Quality Adjusted Life Years (QALYs) have become a household word among health economists. Their use as a means of comparing the value of health programmes and medical interventions has stirred up controversy in the medical profession and the academic community. In this paper, I argue that QALY analysis does not adequately take into account the differentiated nature of the health state values it measures. Specifically, it does not distinguish between needs and preferences with respect to its valuation of health states. (...) I defend the view that needs and preferences are clearly distinguishable, and that the concept of needs cannot be dispensed with, as many health economists suggest. It is argued that the scale along which health states are measured in QALY analysis is not a continuous interval scale, but one which concerns two distinctly different value dimensions. Measuring the values of health state intervals may reveal the weighting attached to the different value dimensions. (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan care. After providing (...) an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

The aim of the article is to give an outline of a value theory suitable for climate ethics, based on a perfectionist account on the convergence between prudential values and moral responsibility. I claim that such a convergence may generate a system of values that specify norms and obligations and attribute responsibility towards future generations, and thereby provides us with a measure of acceptable political action.

Does the contemporary built environment—the ensemble of our humanly created surroundings—make us happy? This question prompts a consideration of the psychological dimensions of economic value, and of Tibor Scitovsky's revisions of standard economic theory. With Scitovsky as a starting point, a model of value based on modern complexity theory and a Maslow‐like rendition of human needs can account for some of the more important exceptions to the law of diminished marginal utility, including those that may undermine the built environment in (...) a market economy. (shrink)

In attempts to compare different distributions with regards to need, so-called “measures of need-based distributive justice” have emerged in recent years. Each of the proposed measures relies on a single dimension of need that is taken into account. This is shown to be problematic since humans experience different kinds of need that appear to be incommensurable. A strategy to deal with this problem is introduced by using multidimensional measures.

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

Bedürfnisse sind etwas, das uns als Menschen grundlegend bestimmt. Der vorliegende Band fasst eine Reihe von Vignettenstudien zusammen, in denen untersucht wird, welche Rolle Bedürfnisse im Umgang mit Problemen der Verteilungsgerechtigkeit spielen. Während sie in Diskussionen zur Verteilungsgerechtigkeit häufig eher unterrepräsentiert sind, wird hier gezeigt, dass sie eine fundamentale Bedeutung im Denken der Menschen haben. Es wird unter anderem deutlich, dass unparteiischen Beobachter*innen graduelle Gerechtigkeitseinschätzungen von Verteilungssituationen vornehmen, die davon abhängig sind, wie umfangreich die beobachteten Parteien mit einem Gut ausgestattet (...) sind. Wenn außerdem bekannt ist, wie hoch deren Bedarf an jenem Gut ist, finden die Einschätzungen relativ zu diesem Referenzpunkt statt. Außerdem werden in der Rolle von unparteiischen Entscheider*innen hypothetische Verteilungsentscheidungen getroffen, die den Bedarf, die Leistung sowie die Verantwortung der betroffenen Parteien berücksichtigen. Hierbei wird der Bedarf einer Partei auch dann zumindest teilweise kompensiert, wenn diese weniger zu der zur Verfügung stehenden Gütermenge beigetragen hat, als sie selbst benötigt. Die Bereitschaft, den Bedarf einer Partei teilweise zu kompensieren, sinkt jedoch, wenn sie dafür verantwortlich ist, mehr als andere zu benötigen oder weniger als andere beigetragen zu haben. Und sowohl in der Rolle von unparteiischen Beobachter*innen als auch in der Rolle von unparteiischen Entscheider*innen wird zwischen unterschiedlichen Bedarfsarten unterschieden, deren Erfüllung verschiedene Wichtigkeit beigemessen wird. (shrink)

The role that need plays in dealing with problems of distributive justice is examined in a series of vignette studies. Among other things, it becomes clear that impartial observers make gradual assessments of justice that depend on the extent to which the observed individuals are endowed with a good. If it is known how high their need for that good is, the assessments are made relative to this reference point. In addition, impartial decision-makers make hypothetical distribution decisions that take into (...) account need, productivity, and accountability. The need of individuals is partially compensated even if they have contributed less to the available amount than they themselves require. However, the willingness to do so decreases if they are accountable for needing more than others or for having contributed less than others. Lastly, both impartial observers and impartial decision-makers distinguish between different types of needs, the fulfillment of which is given different levels of importance. (shrink)

‘Introducing Noddings and the Symposium’ is an overview in three parts following an opening comment The three are these: Noddings’s biography highlighting personal background and professional accomplishments; papers overview pointing to key ideas and themes as well as philosophical, literary and metaphorical inspiration; and response comments that take up ideas from the symposium papers and Noddings’s text in brief reconsideration. These ideas are connection of care theory to Noddings’s happiness, recognition of an ethics in doing philosophy, conceptions of needs and (...) wants, and promotion of critical thinking especially in schools. (shrink)

With regard to any natural resource, we can ask whether we should obtain (more of) it. For instance, we may ask whether we, as a society, should seek to obtain more minerals, or more oil. Furthermo...

