Gawande told us about a study of terminally ill lung cancer patients, some who weren't given this sort of palliative care and some who were. The latter group, on average, chose to receive less life-prolonging but unpleasant chemotherapy treatment, and had some other markers of greater well-being. And then what happened?
This group actually ended up living longer than the others! I suppose this does make sense: happier people tending to live longer.
As an economist, I have been thinking about how the quality v quantity issue might apply to the lives of the living as well as the dying. In the economy, the equivalent of human lifespan is Gross Domestic Product, or GDP - basically, a measure of the total quantity of stuff produced in a year. Economists are careful about making too much of GDP: politicians are not. Indeed, they are obsessed by GDP - specifically in its "growth" from year to year, which has become the holy grail of economic policy.
The commercial mindset that measures well-being in terms of GDP can be insidious. Even the welcome focus in the Budget on reducing child poverty gets justified (by some) as an "investment" in more reliable future workers.
But surely we shouldn't be justifying tackling child poverty because we want to ensure they will pay for our pensions when they grow up. We should look after the children because we love them and because it is our duty - that's where the quality of life is.
Most of the increases in GDP over the past 20 years have not gone to wage-earners (which is actually a big part of the explanation for child poverty), but have been siphoned off by the overseas owners of our banks and into increases in top pay. Is that a good outcome? A rich country that doesn't pay all its workers at least a decent living wage is not a quality country, in my book.
New Zealand shamefully dodges its moral obligation to at least do our share in the global battle against climate change, and turns a tolerant eye to the environmental damage being done to our own waterways - all in the cause of economic growth. Is this how quality people behave - basically, exploiting the commons now at the expense of the well-being of future generations?
I'd like to see us focus directly on the quality of our lives together as parents, children, workers, entrepreneurs, capitalists, citizens. If we want to target outcomes, make sure they are quality outcomes, not the crude quantity measure that is GDP.
New Zealand could become a world-leader in paying less attention to GDP. We might even decide to stop measuring it - it just upsets us and over-stimulates politicians. But if we do measure GDP, we might find - just as dying people may live longer when they have some decent quality of life - an economy in which the important quality issues are dealt with up front, delivers on the quantity side of things as well.
Tim Hazledine is a professor of economics at the University of Auckland Business School.
