Date of Award

2018

Document Type

Open Access Dissertation

Department

Philosophy

First Advisor

Leah McClimans

Abstract

This project explores the epistemology of quality of life measurement. Quality of life measures face a dual epistemic burden both to serve as data for the evidence-based medicine movement and to give patients a greater voice (McClimans 2017). Much time, effort, and money has been invested in these measures over the last 50 years, and yet their theoretical foundations remain weak. It is not clear whether these instruments succeed in measuring what they purport to measure, or what precisely is meant by “quality of life” (Hunt 1997). The epistemic challenges faced in quality of life measurement are not wholly unique. I argue for an analogy between quality of life measures and physical measures first in terms of the dynamics of their development and second in terms of their model dependence. I argue, following van Fraassen (2008) and McClimans (2010b) that the dynamics of measure development have a hermeneutic structure. And, following Tal (2012) I argue that judgments about the validity, accuracy, and comparability of quality of life measures are model dependent. However, there are important contrasts between quality of life measures and archetypal physical measures as well. The concept of quality of life cannot be standardized the same way the concept of temperature can. Its meaning remains open to interpretation. In part, this is because quality of life is an imperfectly understood subject matter (McClimans 2010b). We might also argue that quality of life is inherently subjective (Schwartz and Rapkin 2004), in at least some sense, and that it is a socially constructed Ballung concept (Cartwright and Runhardt 2014). Because the meaning of quality of life cannot be standardized, outcomes may not converge around a single determinate value. In the final chapter, I extend my epistemological survey to the topic of epistemic justice in quality of life measurement. I argue that the chronically ill and disabled are better situated epistemically to evaluate their own health states than the general public (Barnes 2009; Harding 1993; Paul 2014), and that justice requires us to place them at the center of such deliberations (Fricker 2007). This is particularly true when these valuations affect policy.

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