Need-claims are ubiquitous within moral and political theory. However, need-based theories are often criticized for being too narrow in scope and too focused on the material preconditions for leading a decent life for grounding a substantial theory of social justice. The aim of this paper is threefold. Firstly, it will investigate the nature and scope of needs by analysing existing conceptualizations of the idea of needs. In so doing, we will get a better understanding of needs, which will help us (...) to carve out the importance and singularity of basic need claims. Secondly, on the basis of the analysis of needs, it will argue for the concept of a fundamental interest in free social agency, which is much better suited than the idea of basic needs actually to ground a theory of social justice, as it highlights the social and institutional conditions for free agency. Thirdly, using the distinction between basic needs and fundamental interests, it will clarify their respective role in and importance for grounding moral principles. Overall, the paper offers a friendly critique of need-based theories, while arguing for a shift of focus to the idea of fundamental interests. (shrink)

Recent efforts by legislative officials and public health advocates to reform the US food stamp program, or Supplemental Nutrition Assistance Program, have focused on restricting the types of foods eligible for purchase with SNAP benefits, specifically sugar-sweetened beverages. We argue that it is, in principle, permissible for the US government to enact a SNAP-specific SSB ban prohibiting the purchase of SSBs with SNAP benefits. While the government has a duty to ensure that citizens meet their nutritional needs, since SSBs provide (...) negligible nutrition, it has no obligation to subsidize them. Additionally, there is good reason to think that a SNAP-specific SSB ban would enable the government to better fulfill two other duties—improving citizens’ health and providing public services like Medicaid and Medicare in a more cost-effective manner. Still, because the costs and benefits of such a ban remain uncertain, we argue that the government should conduct well-designed pilot projects to help determine the effects of an SSB ban. (shrink)

This paper discusses three topics in contemporary British ethical philosophy: naturalisms, moral reasons, and virtue. Most contemporary philosophers agree that 'ethics is natural' - in Section 1 I examine the different senses that can be given to this idea, from reductive naturalism to supernaturalism, seeking to show the problems some face and the problems others solve. Drawing on the work of John McDowell in particular, I conclude that an anti-supernatural non-reductive naturalism plausibly sets the limits on what we can do (...) in ethics. Moral reasons are widely discussed - in Section 2 I describe some of the criteria that used to distinguish moral practical reasons, and note possibilities and problems. Drawing on the work of Elizabeth Anscombe in particular, I suggest that an inclusive, minimalist account of moral reasons may be most fruitful. There has been a revival of philosophical interest in virtue ethics, which I take to be linked to the emergence of non-reductive naturalisms - in Section 3 I describe three points where virtue ethics has an especially significant contribution to make: learning, motivational self-sufficiency, and the question of whether virtues can be reasons. The naturalism of Section 1 constrains the accounts of moral reasons considered in Section 2, and depends upon an account of virtue as learned second nature, discussed in Section 3. (shrink)

Half of the working poor in developing countries are informal entrepreneurs – they make a living by engaging in commercial activities in the shadow economy. A series of government and market failur...

Some normative theorists appeal to the concept of basic needs. They argue that when it comes to issues such as global justice, intergenerational justice, human rights or sustainable development our first priority should be that everybody is able to meet these needs. But what are basic needs? We attempt to inform discussions about this question by gathering evidence of ordinary English speakers’ intuitions on the concept of basic needs. First, we defend our empirical approach to analyzing this concept and identify (...) a number of its potential features. Then we present three preregistered empirical studies that were conducted to investigate the extent to which ordinary speakers endorse these features. The studies yield convergent evidence for the following three claims: (1) ordinary speakers sometimes apply the concept of basic needs to necessities for a flourishing (not just a minimally decent) life, (2) most ordinary speakers attribute at least some degree of subjectivity to the concept, and (3) most ordinary speakers attribute at least some degree of relativity to the concept. We discuss the implications of these findings for philosophical analyses of _basic needs_. (shrink)

Using practical formalism a deontological ethical analysis of peer relations in organizations is developed. This analysis is composed of two types of duties derived from Kant's Categorical Imperative: negative duties to refrain from the use of peers and positive duties to provide help and assistance. The conditions under which these duties pertain are specified through the development of examples and conceptual distinctions. A number of implications are then discussed.

