Some considerations are urgent and others are not. Sometimes we invite criticism if we neglect the urgency of our situation, even if our action seems adequate to respond to it. Despite this significance, the literature does not offer a satisfactory analysis of the normative structure of urgency. I examine three views of urgency, drawn from philosophical and adjacent literature, which fail to explain the distinctive criticism we face when we neglect the urgency of our reasons. Instead I argue that urgent (...) considerations pre-empt our deliberation about less urgent considerations. Urgency, then, is a meta-normative phenomenon, setting standards for how we handle and respond to first-order considerations, requiring that we close deliberation. In the face of urgency, appropriate action is not enough: commitment is called for. This is how we enact appreciation of our practical reasons, independently of our carrying out the action they call for. (shrink)

Philosophy strives to give us a firmer hold on our concepts. But what about their hold on us? Why place ourselves under the sway of a concept and grant it the authority to shape our thought and conduct? Another conceptualization would carry different implications. What makes one way of thinking better than another? This book develops a framework for concept appraisal. Its guiding idea is that to question the authority of concepts is to ask for reasons of a special kind: (...) reasons for concept use, which tell us which concepts to adopt, adhere to, or abandon, thereby shoring up—or undercutting—the reasons for action and belief that guide our deliberations. Traditionally, reasons for concept use have been sought either in timeless rational foundations or in concepts’ inherent virtues, such as precision and consistency. Against this, the book advances two main claims: that we find reasons for concept use in the conceptual needs we discover when we critically distance ourselves from a concept by viewing it from the autoethnographic stance; and that sometimes, concepts that conflict, or exhibit other vices such as vagueness or superficiality, are just what we need. By considering not what concepts are absolutely best, but what concepts we now need, we can reconcile ourselves to the contingency of our concepts, determine the proper place of efforts to tidy up thought, and adjudicate between competing conceptions of things—even things as contested as liberty or free will. A needs-based approach separates helpful clarification from hobbling tidy-mindedness, and authoritative definition from conceptual gerrymandering. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

This paper presents a new analysis of the concept of non-instrumental need, and, using it, demonstrates how a need-satisfaction theory of well-being is much more plausible than might otherwise be supposed. Its thesis is that in at least some contexts of evaluation a central part of some persons’ well-being consists in their satisfying certain “personal needs”. Unlike common conceptions of other non-instrumental needs, which make those out to be moralised, universal, and minimal, personal needs are expansive and particular to particular (...) persons, generated rather by persons’ non-moral personal commitments. Against objections to the contrary, I show how these are genuine necessities, since unlike mere desires and freely escapable aims, personal needs constitute objective, inescapable, and non-compensable practical requirements. The personal-need-satisfaction theory of well-being combines objectivity with subject-dependence in novel ways, and motivates well-being pluralism at the level of individual agency. Implicating necessity as it does in the structure of individual well-being, this account presents a robust challenge to ethical and political theories that rely on the intrapersonal aggregation of well-being to be unproblematic. (shrink)

From the day on which humans are born they need things. Some of these needs seem “basic,” such as our needs for food, water or shelter. Everybody has these needs. We cannot escape them. We also cannot escape the serious harm that arises when these needs remain unsatisfied. It is thus no wonder that in thinking about what we ought to do some researchers have suggested to first and foremost focus on people's basic needs. Such need‐based theories must answer three (...) main questions: What are basic needs? What are their implications for normative questions? And how can these needs and their satisfaction be measured? Proponents must also defend these theories against objections, such as against the objections that the theories are paternalistic, materialistic, and passivity‐promoting. Depending on their goals and contexts (distributive justice, sustainable development, human rights, etc.), appeals to basic needs may take various different forms. (shrink)

