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How can you determine how your well life is going now and how it will go in the future, so that you could decide whether you want to consider leaving?
Evaluating QOL is not so difficult if your life is either just fine or simply terrible most or all of the time. For example, for most people, if job, family and health are acceptable then life is OK. On the other hand, if your life is full of ups and downs or in the process of change, it can be difficult to make an overall judgment or prediction.
Furthermore, it can be difficult to imagine the bad times when things are good and vice-versa. This makes it difficult to make an overall judgment of your life.
Related problems are those of “faking good” and “faking bad”. Faking good can be motivated by the desire to look good to others, or to avoid admitting to yourself that things aren’t going well. Faking bad or “catastrophizing” can be used to elicit help or attention, or to provide justification for avoiding responsibility.
Your responses to the questions may also be affected by the social conventions that come into play when someone asks you how things are going. Asking this question is usually a way for someone to give you a little stroke and then move on to other things. He does not want you to respond with a recital of your problems. If you do this too often, people will begin to avoid you. Avoiding acknowledgment of problems is the easy way out for you, too. You might ask yourself to what degree this social convention is operating when you consider the questions which follow, many of which ask you in different ways, “How are you doing?”
A question about QOL requires a comparison. Should you compare yourself to others who are similar in some way? Should you compare how things are with how you expected them to be or with how they used to be? Should you compare yourself to people who seem to be much worse off because they are ill, injured or handicapped, or because they are the victims of war, flooding, or other catastrophes? Or should you anchor your judgment in your own internal standard of acceptability which comes from your own physiological responsiveness to different kinds of pleasure and pain?
Once you have settled on how things are going now, you must predict the way things will be in the future. What things about yourself or outside yourself might make things better or worse than they are now? Will time or your own problem-solving lead to improvement? Are there new medications or other treatments in the pipeline that might change your life for the better? Do you have pre-Alzheimer symptoms or other indications that your health might rapidly deteriorate?
Deciding whether to stay in situation or leave it is often a problem. Think about the difficulties in deciding whether to change jobs, end a relationship, stop playing a slot machine, or, as a proxy sufferer, to have a pet put to sleep.
You must try to:
· Pick a time span to use in your assessment of how well things are going,
· Weight good and bad experiences or observations according to criteria of importance or intensity,
· Add or otherwise combine your good and bad experiences into an overall rating,
· Predict how things will be if you do what you can to make things better, taking into account the possibility that things beyond your control might improve or get worse.
You must also accept the fact that there is no way of knowing for sure what will happen if you leave life.
The questions that follow below will help you to make the best assessments of QOL and level of suffering that you can. In addition, you can try to be honest and accurate in your ratings – to resist any tendencies to look good or bad. It will be up to you to pick a period of time to use for your assessment. Try to pick one that is long enough to predict the future.
It will also be up to you to choose a standard of comparison. The questions do not restrict your choice. The reference point most people use is a minimum level of pleasure/satisfaction/contentment that has developed over the years and that is a combination of the factors mentioned above.
The hope is that you will come away from the sections on QOL and suffering with the realization that assessment of these areas is not simple, and that a decision as to whether to stay or leave should not be based on how you happen to see things at a particular period of time. The hope is that responding to the questions get you thinking about ways your QOL could be improved.
The best way to deal with the emotionally-laden complexities of any important decision based on evaluation of QOL or suffering is to consult an expert, such as a counselor or therapist. The questions he or she will ask will help to make sure that your assessment of QOL is as accurate as possible.
Of course the main job of a counselor or therapist is to help you to improve your QOL.
There are many different approaches to measuring QOL. Some examples are included in the Measures of QOL in Appendices at the end of the LLQ. You can begin your consideration of your own QOL with the questions below. If you want to go further, you can try some of the other inventories. Unlike the questions which follow, some of these other inventories will give you a score, and some will sample feelings over a period of time.
The questions which follow ask you to rate areas of your life in terms of pleasure/discomfort and feelings of accomplishment/failure. These often occur together but are not the same thing. You can get a sense of accomplishment from something that is unpleasant to do, and you can get pleasure from some activity that accomplishes nothing except to recharge you so that you can tackle a more worthwhile activity.
You are also asked to rate the importance of each area’s contribution to your sense of well-being. Very low pleasure and accomplishment ratings in very important areas identify problems that need improvement. If they cannot be improved, they will be the ones that provide the strongest pressure to leave.
Because this QOL assessment is supposed to help you to decide whether or to consider leaving, you are also asked to predict the potential for positive or negative change.
So, low or negative pleasure or accomplishment ratings in important areas that have low potential for improvement will be most likely to create the impulse to leave.
