Eubios Journal of Asian and International Bioethics

Both in clinical settings and in bioethical arguments, “happiness” is not a commonly cited concept. The reason seems to be, first, its meaning is too wide and ambiguous, and the second is that the concept of happiness in medicine or bioethics can be substituted by QOL which was introduced into medical practices as an objective and measurable concept and is very useful for medical staff to judge how to treat a patient. There are two kinds of health-related QOL: comprehensive QOL and disease-specific QOL. However, recently, researchers have tried to devise a scale of happiness in several ways. Roughly speaking, the subjective happiness scale can be built into comprehensive health-related QOL, but it is difficult to find the counterpart of disease-specific QOL in the field of happiness. Virtue based happiness is quite difficult to be translated or built into QOL. Virtue based happiness is long-term happiness and realized by a man of virtue. Modern medical care, following individualistic liberalism, has the principle of respect for autonomy of a patient, the basis of which is the right to the pursuit of happiness which is dependent on patient’s feelings. Regarding subjective happiness, most of its role is now covered by QOL. Then what, if any, is the role peculiar to the concept of happiness in medicine or bioethics? There seems to be at least two places where the concept of happiness can play an important role. The first is regarding the “enhancement problem”, and the other is happiness of the medical staff instead of the patient. 1. Happiness is not a common word in bioethics. Both in clinical settings and in bioethical arguments, “happiness” is not a commonly cited concept. For example, there is no separate article of “happiness” in Encyclopedia of Bioethics 3 ed (1). According to its index, the term appears on page 185 only, though we may find it on other pages. Moreover, there is no separate article of “well-being”, and its term appears on pages 758, 2047, 2380-2381, and 2484. On the other hand, there is a separate and comparatively long space for the concept of QOL (Quality of Life), i.e., pp,1388-1402, and we can see or hear about it very often in clinical settings and bioethics. The reason for the less emphasis on the concept of happiness seems to be, first, its meaning is too wide to be applied to medical practices and bioethical arguments. The second is that the concept of happiness in medicine or bioethics can be substituted by QOL which was introduced into medical practices as an objective and measurable concept and is very useful for medical staff to judge how to treat a patient. Historically speaking, QOL is said to have first appeared in ‘Great Society Speech’ (2) by President Lyndon Johnson in 1964 as “quality of our American citizen” i.e. as quality of the nation. But in this speech also appears the sentence “it is a place where men are more concerned with the quality of their goals than the quantity of their goods”, where QOL of each people is referred to. As this speech shows, roughly speaking, QOL has two mutually related usages, i.e., QOL of a nation or a society and QOL of an individual. In clinical settings and in bioethics arguments, QOL of an individual patient, i.e., health-related QOL, is dominant. There are two kinds of health-related QOL: comprehensive QOL and disease-specific QOL. An example of a comprehensive QOL scale is SF36 (Medical Outcomes Study 36-item Short Form Health Survey) which assesses the following general health concepts: physical functioning, role limitations due to physical health problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems and mental health (3). This scale was made in the U.S. and translated and used in about one hundred and twenty countries. Another example is EQ-5D (Euro QOL), which is simpler than SF36 and assesses mobility, self-care, usual activities, pain/discomfort and anxiety/depression (4). In addition to a comprehensive scale, there are a lot of disease-specific QOL scales such as QOL scale of cancer, Alzheimer's disease and neurologic diseases. As for happiness or well-being, now we have various scales. Researchers have tried to describe happiness in several ways, e.g., consisting of positive emotions and positive activities, or distinguishing three kinds of happiness: pleasure (positive sensory experience), engagement (involvement with one’s family, work, romance and hobbies), and meaning (using personal strengths to serve some larger end). Also researchers have identified attributes correlating with happiness: relationships and social interaction, extraversion, marital status, employment, health, democratic freedom, optimism, endorphins released through physical exercise and eating chocolate, religious involvement, income and proxy to other happy people (5). With regard to the methodology of measurement, including QOL, happiness and well-being, there are two basic kinds: subjective and objective. Subjective methodology focuses on self-reported levels of happiness, pleasure, fulfillment and the like. Objective measurements focus upon quantifiable indices of social, economic, and health indicators. Some try to combine the two basic measurements (6). We can say that the distinction between subjective and objective methodology approximately corresponds to the distinction between subjective and objective happiness, well-being and QOL. Eubios Journal of Asian and International Bioethics 26 (November 2016) 215 In the field of subjective well-being (happiness), so called set-point theory has been dominant over the past several decades, the central proposition of which is that adult individuals have differing but stable levels of subjective well-being, i.e., adult set-point do not change except temporarily in the face of major life events. However, recently it has been criticized and researchers have begun to pay attention to the dynamics of happiness (7). 2. Happiness and Health-related QOL The title of this paper is ‘Happiness in Bioethics’, therefore, when I refer to QOL, I will focus on healthrelated QOL. Now I will try to show the outline of the relationships between happiness and QOL. To begin with, it is useful to compare a subjective happiness scale with a comprehensive health-related QOL scale. To make the consideration simpler, I give two examples of a scale with four or five items: one is Subjective Happiness Scale (SHS) by S. Lyubomirsky (8) and the other is EQ-5D (Euro QOL) stated above. SHS’s 4 items were derived from original 13 selfreport items through several tests (Lyubomirsky, S. et. al. p.140). SHS uses 7-point Likert scales. 4 items are as follows: 1. In general, I consider myself: from “not a very happy person” to “ a very happy person”. 2. Compared to most of my peers, I consider myself: from “less happy” to “more happy”. 3. Some people are generally very happy. They enjoy life regardless of what is going on, getting the most out of everything. To what extent does this characterization describe you? From “not at all” to “a great deal”. 4. Some people are generally not very happy. Although they are not depressed, they never seem as happy as they might be. To what extent does this characterization describe you? From “not at all” to “a great deal”. The EQ-5D health questionnaire requires you to place a tick in one box in each group.