The Journal of Valuelnquiry 29: 269-278, 1995. © 1995 KluwerAcademic Publishers. Printed in the Netherlands.

Review article

The quality of life ROBERT HALLIDAY Utica College o f Syracuse University, Utica N Y 13502-4892, USA

The book The Quality of Life, edited by Martha C. Nussbaum and Amartya Sen (Oxford: Clarendon Press, 1993) comes out of a conference organized by WIDER (World Institute for Development Economics Research of the United Nations University) in 1988. WIDER exists, in part, to provide a forum for interdisciplinary research, and this is reflected in the cross-section of philosophers, economists, and social theorists who contributed to this discussion on defining and measuring the quality of life. The sixteen essays are grouped into four sections: (1) "Lives and Capabilities," which addresses ways and means of quantifying the quality of lives; (2) "Traditions, Relativism and Objectivity," which focuses on the universality of value assertions; (3) "Women's Lives and Gender Justice," which concentrates on the particular issues raised by the condition of women's lives; and "Policy Assessment and Welfare Economics," which explores questions about "welfare economics (broadly defined) and the formation of public policy" (p. 6). In many cases essays are followed by commentary which repays as much attention as the essays themselves. Despite the book's inclusive title, its focus is clear; the essayists wish to discuss the concept of quality of life as it pertains to development economics. Now development is not an easy topic to discuss. Epistemologically it is fraught with both empirical and conceptual difficulties, while politically it raises accusations from misguided good intentions to paternalism or rampant colonialism. The contributors to this volume largely stay away from the political aspects of this subject and focus instead on the epistemological. Three questions run as a unifying thread throughout this discussion: (1) When we are measuring the quality of a life, what are we measuring? (2) How are we to measure that quality? and, (3) Can the evaluations of quality of life based on these measurements have any cross-cultural value? In part one of this review article I concentrate on the issues raised by the initial pair of questions. In part two, I focus on the problems of cross-cultural evaluation. Part three contains some closing reflections on the book as a whole and its place in the quality of life discussion.

270 . Amartya Sen and G.A. Cohen grapple with the question of what we are measuring when we are measuring quality of life by asking whatmust be distributed equally in an ideal egalitarian society. John Rawls has criticized the standard utilitarian answer, happiness or desirable mental states, usually referred to as %velfare," on the grounds that the aggregative nature of utilitarianism and its concentration on welfare are both objectionable. Rawls suggests replacing equal distribution of welfare with an equal distribution of primary goods. Both Sen and Cohen agree with Ralws's criticism of utilitarianism but disagree with his suggested replacements. In "Capability and Well-Being," Sen identifies a point between the possession of a primary good (such as food) and the welfare which results from the possession of such a good (say, the pleasure provided by a good meal). This he calls a "functioning," which he defines as "[part] of the state of a person- in particular the various things that he or she manages to be or do in leading a life" (p. 31). Rather than concentrating on having food or experiencing the pleasure of a good meal, Sen's analysis concentrates on the state of being adequately nourished. The list of basic functionings may be relatively brief while that of the more complex functionings, including such features as achieving self-respect or being socially integrated, may be "much longer and much more diverse" (ibid.). As well as functionings, or states of being, Sen also describes "capabilities," or corresponding abilities to achieve those functionings and to choose between alternate sets of functionings. The quality of life is measured in terms of capabilities and functionings, and equality means an equal distribution of those. In "Equality of What? On Welfare, Goods, and Capabilities," Cohen criticizes Sen for having a view of the quality of life that is too action-centered, holding that the most important part of capabilities is that "they provide [people] with the capacity to do things" (p. 18). Cohen points out that many benefits of a good life have little to do with my achieving things; a baby does not have to feed itself to experience the quality of life associated with being fed, and I do not personally have to wipe out the anopheles mosquito to experience the benefits of a malaria-free environment. Rather than capabilities, Cohen wishes to make "midfare" the prime yardstick in quality of life issues. "Midfare" is the term he uses for those states of being that come midway between goods and utilities, for example, the state of being educated that comes between the possession of books and the pleasure derived from being educated. Sen's excessive focus on activity, argues Cohen, comes from his preoccupation with freedom in the sense of a "freedom to do'" (p. 24):