5.1 Use this scale to rate Pleasure and Sense of Accomplishment
BA = Better than Acceptable
A = Acceptable
LA = Less than Acceptable
Use this scale to rate Importance
H = High
M = Moderate
L = Low
Use this scale to rate Potential for Positive or Negative Change:
+ = Positive change possible or expected
0 = None
- = Negative change possible or expected
Physical health:
Pleasure (BA, A, NA)
Sense of accomplishment (BA, A, NA)
Importance (H, M, L)
Potential for improvement (+, 0, -)
Emotional or psychological health:
Work or study:
Family:
Social life and friends:
Physical activity:
Artistic or expressive activity:
Involvement in other realities (reading, TV, computer games, other media):
Appetite or physiological satisfaction (sex, eating, drinking, medication, drugs):
Standard of living (money, investments, material possessions):
5.2 Your “self” contributes to your QOL. You live with your self all the time so how you get along with your self is important. How satisfied are you with your self? What is it like for you to live with yourself:
5.3 List anything else that contributes to your current QOL:
5.4 How much of the time do you feel good about the way things are going, because you are accomplishing things, because you are having a good time, or because you making progress towards improving your QOL:
Almost every day
Most days
Some days
Very few days
Almost never
I take life a day at a time and don’t look back.
The other side of QOL is suffering ...
Some people believe that suffering always has meaning or value:
· Suffering ennobles the sufferer. Anyone who suffers is a hero and, like the mountain climber or other extreme adventurer, is an inspiring example of what human beings can endure.
· Suffering leads to spiritual growth by focusing a person’s attention on answering a series of important questions beginning with “Why?”.
· A person becomes closer to his God by suffering -- in the case of the Christian religion, by suffering as Jesus did – or by making a connection between his suffering and God or Allah’s purpose.
It is also possible that suffering may have physiological or psychological benefits. In some situations, certain kinds of suffering may stimulate the release of the body’s natural opiates (endorphins). Suffering is typically followed by a feeling of relief that is uniquely pleasurable. Suffering can also relieve guilt and shame.
A significant number of people believe that pain of suffering in the last stages of life is balanced by opportunities for spiritual growth and for becoming closer to those you love. They believe you will discover an immense peace and a sense of worth in finding meaning in your suffering and in improving or resolving your relationships with significant people in your life. Both you and your survivors will benefit in ways that you and they couldn’t if you left life voluntarily.
If you do believe that suffering is an always a positive or meaningful experience, the conclusions you draw from your responses to the questions that follow will be different than those who find that suffering is often meaningless. You will say, “Yes, I do (or will) suffer, but because suffering has benefits or positive meaning for me, I do not consider it to be something to be avoided".
5.5 The following question asks about your current levels of discomfort or suffering in various areas.
Fill in degree of suffering created by the situation using this rating scale:
There is a space for you to put how long your suffering has lasted (the duration) in days, weeks, months or years.
There is another space for you to indicate the direction you expect any change to take, using this scale:
+ = Change for the better possible or expected
0 = No change possible or expected
- = Change for the worse possible or expected
Painful or uncomfortable physical symptoms:
Degree(H, M, L) Duration: Change(+, 0, -):
Incapacitating physical problems or handicaps:
Emotional or psychological problems
Problems or frustrations with job, finances, or standard of living:
Problems, frustrations, or conflicts with family or friends:
Other interpersonal problems (loneliness, being misunderstood, being a target of prejudice):
Threats to survival (war, crime, drought or starvation, frequent flooding or hurricanes, or other natural disasters):
Other environmental problems (toxic air or water, crowded living conditions, stressful or depressing weather):
Other kinds of suffering:
5.6 When you look over the list, would you say that your overall level of suffering is:
Acceptable, easily tolerated,
Somewhere between “acceptable” and “tolerable”
Tolerable, meaning "not ideal, but acceptable",
Somewhere between “tolerable” and “barely tolerable”,
Barely tolerable, barely acceptable,
Not tolerable, but I have no choice but to accept it
5.7 What would other people say about your of your QOL or level of suffering? Would they wonder how you can stand it? Would they think you are doing OK or as well as anyone could expect? Would they think you were doing well compared to others like yourself? Would they think you were lucky and envy you? Would these opinions make a difference to you:
5.8 What would you say if you were looking over the responses of another person that were the same as yours:
A version of this next question will be asked at several points later on, as you consider other factors that affect your thoughts and feelings about leaving life:
5.9 Is your QOL or the degree of suffering that you are enduring now and that you expect to face in the future enough for you to consider leaving life:
5.10 Which of these additional factors could influence your ideas and feelings about leaving:
My assessment of my worth to the world,
How much other people (or animals) need or care about me,
Permission from others that it would be OK for me to leave when I want to or under certain circumstances,
Permission from society that it is OK to leave when I want or under certain circumstances,
The availability of a pain- and anxiety-free means to leave,
The availability of a way to make my leaving useful or financially rewarding,
The availability of a way that I can live on through some kind of tangible memorial,
The availability of more knowledge about what happens after life.
