Qualitative criteria in therapeutic evaluation and decision-making in oncology.

Two problems are envisaged: --the relationship between the "statistical decision" and the individual decision. Long before the existence of decision-making aids, medical knowledge has always been of a statistical nature. Ever since medicine became an organised science, the treating of a patient and not just the illness has been a constant problem. At present, it is by no means certain that we have the right to apply the strategy recommended by a well organised therapeutic trial, with our eyes shut. If for no other reason, simply because the criteria of judgment of the trial may not necessarily be the criterion best adapted to the patient concerned. --how to implicate in decision and evaluation non-quantitative criteria such as the quality of survival. Having recalled the distinction made by Wood--impairment, disability, handicap--an attempt is made to specify the state of sanometric research providing physicians with health indexes that are finer than the simple Boolean criteria of Life/Death. In conclusion, the question can be raised as to how pertinent, it is to consider death as the lowest level of health, and as to what role should be left to the patient in the choice of decision-making criteria for problems directly concerning his own fate.