271 unlike the freedom to choose whether or not to eat, freedom from hunger is not constitutively freedom to do anything. Sen speaks of exercising such "capabilities" as freedom from hunger and freedom from malaria . . . . Sen's application of the term "capability" both to the freedom to avoid morbidity and to the freedom from morbidity shows that, in the attempt to bring the very different issues with which he is concerned under the single rubric of "capability", he is led to make equivocal use of the word "freedom". (p. 25) Cohen's point is a powerful one; "freedom to" and "freedom from" are different, although related, concepts. However, there is little in Cohen's idea of midfare that is not captured in Sen's concept of functionings. Both describe states of being that may require certain goods or conditions (food or a malariafree environment) for their realization, and that are experienced by those in these states as beneficial. This similarity is something that Sen points out in "Capability and Well-Being." Sen goes on to argue that his emphasis on freedom is warranted because "[a]cting freely and being able to choose may be directly conducive to well being" (p. 39). It is also true, however, that, while Sen mentions the cases of children and elderly people whose quality of life may involve little agency, his work does focus on the lives of autonomous adults. Cohen's reminder, that many elements of well-being have to do with what we did not strive for or choose, is important. This has been recognized by, for instance, the Comparative Scandinavian Welfare Study which included such factors as the nitrous acid concentration in the air in its quality of life assessment, and by B.M.S. van Praag who factored in the influence of climatic differences on welfare. There has to be room for what Bernard Williams called "moral luck." The language of "capabilities" and "functionings" has over recent years become more prevalent in discussions of well-being and quality of life. There is a problem, however, in translating these capabilities into quantifiable aspects of real lives. When governments, bureaucracies, or academics ask about the quality of life enjoyed by a particular group of people, they usually want answers in the form of numbers. Some methods of generating those numbers are discussed in the essays by Robert Erikson, "Descriptions of Inequality: The Swedish Approach to Welfare Research," Erik Allardt, "Having, Loving, and Being: An Alternative to the Swedish Model of Welfare Research," Dan Brock, "Quality of Life Measures in Health Care and Medical Ethics," and B. S. M. van Praag, "The Relativity of the Welfare Concept." Erickson's essay describes the Swedish government's attempt to measure the "distribution of welfare in non-monetary terms" (p. 68), while Allardt describes the Comparative Scandinavian Welfare Study which attempted a contemporaneous comparative study across Denmark, Finland, Norway, and Sweden. Both of these essays, as well as that by Brock, suggest a range of criteria by which

272 the standard of life of an individual of population might be assessed. In each case the criteria consist of a list of component elements of wellbeing, together with indicators of the extent to which those component elements are realized. For instance, the Swedish survey has housing as one component, with the number of persons per room and the amenities provided as two indicators. Dan Brock describes, among other yardsticks, the "Sickness Impact Profile" which includes social interaction as one component and the number of social activities with groups of people as the indicator. The indicators used in most of these surveys are, as Allardt points out, objective rather than subjective; they focus on the provision of resources and not the individual's satisfaction with the life provided by those resources. The Swedish survey, for instance, focused on "the individual's command over resources in the form of money, possessions, knowledge, mental and physical energy, social relations, security and so on, through which the individual can control and consciously direct his living conditions" (p. 72) [italics in original]. This approach inevitably raises two questions: (1) Can such a diverse group of components be reduced to a single quality of life indicator? and, (2) Should we rely on such objective, observer point of view indicators, or should we take into account the satisfaction an individual expresses with a particular component? The majority of the authors who tackle the first question agree that a wideranging set of variables cannot be reduced to a simple indicator; there are just too many incommensurable values at stake. It is simply intuitive that the rich tapestry of human lives and the way in which people may choose, say, time with family over earned income, makes the reduction of multitudinous components to one scalar quantity both impossible and undesirable. Even classical utilitarianism of the Benthamite type has to allow for the trade-offs we make between fecundity and propinquity of happiness, and by the time Mill has introduced the distinction between quality and quantity of happiness all possibility of a simple reduction to one variable is lost. A far more difficult time is had with the second question, whether investigators should take into account the expressed feelings of those whose lives are being measured. The pressure to include reported satisfaction comes from a number of directions, the first of which originates in a perceived flaw in the interpretation of data. Bengt-Christer Ysander, in commenting on Erikson's essay, points out that investigators almost never succeed in measuring anything like a capability but have instead to make do with "particular individual achievements from which they could construct or estimate capabilities" (p. 84). For instance, Ysander points out that political capability is measured in terms of"a certain probability that you will get politically organized, make speeches, and write to the newspapers" (p. 85). The assumption is that such activity indicates a satisfactory integration into the political processes that affect you. However, it could also indicate the reverse. Perhaps it is frustra-