Effective altruism is a movement which aims to maximise good. Effective altruists are concerned with extreme poverty and many of them think that individuals have an obligation to donate to effective charities to alleviate extreme poverty. Their reasoning, which I will scrutinise, is as follows: -/- Premise 1. Extreme poverty is very bad. -/- Premise 2. If it is in our power to prevent something very bad from happening, without thereby sacrificing anything else morally significant, we ought, morally, to do (...) it. -/- Premise 3. Individuals ought to choose the effective option in preventing very bad things. -/- Premise 4. Donating to effective charities is one of the best ways to alleviate extreme poverty. -/- Conclusion. Individuals ought to donate to effective charities working towards extreme poverty alleviation where doing so does not require them to give up anything of moral significance. -/- I will scrutinise each of these premises in turn. -/- For Premise 1, I focus on hedonistic utilitarianism and criticise its outlook on extreme poverty. I claim that hedonistic utilitarianism might be problematic for effective altruism. -/- Premise 2 is Peter Singer's Weaker Principle of Sacrifice. I introduce several possible interpretations of it, and press several objections to it by stressing overpermissiveness, luck, and rights. I defend strengthening the Weaker Principle of Sacrifice without making it overdemanding. -/- I claim that Premise 3 can be attractive to both consequentialists and non-consequentialists. Nevertheless, by showing that effectiveness sometimes violates fairness, I propose a method which avoids always helping the greater number and always giving everyone equal chances of being helped, which is compatible with effective altruism. -/- Against Premise 4, I assess the systemic change objection, which states that effective altruism unjustifiably distracts individuals from systemic change. By considering risk and the moral standing of the future extremely poor, I claim that the systemic change objection is partially successful, but cannot undermine effective altruism. -/- After analysing all of these, I argue that individuals have an obligation to donate to effective charities to alleviate extreme poverty where doing so does not require them to give up anything of moral significance. (shrink)

The article presents an original needs-based partial theory of human injustice and shows its relationship to existing theories of human need and human liberation. The theory is based on an original typology of three social structural sources of human injustice, a partial theorization of the mechanisms of human injustice, and a needs-based theorization of the nature of human injustice, as experienced by individuals. The article makes a sociological contribution to normative social theory by clarifying the relationship of human injustice to (...) human needs, human rights, and human liberation. The theory contends that human injustice is produced when oppression, mechanistic dehumanization, and exploitation create systematic inequality in opportunities to address human needs, leading to wrongful need deprivation and the resulting serious harm. In one longer sentence, this needs-based partial theory of the sources, mechanisms, and nature of human injustice contends that three distinct social systemic sources—oppression, mechanistic dehumanization, and exploitation—produce unique and/or overlapping social mechanisms, which create systematic inequality in opportunities to address universal human needs in culturally specific ways, thus producing the nature of the human injustice theorized here: wrongfully unmet needs and serious harm. (shrink)

In his article, “Equality as a Moral Ideal”, Harry Frankfurt argues against economic egalitarianism and presents what he calls the “doctrine of sufficiency.” According to the doctrine of sufficiency, what is morally important is not relative economic equality, but rather, whether somebody has enough, where “having enough” is a non-comparative standard of reasonable contentment that may differ from person to person given his/her aims and circumstances. The purpose of this paper is to show that Frankfurt’s original arguments in support for (...) his doctrine of sufficiency have critical problems that Frankfurt himself does not properly recognize. In the end, I will argue that in order to solve these problems the doctrine of sufficiency cannot help but to incorporate certain prioritarian commitments – commitments which many would view as implying economic egalitarianism. This is embarrassing for a doctrine whose raison d’être was mainly to defeat economic egalitarianism. (shrink)

Claims about needs are a ubiquitous feature of everyday practical discourse. It is therefore unsurprising that needs have long been a topic of interest in moral philosophy, applied ethics, and political philosophy. Philosophers have devoted much time and energy to developing theories of the nature of human needs and the like. -/- Philosophers working on needs are typically committed to the idea that there are different kinds of needs and that within the different kinds of needs is a privileged class (...) of needs that is especially normatively significant. -/- Some philosophers go further and make rather grand claims about needs. They claim that needs are central or fundamental to moral thinking and that we must have a needs-centred moral theory or a general reorientation of moral philosophy around needs. -/- In this paper I aim to do two things. First, to show how applying recent work on modal terms can help us to understand thought and talk about needs. This is the positive part. I then use these ideas to cast doubt on the more ambitious claims about needs. Put briefly, a proper understanding of claims about needs undermines the idea that the concept of needs is fundamental in moral thought or in moral philosophy. Ambitious needs theory fails. (shrink)

