Ethics and Quality of Life of Kidney Transplant Patient M.G. de Ortu ´ zar T HE TERM “quality” has a recent history. It comes from the quality of material’s theory developed during the ﬁrst decades of the 20th century. The quality control method led to the use of statistical techniques to determine the quality level of the products. 1,2 In the 1970s, the concept of “quality” was applied to economics and sociology to ﬁnd indexes of quality of human life in different societies. Those indexes were determined at ﬁrst by the relationship between economic wealth and amount of population, reducing the problem to that of the appropriate income. By this means, economicists deﬁne, up from a parcial approach (A), the index of quality of life in terms of PBN. 3 In the last decades, some authors like Amartya Sen, point out the mistake of using concepts related to the manage- ment theory (eg, the quality concept quantitatively deﬁned) to analyse people’s life conditions. “Human development” (B) cannot be measured in terms of income. 4 Besides participation through consumption, there are human ideals of self-realization; that is to say, capacities, talents, and necessities that make differences in the use of goods and services, and consequently, in the results reached by each society. 5 Those two social tendencies in the evaluation of quality of human life, generally called recuctional approach (A) and integral approach (B), are important for the evaluation of quality of life in health, since they appear again as opposite tendencies in the sanitary level. QUALITY OF LIFE IN HEALTH The “economicist” tendency to measure results in quanti- tative terms was the main characteristic of health attention as from the second half of the 20th century. Since then, the evaluation of the structure (quantity and quality of equip- ment and personal), of the process of sanitary assistance (protocols of medical attention and of inﬁrmacy), and the quality of results (through curves of patient’s survival rates of morbility and mortality) were made deﬁning quality indicators in terms of utility and efﬁciency. The expense of the various new treatments made it necessary to study the distribution of short resources to maximize their use. The economic-scientiﬁc tendency favored efﬁciency and effectivity over other attributes, 6 defending biological pa- rameters as exclusive criteria. 7 Those criteria caused con- ﬂicts and tensions in spite of the growing social claims in pursuit of equality of opportunities and equitative reception of services. This was ﬁnally solved with the recognition of health as a social right in the middle of the 20th century. The defendants of integral health right say that there is a social obligation to cover health necessities caused by illness or disability, as they diminish the normal range of oppor- tunities open to individuals of each society. 8,9 Since that moment, the evaluative measures on quality of life used in both health care and medical ethics were applied according to two clear objectives 10,11 : (1) as a criterion for making limit decisions (to begin or to suspend the artiﬁcial support), and (2) as a criterion for evaluating treatment results (to select between two alternative treat- ments, eg, dialysis and kidney transplant) and for evaluating health programs. According to the second context, we have collected some relevant information about treatment efﬁciency, compairing it with alternative treatments and looking for a continuous improvement. At ﬁst, treatments and quality of the patient’s life were evaluated through strictly biological parameters, measuring and numbering its “goals” by means of survival curves. Those quantitative measures are partial and do not describe the complexity of the elements that affect treat- ment results, and it is necessary to take them into account to evaluate quality of life. Considering only the survival time as a successful mea- sure and treatment efﬁciency led to the elaboration of new measuring instruments in health. For example, the Karnofky and Burchenal Scale, elaborated shortly after World War II to measure quality of life of the patients with cancer and treatment efﬁciency; The Health General Sur- vey known as SF-36 (Shortform 36 items) created to measure eight of the most important areas considered representative of the basic functions of human being and his or her welfare (physical functioning, physical proﬁle, cor- poral pain, general health, vitality, social behavior, emo- tional proﬁle, mental health); Sickness Inpact Proﬁle (SIP) that measures biological functions (rest, walk, etc), and From the Bioethics, CUCAIBA, Centro Unico Coordinador de Ablacion e Implante de la Provinicia de Buenos Aires, Buenos Aires, Argentina. Address reprint requests to Marı´a Graciela de Ortu ´ zar, Calle 51 Nro1120 (1900), La Plata, Argentina. © 2001 by Elsevier Science Inc. 0041-1345/01/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(00)02712-3 Transplantation Proceedings, 33, 1913–1916 (2001) 1913