273 tion at being excluded from decisions that leads you to political activity. In the light of this, perhaps reported satisfaction is a necessary counterbalance. The methodologicalpoint here is a powerful one; as any social scientist knows, hypothesizing from behavior to cognitive or affective state is a risky business, but it seems to me that with due care and attention this can be overcome. The Swedish survey uses "ability to file complaints" as one indicator of political resources and this is surely a more revealing indicator of one's integration into a political process than simply going on marches or writing to newspapers, although I would have thought that "ability to file complaints with a reasonable chance o f success or fair treatmenf" might be even more revealing. The second direction from which pressure to include reported satisfaction comes is the feeling that ignoring such reports risks "a dogmatism of experts" (p. 92) and bypasses what we assume is an essential element of lives that are worth living. The problem is that different people may have different levels of satisfaction with the same set of resources, depending on such variables as future expectations, previously experienced levels of resources, or knowledge of alternatives. In her commentary on Onora O'Neill's paper, "Justice, Gender and International Boundaries," Martha Nussbaum, reflecting on the epistemological effects of oppression, points out that women frequently report when polled that they do not desire more education. But how should we regard such answers? When such replies are given in situations in which it is clear that the women in question have little experience of education, little i n c e n t i v e . . , from the society around them to pursue their education, and no clear paradigms of women's lives that have been transformed by education, it seems clear that their announced contentment with the uneducated life means little. (p. 325) Allardt rues the lack of any "strong empirical correlations between the outcomes of objective and subjective measures" (p. 92), but something of this sort is precisely what van Praag attempts to provide. His essay, "The Relativity oftheWelfare Concept," is described by the commentator, Siddiq Osmani, as a "distilled form [of] two decades of research" (p. 386)in which van Praag and his colleagues used a questionnaire to ask people what levels of income they would describe as "good," "sufficient," "very bad," etc. From the responses, an "operationally useful," interpersonally comparable, measure of utility is created by some ingenious statistical manipulation. Admittedly, the measure of utility is confined to income, but it does manage to produce some surprisingly uniform results. Although people attach different incomes to the same verbal labels, once these income levels are converted into what van Praag calls utility numbers (by compensating for past and present income, family size, social reference, etc.), an almost perfect correlation occurs be-

274 tween utility numbers and verbal labels. Could this be the universal measure o f utility that Allardt asked for? Unfortunately, as Osmani points out, to go from utility number to verbal label to individual welfare requires that two connections be made. Van Praag may have made the connection between utility number and verbal label, but the connection between verbal labels and individual welfare is another matter altogether. This rests on an article o f faith, that "the same verbal level means the same level o f welfare for everyone" (p. 389). This does not mean, however, that an approach such as this is not a revealing and useful tool. Although we may each describe similar levels of personal utility by different nomenclature, in a commtmity of language users there is an effective degree of commonality. We may not be able to say that those who describe the quality o f their lives as "comfortable" do not mean the same as those who describe their lives as "barely comfortable," but we can surely say that a difference exists between those who describe their lives as "pleasantly comfortable" and those who describe their lives as "extremely arduous." What is most evident throughout this discussion o f the nature and quantification of the quality o f life is the fruitful tension between different academic disciplines as they approach this subject with different desires and demands. On the one hand is the desire for as complete and theoretically unimpeachable an account of the quality of life and its measurement as possible. On the other hand is the desire to create "operationally useful" tools and standards. As James Griffin says: Now, what one includes in an account of a good life will, I think, depend upon what the notion of a good life is used for. We need a full notion in taking decisions about how we want to live our own lives and the doctor probably needs the same full notion in taking decisions about what the best trade-offs are for a particular patient. It is, I think, a different, perhaps narrower, notion of the good life that comes into play in many of a government's decisions about how it ought to allocate resources. And it is not a mention of the good life at all, but some accessible, tolerably reliable indicator o f it, that we often have to fall back on. (p. 136) As in any exercise in praxis, both the practical and the theoretical need and inform each other. The conversation between them should never intend to result in victory for one side but rather for mutual enrichment. Unfommately, such reflexive cooperation is all too rare in academia, which is what makes WIDER's approach so refreshing. This productive tension between theory and practice is also evident, although to a lesser degree, in the discussion of the possibility of cross-cultural evaluation o f quality of life, and to this I now turn.

275 .

One interesting effect of conducting the debate over the quality of life in the language of capabilities and functionings is to recast some old and new philosophical debates. The possibility of universal values is recast in terms of the question"Is there something like a complete list of the relevant functionings?", which is asked by Wulf Gaertner (p. 63), and the epistemology of universal values becomes a question of how we might draw up or justify such a list. The need to be able to do this is paramount. As Martha Nussbaum says: Providing a powerful account of rational ethical argument [is] one of the central challenges for a practical philosophy, a philosophy that will really help people to make progress on troublesome human problems. (p. 232) Among these troublesome human problems she includes: improving "the position of women, as established by local traditions in many parts of the world," and criticizing, in the name of practical reason, "traditions of slave holding and racial inequality, religious intolerance, aggressive and warlike conceptions of manliness, and unequal norms of material distribution" (p. 243). A practical program of this scope needs a sound foundation from which to launch its criticisms; the question is, can practical reason provide it? Skeptical doubts about the justifiability of normative assertions often have their root in a perceived distinction between "facts" and "values," a distinction addressed by Hilary Putnam in "Objectivity and the Science-Ethics Distinction," by Michael Walzer in "Objectivity and Social Meaning," and by Thomas Scanlon in "Value, Desire, and Quality of Life." Putnam argues that the strict fact/value dichotomy is an incoherent position, for facts and values are necessarily entangled, but that, nevertheless, a notion of objectivity of ethical ideas is not possible. We are instead fated to be "beings who cannot have a view of the world that does not reflect our interests and values, but who are, for all that, committed to regarding some views of the w o r l d . . , as better than others" (p. 156). Michael Walzer takes a similar line, concluding that, because values are socially constructed their objectivity is also a social construct. Such an objectivity is "probably not the kind that philosophers seeking objectivity are interested in" ~ . 176), for it is not the way things really are, or must be. It cannot, for instance, provide an Archimedean point from which to criticize a culture in which both men and women regard women as objects to be traded. There is, he says, "no morally acceptable way of denying the woman-whois-an-object-of-exchange her own reasons and her own place in a valued way of life" (p. 175). Scanlon argues that one's preferences "are not the source of reasons but reflect conclusions based on reasons of other kinds" (p. 192) and

276 are therefore open to criticism. However, he still maintains that it is unlikely that any unified account of what makes things good is to be had since it is "unlikely that there are any good making properties which are common to all good things" (p. 191). The move from the idea that normative statements cannot hope for "real objectivity" to the idea that whatever "pseudo-objectivity" they may acquire from being embedded in social matrices is incapable of external criticism, is one that is criticized by Charles Taylor in "Explanation and Practical Reasoft' and by Martha Nussbaum in "Non-Relative Virtues: An Aristotelian Account." Taylor's essay is a detailed, rich, and insightful look at the way in which moral reasoning works, and of its resources for cross-cultural criticism. He argues that our conceptions of practical reason have been distorted by the weight of moral skepticism and that moral disputes have been "rendered irrational and seemingly inarbitrable by an influential but erroneous model of foundationalist reasoning" (p. 221). This model has resulted in incorrect assumptions about what moral argument looks like. As Hilary Putnam points out, "There is a weird discrepancy between the way [some] philosophers... make ethical arguments sound, and the way they actually sound" (p. 146), and Taylor is quick to utilize this point. Moral philosophy all too often worries about what we would or could say to someone who u_nconfusedly rejected what we take to be a fundamental part of the moral foundation, such as a belief in the inviolability of innocent human life. But, asks Taylor, how often do we really meet up with someone who actually takes this position? The task of moral reasoning is therefore "not to disprove some radically opposed first premise.., but rather to show how the policy is unconscionable on premises which both sides accept and cannot but accept" (p. 209). In place of foundationatist reasoning Taylor offers the model of what he calls an ad hominem style of argument. In this mode the job of the practical reasoner is "to show up the special pleas" (ibid.) by which objectionable schemes try to leave people out of moral consideration. We can effectively respond to such moves by identifying the transitions by which someone gets from a mutually acceptable premise (human life is to be preserved) to an objectionable conclusion (it is acceptable to kill unbelievers) and then proposing "to our interlocutors transitions mediated by such error-reducing moves [as] the identification of contradiction, the dissipation of confusion, or rescuing from (usually motivated) neglect a consideration whose significance they cannot contest" (p. 224). While Taylor's solution to the supposed inarbitrabitity of moral disputes is to focus on the process of reasoning from common foundations, Nussbaum's approach is to reexamine the foundations. Her essay argues that an Aristotelian approach can root discussion of the quality of life in sets of "shared human experiences." These experiences "clustering around certain focuses

