This paper proposes the idea of thinking about practical rationality in terms of self-regulation and defends the thesis that self-regulation is a virtue, insofar as we have reason to think it is our highest form of practical rationality. I argue that understanding self-regulation as a virtuous form of practical reasoning is called for given the kinds of limitations we face in developing agency and pursuing our goals, and presents us with several advantages over traditional understandings of practical rationality.

Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, ‘value’ refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of (...) using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley’s “agential flourishing” theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations. (shrink)

While notions of spirituality, spiritual experience and spiritual development seem much neglected in the literature of modern analytical philosophy, such terminology continues to be current in both common usage and religious contexts. This author has previously taken issue with some recent attempts to develop conceptions of spirituality and spiritual experience as substantially independent of religious attachment. Notwithstanding this, the present paper considers whether such a ‘religiously-untethered’ notion of spirituality, spiritual experience or sensibility might yet be sustainable in terms of two (...) key criteria: as a capacity for non-instrumental perspectives on, or interpretations of, the world of ordinary experience; and as a corresponding capacity to identify goals and values that transcend or are not reducible to the meeting of immediate natural or material—either individual or social—needs. (shrink)