Ever since the publication of Harry Frankfurt’s “Equality as a Moral Ideal” :21–43, 1987), the doctrine of sufficiency has attracted great attention among both ethical theorists and political philosophers. The doctrine of sufficiency consists of two main theses: the positive thesis states that it is morally important for people to have enough; and the negative thesis states that once everybody has enough, relative inequality has absolutely no moral importance. Many political philosophers have presented different versions of sufficientarianism that retain the (...) general spirit of what Frankfurt had proposed in his seminal work. However, all of these different versions of sufficientarianism suffer from two critical problems: they fail to give right answers to lifeboat situations, and they fail to provide continuous ethical judgments. In this paper, I show a version of utilitarianism that solves these problems while retaining the major attractions of sufficientarianism. I call it “prospect utilitarianism.” In addition, I show that prospect utilitarianism can avoid standard objections to utilitarianism and has aspects that can appeal to both prioritarians and egalitarians as well. (shrink)

This dissertation is a contribution to the debate about ‘climate justice’, i.e. a call for a just and feasible distribution of responsibility for addressing climate change. The main argument is a proposal for a cautious, practicable, and necessary step in the right direction: given the set of theoretical and practical obstacles to climate justice, we must begin by making contemporary development practices sustainable. In times of climate change, this is done by recognising and responding to the fact that emissions of (...) greenhouse gases, with climate change as their result, are an immanent threat to any reflectively embraced development project. In the universal pursuit of progress, basic needs of both present and future people are put at risk. Even so, a political stalemate and business-as-usual prevail. The situation is locked up by an uncertainty about the exact impacts of choices made and by the reasonable disagreement of modern societies. The result is passiveness, and the passing on of a slowly and indiscernibly growing problem to future generations. This dissertation brings out a crucial message about the need to make our development sustainable. Instead of delaying action through trying to resolve the intractable epistemic and normative uncertainty fully, the focus should be on vindicating already shared points of practical convergence. On the constructivist method here adopted, the task is to characterise the agent and the situation faced from a practical and first-person point of view. More specifically, to specify the practical problem climate change gives rise to; the moral importance of needs (chapter three); how a principled priority of basic needs can be defended (chapter four), intergenerationally (chapter five) and internationally (chapter six); and what natural and social limits there are to development (chapter seven). These conceptions narrows the practice of development in the present context: it can be concluded that development must not risk the basic needs of anyone implicated. This common ground brackets off disagreement irrelevant to the urgent need to act, and so brings together otherwise deeply divided agents. A sufficientarian basic needs-principle, as the focus of an overlapping consensus, is practicable and anticipatory in the disuniting moral conundrum of climate change. (shrink)

Sufficientarianism is a theory of social justice that determines individual entitlements by setting a threshold of what is enough for a decent life. Sufficientarianism therefore seems to be a suitable ally for theories of climate justice, because it restricts claims of justice to a minimum. Furthermore, the notion of sufficiency has been theorized in ecological discourse, so there is pertinent conceptual overlap between the two perspectives. In this paper, I aim to combine sufficientarianism with eco-sufficiency. I will use a framework (...) of needs to highlight different normative urgencies involved in practices that involve carbon emissions. However, as I will argue, the normative urgency of needs might cause problems for restricting emissions to levels that are compatible with planetary limits. In brief, the very aim of achieving sufficientarian justice might clash with the aim of eco-sufficiency. Sufficientarians should therefore critically engage with needs satisfiers as well, which are the means provided to satisfy needs. This step in my argument will be achieved through complementing sufficientarianism with an element of comparative justice, that is, interpersonal and diachronic considerations that help to determine the comparative urgency of claims. The overarching aim of sustainable sufficientarianism is to provide enough for everyone to live a decent life over time. (shrink)

