Health-related quality of life between naturalism and hermeneutics

Interest in measuring Quality of life (QOL) in modern medicine has increased considerably in recent years. However, there is no generally agreed definition of QOL, but the term encompasses several constructs, including physical, functional, emotional, social and cognitive domains. A psychometric approach is typically applied, but major problems conceptual confront this tradition. It is argued that QOL research follows a naturalistic tradition in medicine, and that the theoretical status of the QOL concept remains ambiguous. Hence, the more neutral term multidimensional evaluation is suggested as more appropriate than QOL. Hermeneutic thinking with its focus on meaning, understanding and interpretation of the individual placed in a historical and social context is briefly introduced and its role for QOL discussed. A radical hermeneutic position focusing solely on the subjectivity of the individual is rejected, and a balanced view is suggested. Such a view should not ignore that man is a biological organism which can be subjected to naturalistic studies, but it should also take into account those features which constitutes man as a person, e.g. understanding and interpretation. Future QOL research may benefit from an integration of philosophical reflection on health and disease issues and a psychometric tradition.