported into medical practice. The author calls the life in 'prolongation of life' <vita biologica>, biological life, for it is the life the modem medicine based on biology has been attending at. While prolongation refers to the quantity of the biological life, medical normality or abnormality, among others, can be said to refer to its quality.
By contrast, using the term 'quality of life', medics in palliative care are concerned with whether the patient suffers, and to what extent. This includes not only physical symptoms, e. g., pains, but also psychological, social and spiritual problems. According to the author's view, the general measure of the quality of life is the freedom, or the opportunity to do things, and thus its conception is presumably close to Sen's 'capability'.
Differentiating the quality of life from the quality of biological life, the author introduces <vita bio-graphica>, biographical life, to show the other conception of life, for it is concerned with how one can describe one's life, i. e., a life told as a narrative. The quality of life is concerned with what I can chose now, what I am capable of, and if I can comfortably be here, or I am accepted by the people surrounding me.
The vita biographica also has its quantity, which is not measured by the length of time, but by our judgment such as : 'It's enough', 'It isn't enough yet', etc.. It is the narrative that is judged, i. e., if it can be finished now, or not. The narrative of one's life is connected with those of others' lifes. Our narratives permeates each other mutually so that one's life in this sense is not independent of others'. The vita biologica is a sine qua non for the vita biographica, and we sometimes support the latter by way of treating the former. From this point of view, the author tries to analyse the problem of withdrawing life-sustaining treatment, especially when it way result in the patient's death. By this choice one cannot but intend, not only permit, the patient's end of the vita biographica, but does not do anything actively against the vita biologica. The author, has not yet explored the full implications of this theory, and wishes to continue to develop it between now and the time of the symposium.