Philosophers often identify needing something with requiring it to avoid harm. This view of need is roughly accurate, but no adequate analysis of the relevant sort of requirement has been given, and the relevant notion of harm has not been clarified. Further, the harm-avoidance picture must be broadened, because we also need what is required to reduce danger. I offer two analyses of need (one probabilistic) to address these shortcomings. The analyses are at a high level of generality and accommodate (...) our ordinary notion of need as well as narrower conceptions. I also explain why the only extant, detailed modal account of need, David Wiggins’s (1987/1998), is inadequate. My analyses imply that to have a need for something is to have the (expected) quality of one’s life depend counterfactually on it in a certain way. The analyses shed some light on need’s distinctive normative significance. (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)

Felt necessity, or the phenomenon of experiencing some person or object as a felt need, plays important roles in structuring human agency. Philosophical treatments of the relationship between agency and felt necessity have tended to focus on appetitive needs and necessities arising from a particular type of care. I argue that we have much to gain by considering a third underexplored variety of felt necessity that I call “attachment necessity.” Attachment necessity has its own distinct parts to play in structuring (...) agency, and like its more familiar relatives, it can also illuminate important aspects of addiction and love. (shrink)

In answering normative questions, researchers sometimes appeal to the concept of basic needs. Their guiding idea is that our first priority should be to ensure that everybody is able to meet these needs—to have enough in terms of food, water, shelter, and so on. This article provides an opinionated overview of basic needs in normative contexts. Any basic needs theory must answer three questions: (1) What are basic needs? (2) To what extent do basic needs generate reasons for action and (...) how are these reasons to be understood? (3) How are basic needs and their satisfaction to be measured? I address these questions in turn. Then I also briefly discuss the theoretical potential of appealing to basic needs in normative contexts. It turns out that future research in this area could benefit from a higher degree of interdisciplinarity and methodological reflection, and that, generally speaking, basic needs theories are more promising than they have often been claimed to be. (shrink)

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according (...) to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns. (shrink)

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

In this paper, I argue that a well-known objection to subsistence rights developed by Onora O'Neill - namely, that such rights would generate obligations without an obligation-bearer, can be answered if we take such rights to impose an obligation on the world's population, taken collectively.

Much of the debate around temporary foreign worker programs in recent years has focused on full or partial access to rights, and, in particular, on the extent to which liberal democratic states may be justified in restricting rights of membership to those who come and work on their territory. Many accounts of the situation of temporary foreign workers assume that a full set of rights will remedy moral inequities that they suffer in their new homes. I aim to show two (...) things: first, and based on experiences reported by former Live-in-Caregivers in Canada who now have access to the full set of citizenship rights, and German citizens who are descendants of Kurdish guestworkers in Germany, I have proposed that even after gaining citizenship, many of them experience social stigma and a sense of exclusion. Second, I have argued that this neglects a basic need that individuals have, which is to have access to relational resources within society in order to be protected against social deprivation. This need is seemingly immune to be effectively protected through the known catalogue of social, civic and political rights. Instead, I argue that social deprivation needs to be analyzed through the lens of institutional vulnerability to yield an analysis of the moral obligations of liberal democratic states. (shrink)

In this paper we aim to examine a novel view on distributive justice, i.e. limitarianism, which claims that it is morally impermissible to be rich. Our main goal is to assess the two arguments provided by Ingrid Robeyns in favour of limitarianism, namely the democratic argument and the argument from unmet urgent needs and the two distinct limitarian views which these arguments give rise to. We claim that strong limitarianism, which is supported by the democratic argument, should be rejected as (...) it fails to fully instantiate the value of political equality, while having some other unattractive implications as well. By contrast, we argue that weak limitarianism, which is supported by the argument from unmet urgent needs, should be endorsed, albeit in a qualified version which also takes responsibility constraints into consideration. (shrink)

This essay seeks to explain a morally important class of psychological incapacity—the class of what Bernard Williams has called “incapacities of character.” I argue for two main claims: (1) Caring is the underlying psychological disposition that gives rise to incapacities of character. (2) In competent, rational adults, caring is, in part, a cognitive and deliberative disposition. Caring is a mental state which disposes an agent to believe certain considerations to be good reasons for deliberation and action. And caring is a (...) mental state which structures an agent’s practical deliberation, by establishing presumptive boundaries on the landscape of possibilities over which her deliberative imagination ranges. Incapacities of character are a consequence of the structure which these presumptive boundaries give to an agent’s deliberation. (shrink)

Instrumentalism about need suggests that the significance of an agent's need for x depends on the end for which x is needed. Instrumental accounts have, however, been vague about the transfer or transmission of normative significance supposed to be occurring from ends to needs. How should such transmission be understood, and how can we assess the amount or degree of significance being transmitted in particular cases? The Relational Account (RA) combines work on normative transmission principles and the strength of reasons (...) in order to clarify these issues. RA, it is argued, both (1) improves the instrumental view on need and (2) can be used to analyze and assess a large range of needs and arguments from need-including 'basic needs', which some argue require non-instrumental explanation. While the paper develops an instrumental view, the analysis of the normativity of the needs-end relation will also be helpful for clarifying instrumental relations between different kinds of need in non-instrumentalist theories-such as relations between 'absolute' and intermediate needs. (shrink)

Many moral philosophers in the Western tradition have used phenomenological claims as starting points for philosophical inquiry; aspects of moral phenomenology have often been taken to be anchors to which any adequate account of morality must remain attached. This paper raises doubts about whether moral phenomena are universal and robust enough to serve the purposes to which moral philosophers have traditionally tried to put them. Persons’ experiences of morality may vary in a way that greatly limits the extent to which (...) moral phenomenology can constitute a reason to favor one moral theory over another. Phenomenology may not be able to serve as a pre-theoretic starting point or anchor in the consideration of rival moral theories because moral phenomenology may itself be theory-laden. These doubts are illustrated through an examination of how moral phenomenology is used in the thought of Ralph Cudworth, Samuel Clarke, Joseph Butler, Francis Hutcheson, and Søren Kierkegaard. (shrink)

Recent medical innovations like ‘omics’ technologies, mobile health (mHealth) applications or telemedicine are perceived as part of a shift towards a more preventive, participatory and affordable healthcare model. These innovations are often regarded as ‘disruptive technologies’. It is a topic of debate to what extent these technologies may transform the medical enterprise, and relatedly, what this means for medical ethics. The question of whether these developments disrupt established ethical principles like respect for autonomy has indeed received increasing normative attention during (...) the past years. Yet, more fundamental ethical considerations of a possible disruption of the concept of ‘medical necessity’ (and the potential ensuing clinical ramifications) have been limited if not absent. It is our modest – though morally and practically relevant – aim to address this objective in this article, by exploring how the current wave of allegedly disruptive innovation is invoking a resurgence of this concept and related debates on ‘the’ goal(s) of medicine. (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...

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)

Aristotle considers friendship the greatest external good, one integral to the attainment of happiness. However, while Aristotle limits distrust to what he calls imperfect forms of friendship, subsequent philosophers have stressed our uncertainty regarding the benevolence, beneficence and loyalty we may expect of friends. They do so in part because overcoming this uncertainty requires the exercise of the virtues of trust and loyalty if our friendships are to survive intact. For example, insofar as Aquinas holds that we cannot scrutinize the (...) wills of others - thus inviting uncertainty regarding their present and future conduct - he argues that friendship requires the virtue of hope as a cause of friendly love, a hope which helps us to make virtuous presumptions about others' wills. Likewise, Kant argues that all de facto friendships are plagued by epistemic uncertainty regarding the wills of others. In consequence, he treats loyalty as an unenforceable ideal of virtue. Kierkegaard goes further, framing his treatment of non-agapic love - in which he argues that friendship cannot be ethically justified - with a discussion of deception in Works of Love. If Aristotle is correct in thinking that friendship `is a virtue, or involves virtue', and that `loving is the virtue of friends', then addressing the epistemological, conceptual, and normative concerns these philosophers have regarding trust and loyalty between friends is needed to understand a central goal of the ethical life: the perfection of love. After a historical survey of the thought of these four thinkers regarding the relationship between friendship and loyalty, this study suggests that contemporary problems about the origins, nature, and limits of loyalty can be fruitfully resolved using insights derived from the historical survey. (shrink)