Other:
5.11 Let's say that you were in physical or psychological pain that was not going to get better. There is no hope of a cure. You have concluded that you could not adapt to the pain, and you could find no meaning in your suffering. You were not doing anyone any good by continuing to live. Would you consider leaving:
... if you could leave life painlessly and it was acceptable to your family and to society to do so;
... if the above were true and you were paid to do so;
... if the above were true and your leaving would be contribute to society, say, by participation in medical research;
... if you received help in dealing with unfinished business such as unresolved conflicts or other negative feelings between you and those you love.
...if the people around you agreed, however reluctantly, that your leaving would be the best thing,
5.12 What other conditions you can think of that would make you feel more comfortable about leaving:
5.13 What would you do if you invited into a UFO, with the assurance that you would have a life free from meaningless suffering? How much risk would you be willing to take? What evidence would you need before you decided to go:
Before you leave this section, you should realize we don’t ordinarily spend much time looking backwards in order to make a serious judgment about how well we are doing. Most of us simply forge ahead and assume things will improve or we work hard to make things better. So, you should realize that the sense of dismay from remembering bad experiences is created partly by this scanning backwards and may well disappear when you return to living more in the present and future.
Often we treat others differently from ourselves. We may be kinder to others or we may hold them to harsher standards, condemning them for things we may be blind to in ourselves. In any case, expressing how we think other people who are suffering should behave or be treated leads to the question, “Shouldn't this apply to me?”
5.14 Have you ever known a person that you believed would be better off permanently asleep? Have you ever wished that the life of a person who appeared to be suffering terribly would end:
5.15 Is there such a thing as complete hopelessness that is justified by the facts? Is it ever the case that there is nothing that anyone can do to make things better? Is there such a thing as "rational suicide":
There are people whose suffering is meaningless to them, and below their level of acceptability and who have almost no hope for improvement. They are in “persisent intolerable discomfort" (PID). Some of these PID’s might welcome the opportunity to leave life if there were a painless method available to them and if certain other conditions were met. In this category would be some people in prisons, nursing homes, mental hospitals, as well as those in refugee camps and in very poor countries. Some people who are handicapped or who have chronic incurable diseases might also want to leave. (This is not the place to talk about the significant problems and unintended consequences that offering such a choice might create. For a brief discussion of one issue, see 8: You and the ‘slippery slope'.)
5.16 Which of these groups do you think should be offered the means to leave life:
Terminally ill people,
Those with intractable physical pain,
Those with intractable psychological pain,
Prisoners,
Prisoners serving life sentences,
People who are starving,
Nursing home residents,
Handicapped or disfigured people,
Anyone who asks.
Anyone else?
5.17 Especially if you checked “Anyone who asks”: What safeguards do you think should be put in place:
We should make sure that the person is rational and not suffering from a mental disturbance.
We should make sure that the person is not being pressured to leave by greedy relatives or an unjust social system that restricts him to a low QOL.
We should make sure that the person goes through a process of decision-making with a professional who checks and challenges every step.
There should be a short waiting period (less than two weeks) to allow the person to change his mind.
There should be a longer waiting period to see whether the person could adapt to his situation.
Anyone who asks should be helped to leave. Everyone has the right to choose.
Anyone who asks should be helped to leave because it will save resources and help deal with the problems of overpopulation.
5.18 Which of the following do you think are good reasons for not offering people the opportunity to leave life voluntarily?
... because making this opportunity available would:
... lead to an increase in the number of people leaving that would continually remind us of our own mortality,
... force us to make uncomfortable and complicated decisions about when we or other people who are suffering should consider leaving life,
... deprive people of the opportunity to grow spiritually or to find meaning in their suffering,
... create the need for people who would help others to leave life, a class of professional murderers
... lead to abuses, such as trying to convince people whose care is inconvenient or expensive that their lives are no longer worth living.
Other reasons:
5.19 Having an escape route from an unpleasant situation can give a person the motivation to risk trying to make things better where he is because he knows he can leave if his attempts fail. Do you think that knowing that you could leave when you wanted to would help you endure a bit more suffering before you gave up: