Value of Life (VOL):

The Fundamental Construct of Ultimatology

by John Tennison, MD.  Copyright December, 1998.  All Rights Reserved.  See www.ultimatology.org for more details.

   The fundamental construct of ultimatology is what I call, "Value of Life" or VOL.  VOL is a scalar entity which is derived from a consideration of Quality of Life and Quantity of Life.  Mathematically speaking, it is the positive area under the curve when Quality of life lies on the Y-axis and Quantity of life (lifespan) lies on the X-axis.

    The following slide set and commentary elucidate the principle of "Value of Life" (VOL).

   Note:  We don't know that "Quality of Life" will drop to Zero at the point of death as the three graphs below suggest.  However for the sake of simplicity, the graph is drawn with the line of the graph meeting the X-axis at the time of death.  However, I readily admit that, if there is an afterlife, there would also be a subjective experience and thus a "Quality of Life" capable of assuming non-zero values.

We can imagine two extremes:  the "Short-lived, thrilling, life," and the "Long-lived, boring, life."  However, as we can see in the following slide, both of these hypothetical lives has equal VOL.  That is the areas of their rectangles on the graph are equal.  Who can say that one of these lives is inherently better than the other?  I, for one, cannot.  Although they have qualitative differences, it would be a value judgment for me to claim that one was "better" than other. 

    However, if we were able to maximize Quality-of-Life and Quantity-of-Life, the following graph would result.  Here, the VOL (positive area under the curve) has been maximized.   Attempting this maximization is the goal of Ultimatology.

   Some might suggest that the practice of "primary prevention," within the specialty of Preventive Medicine already addresses the goals of Ultimatology.  Yet, in actual practice, Preventive Medicine focuses more on disease prevention than on health promotion.  Thus, there is a unique niche that can be filled by Ultimatology.

   The graph below reminds us that, like many other quantities, HEALTH exists as a continuum.  There are NO natural boundaries by which we can say that someone on one side of a boundary is "ill," while someone on the other side of that boundary is "well."  Almost all criteria for disorders, both mental and physical, are ARBITRARY.  Even the revered standard of calling a parameter "abnormal" as a result of lying more than two standard deviations from the mean is a COMPLETELY ARBITRARY STANDARD.  In most cases, treatment efficacy would in no way be lessoned by our regarding such outliers as "VARIATIONS OF NORMAL," rather than regarding someone as "abnormal" for having met some arbitrary threshold.  By placing people in these cognitively distinct categories, we have inadvertently moved them from a position of being considered in the "In Group" to being considered in the "Out Group."  In doing so, we have lessoned that chance that physicians and the public at large will be able to empathize and thus identify with the people we purport to help.

   The graph below demonstrates the Ultimatology would focus on a unique area of the health continuum which is not adequately addressed by conventional medicine.

   Since medicine is in general a rather conservative profession, I would anticipate that there will be significant resistance to the idea of a new medical specialty.  However, I would contend that the ideas of Ultimatology should be assessed on the basis of there merit or lack thereof, not simply as a result of fear of the new or unusual.  As it is likely that some will consider Ultimatology too "grandiose" to be taken seriously, I am reminded of the following quotation by Mark Twain.