Instrumentalists about need believe that all needs are instrumental, i.e., ontologically dependent upon ends, goals or purposes. Absolutists view some needs as non-instrumental. The aims of this article are: clearly to characterize the instrumentalism/absolutism debate that is of concern (mainly §1); to establish that both positions have recent and current adherents (mainly §1); to bring what is, in comparison with prior literature, a relatively high level of precision to the debate, employing some hitherto neglected, but important, insights (passim); to show, (...) on grounds not previously to the fore in the literature, that insofar as instrumentalism’s advocates have provided arguments for the position, these are unsound (§2); to argue against instrumentalism using a new dilemma concerning whether ‘end’, ‘goal’ and ‘purpose’ are interpreted in a mentalistic manner (§3); to elucidate the implications of the needs/need-satisfiers and preconditions/means distinctions for the debate (§4). (shrink)

This paper aims to provide an argument for saying that a publicly funded health care system, available to all free at the point of delivery, is morally superior to a market system, and to provide a framework for deciding questions about which forms of health care should be included in such a public system. The argument presents health care as a ‘head’, in the sense of something to which human beings are morally entitled as a necessary condition for a life (...) worthy of human dignity. Alternative arguments for similar conclusions, proposed by Daniels and Buchanan, are critically examined and rejected. (shrink)

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the (...) United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. (shrink)

Many corporations are large, powerful, and wealthy. There are massive shortfalls of global justice, with hundreds of millions of people in the world living below the threshold of extreme poverty, and billions more living not far above that threshold. Where injustice and needs shortfalls must be remediated, we often look towards agents’ capabilities to determine who ought to bear the costs of rectifying the situation. The combination of these three claims grounds what I call a ‘linkage-based’ account of why corporations (...) have demanding positive duties to the global poor. In this paper, I put forward a distinctive linkage-based account of corporations’ positive duties centred on the idea of dependence and the importance of meeting agents’ core needs. In addition to outlining and defending this account, I will show that we can utilise its basic conceptual components to make headway on questions that have received insufficient attention in the business ethics literature; specifically, we can say something substantive about the weighting of needy agents’ competing claims to assistance, and about the limits to the demands that can be lodged against corporations on the basis of others' unmet needs. Having integrated considerations of duties' grounding, their comparative weight, and the limits of their demandingness into a single account of corporate positive duty, I conclude by discussing a challenge to attributing to corporations duties owed to the worst-off amongst the global poor. (shrink)

ABSTRACTOne of the central claims of democratic theory is that the institutional features of democracy systematically cause government to respond to the people's needs. In fact, however, democracy might logically be expected to be especially responsive only to the people's desires, not their needs. Responses to people's objective needs can be substantially different from responses to their subjective desires. Democratic institutions therefore cannot guarantee responsiveness to basic human needs. Democracy, should, at least in principle, thus be confined to the sphere (...) of wants rather than needs. (shrink)

The harms of climate change are deeply uncertain. Though climate change will render most individuals more vulnerable to harm, many individuals will not actually suffer climate-related harms. In this paper, I argue that vulnerability to harms is itself a harm, because it undermines our enjoyment of the good of security. After some brief remarks on the concept of security, I give three reasons for thinking that depriving an individual of the security of basic goods harms them: it has a strong (...) contingent connection to fear and anxiety, it directly undermines their ability to make reasonable plans, and security may reasonably be valued as an end in itself. This suggests that one of our goals in determining climate policy ought to be mechanisms which ensure the security of basic goods. (shrink)

This paper examines how people think about aiding others in a way that can inform both theory and practice. It uses data gathered from Kiva, an online, non-profit organization that allows individuals to aid other individuals around the world, to isolate intuitions that people find broadly compelling. The central result of the paper is that people seem to give more priority to aiding those in greater need, at least below some threshold. That is, the data strongly suggest incorporating both a (...) threshold and a prioritarian principle into the analysis of what principles for aid distribution people accept. This conclusion should be of broad interest to aid practitioners and policy makers. It may also provide important information for political philosophers interested in building, justifying, and criticizing theories about meeting needs using empirical evidence. (shrink)

According to the so-called Classical Theory, concepts are mentally represented by individually necessary and jointly sufficient application conditions. One of the principal empirical objections against this view stems from evidence that people judge some instances of a concept to be more typical than others. In this paper we present and discuss four empirical studies that investigate the extent to which this ‘typicality effect’ holds for the concept of basic needs. Through multiple operationalizations of typicality, our studies yielded evidence for a (...) strong effect of this kind: Participants tended to recall the same core examples of the concept in a free-listing task. They judged some basic needs to be more typical than others. The items that were judged to be more typical were listed more frequently in the free-listing task. These items were listed earlier on in the free-listing task. Typical basic needs, as well as non needs, were classified faster than atypical basic needs in a reaction time study. These findings suggest that the concept of basic needs may have a non-classical structure. If so, the quest for a simple and robust intensional analysis of the concept may be futile. (shrink)