277 can provide reasonable starting points for cross-cultural reflection'' (p. 2 ~ ) . By "hanging on to a general (and very open-ended) picture of human life, its needs and possibilities, but at every stage immersing [ourselves] in the concrete circumstances of history and culture" (p. 259), we can find a foundation from which to launch the ambitious project of practical ethics outlined above. Both the need for and the effectiveness of such approaches can be seen in those papers that tackle a set of relatively new philosophical questions, those concerning the differences between the attitudes and social environments of women and men. Julia Annas, "Women and the Quality of Life: Two Norms or One?", and Onora O'Neill, "Justice, Gender, and International Boundaries," address the questions of whether women and men have fundamentally different sets of capabilities in terms of which the quality of their lives should be measured. That such a difference might exist is a dangerous possibility, O'Neill argues, because it leads inevitably to a relativism of standards of justice, and "any relativism tends to prejudice the position of the weak, whose weakness is mirrored and partly constituted by their marginalization in received ways of thought and by their subordination and oppression in established orders" (p. 304). Undesirable consequences do not themselves remove the veracity of a fact, however, although history is replete with unfortunate examples of people who thought otherwise. What is needed is sustained argument along the model provided by Nussbaum and Taylor. BothAnnas and O'Neill argue (Annas from an empirical standpoint, O'Neill from a Kantian one) that there are no such fundamental differences• Using an approach that shares much with Nussbaum, Annas argues that we can and do have a notion of human nature, a notion built upon past experience. O'Neill, on the other hand, in a move that is reminiscent of Taylor's identification of special pleading, identifies certain models of assessing justice, notably the contractarian, as trading on weaknesses already in the system. Problems of injustice faced by women are, O'Neill argues, "cases of more general difficulties faced by the weak, the marginalized, the exploited" (p. 324). Some objections can be raised to these approaches. For instance, Maragarita Vald6s, in commenting on Annas, argues that an empirical approach to human nature, based on past experience, gives no reassurance concerting the future. As women try to expand their participation in the world they enter areas in which there is no past experience and differences may be found here that justify inequitable treatment. Such objections are, however, part of the concrete debate that can be entered into; debate in which, as Nussbaum says: •

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The rejection of the idea of ethical truth as correspondence to an altogether uninterpreted reality does not imply that the whole idea of searching for the truth is an old fashioned error. (p. 260)

278 .

This century has not been a good one forAnglo-American moral philosophy. The project of practical reason was not well served by logical positivism, by the sterile ruminations of emotivism, or by the ivory-towered abstractions of non-naturalism. In conjunction with naturalist and foundationalist epistemologies, these theories have lead to a perception of normative issues as lying beyond the grasp of reason and debate: morality becomes a matter of purely personal choice, and we are deprived of the resources to combat odious practices with anything other than the exercise of force. Recent years have seen an upsurge, however, in attempts to formulate intellectually respectable tools for analyzing and resolving moral questions. This work has been driven, in part, by a new urgency to resolve problems that have become more pressing as the world shrinks, technology expands, and communities and individuals everywhere compete for scarce resources. The demand for solutions has forced a new measure of cooperation between disciplines as theories are applied to the practical problems of the world and its human communities. The contributors to The Quality of Life are all involved in this project of pragmatic cooperation, and their book is an important part of a revitalized and intellectually well-grounded attempt to deal with issues of justice and well-being. The importance of having contributions to this discussion from a variety of disciplines, experiences, and points of view is amply demonstrated in this volume. It is surprising, therefore, to see how homogenous the list of authors is. There are about twice as many men as women, and all but two of the contributors are affiliated with majorAmerican or European universities. I suspect the discussion would have benefited by the inclusion of those whose perspective is formed outside of Europe and the U.S.A. Similarly, although most of the writers are well read in the details of applying theories of development, it would have been good to hear from those who are in the front line and are most immediately familiar with the nitty-gritty details that elegant theories must accommodate if they are to be more than museum pieces. That said, however, this collection of essays provides an extraordinarily rich and acute discussion of both the theory and the practice of examining and enhancing the quality of life.