Conservatism’s core claim is that traditions play an important, if not essential, role in the acquisition of normative knowledge. However, that thesis has never been adequately defended. Three things are missing from conservative political thought: a traditionalist account of propositional normative knowledge, an explicit and sustained positive argument for traditions’ role in the acquisition of normative knowledge, and deference to relevant work in other areas of philosophy, especially epistemology. In this thesis, I provide an argument for conservatism which remedies each (...) of these defects. I call it the Social Knowledge Argument. According to the Social Knowledge Argument, some beliefs formed out of deference to the traditions of one’s society constitute normative knowledge, since deference to the traditions of one’s society is a reliable process for normative belief formation in some societies. Deference to the traditions of one’s society is reliable in some societies because traditions are the outputs of cultural evolution and the latter tends to produce traditions that capture the demands of normative domains such as morality. The Social Knowledge Argument constitutes a traditionalist account of propositional normative knowledge, is an explicit argument for traditions’ epistemic role, and utilises intellectual resources unavailable to previous generations of conservative writers. Specifically, the Social Knowledge Argument assumes a process reliabilist theory of knowledge, and these are of recent provenance, and while conservatives have always appealed to cultural evolution, I am able to draw on fully-fledged scientific accounts of cultural evolution which were unavailable to or neglected by previous conservative writers. (shrink)

Most philosophical accounts of human rights accept that all persons have human rights. Typically, ‘personhood’ is understood as unitary and binary. It is unitary because there is generally supposed to be a single threshold property required for personhood. It is binary because it is all-or-nothing: you are either a person or you are not. A difficulty with binary views is that there will typically be subjects, like children and those with dementia, who do not meet the threshold, and so who (...) are not persons with human rights, on these accounts. It is consequently unclear how we ought to treat these subjects. This is the problem of marginal cases. I argue that we cannot resolve the problem of marginal cases if we accept a unitary, binary view of personhood. Instead, I develop a new non-binary personhood account of human rights, and defend two main claims. First, there are many, scalar properties, the having of which are conducive to personhood. Second, different subjects have different human rights depending on which of these properties they have, and what threats apply to them. On my view, and contra most existing accounts, most marginal cases have some degree of personhood and are entitled to some human rights. (shrink)

Since its publication in 1971, John Rawls’ A Theory of Justice has defined the terrain of political philosophical debate concerning the principles, scope, and material implications of social justice. Social justice for Rawls concerns the principles that govern the operation of major social institutions. Major social institutions structure the lives of citizens by regulating access to the resources and opportunities that the formulation and realization of human projects require. Rawls’ theory of social justice regards major institutions as just when they (...) distribute what he calls “primary goods” in a manner that he regards as egalitarian. Hence, the subsequent social justice debate has been shaped by and large as a debate about the meaning and implications of egalitarianism. While on the surface a debate about egalitarianism as a distributional principle seems to uncover the core problem of social justice—how much of what everyone should get as a matter of right—the entire history of the debate has been conducted in abstraction fr om what matters most to people’s lives. It is as a corrective to such abstractions that the life-value approach to social justice has been developed. (shrink)

The basic work for this book was carried out during the spring of 1989 in Edinburgh, where I had been granted a research position at The Institute for Advanced Studies in the Humanities. I should like to express here my indebtedness to the Institute for the opportunity thus afforded me. I should also like to say how very grateful I am for the stimulating conversations I had there with Professor Timothy Sprigge and Dr. Elizabeth Telfer. Dr. Telfers’s own treatise Happiness (...) has been a major influence on my view of the questions involved. The basic view of health and illness presented in this book is more fully set out in my On the Nature of Health. As in the case of my previous larger projects, I have received a great amount of support and may wise comments from Professor Ingmar Pörn, Helsinki. Three Danish experts – Anton Aggernaes, Erik Ostenfeld and Peter Sandøe – have made valuable comments. Professor Heng ten Have, Nijmegen, has improved my reading of the philosophy of Jeremy Bentham. I should also like to thank my colleagues at the Department of Health and Society, University of Linköping, for helping me to avoid a number of the pitfalls that can so easily stumble into when it comes to a treatise like this. Especially I should like to mentioned Per-Erik Liss, Ingemar Nordin and Bo Petersson, all three of whom have read and commented on the entire manuscript. A Swedish version of this book, Livskvalitet och hälsa, came out in 1991. I have been made quite a number of corrections and additions, one type of addition being replies to critical points made in reviews of the Swedish version. I should like to thank Malcolm Forbes for valuable help putting my English into publishable condition. Linköping, May 1993 Lennart Noredenfelt. (shrink)