People have various desires, but it is a contested moral issue when a desire becomes of such importance that it legitimizes a moral claim on others. This paper explores how the normative significance of desire satisfaction can be assessed and argues that a normatively significant desire can constitute a pro tanto obligation to help satisfy it. The paper presents a framework that relates the normative significance of a given desire to the general goal of living a reasonably valuable life and (...) inquires how the latter can be given determinate content without excluding a heterogeneity of the personal good. The paper contends that the set of possibly normatively significant desires is thus restricted by considerations about intelligibility, adequacy, and replaceability, which are mediated by societal background theories. (shrink)

This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be used in favour of exceptionally advantageous economic terms for orphan drugs. These arguments share the common feature of all referring to considerations of justice or fairness: the argument of the irrelevance of group size, the argument from the principle of need, and the argument of (...) identifiability. It is argued that all of these arguments fail to support the conclusion that orphan drugs should be subsidized to a larger extent than treatments for common diseases. The argument of the irrelevance fails to distinguish between directly and indirectly relevant considerations of fairness or justice. The recent attempt to revive the moral relevance of identifiability has provided no novel reasons to think that identifiability is morally relevant in itself or due to considerations of fairness and justice. The argument from the principle of need does not fail due to any inherent flaw in the principle as such. Rather, this principle can be interpreted in different ways, and none of these interpretations support exceptionally advantageous terms economically for treating rare diseases specifically. It is concluded that we are awaiting justice based reasons for the preferential treatment of orphan drugs. (shrink)

Connections between one's own welfare and that of others abound if we pause to look for them, although philosophical theories of selfhood have only very recently begun to incorporate these connections. This essay draws on recent work on need to argue that one of the strongest expressions of these connections is to be found in the relational needs that they can generate. While paying heed to needs that arise from the relational nature of selfhood at large, this essay pays particular (...) attention to what I call “transpersonal needs”: needs that occur when one's experience of the needs of others gives rise to certain needs of one's own. I argue that the best criterion for defining need is vulnerability to harm, but this does not mean that having a need is something that is purely harmful. Having certain needs can also enrich one's life. Further, while every need entails a corresponding vulnerability to harm, some of these potential harms are more detrimental to one's welfare than others, with some relational needs standing among those that can result in the greatest harm if unanswered. (shrink)

What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...) distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (shrink)

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)

ABSTRACTThis paper integrates some Buddhist moral values, attitudes and self‐cultivation techniques into a discussion of the ethics of cognitive enhancement technologies – in particular, pharmaceutical enhancements. Many Buddhists utilize meditation techniques that are both integral to their practice and are believed to enhance the cognitive and affective states of experienced practitioners. Additionally, Mahāyāna Buddhism's teaching on skillful means permits a liberal use of methods or techniques in Buddhist practice that yield insight into our selfnature or aid in alleviating or eliminating (...) dukha . These features of many, if not most, Buddhist traditions will inform much of the Buddhist assessment of pharmaceutical enhancements offered in this paper. Some Buddhist concerns about the effects and context of the use of pharmaceutical enhancements will be canvassed in the discussion. Also, the author will consider Buddhist views of the possible harms that may befall human and nonhuman research subjects, interference with a recipient's karma, the artificiality of pharmaceutical enhancements, and the possible motivations or intentions of healthy individuals pursuing pharmacological enhancement. Perhaps surprisingly, none of these concerns will adequately ground a reflective Buddhist opposition to the further development and continued use of pharmaceutical enhancements, either in principle or in practice. The author argues that Buddhists, from at least certain traditions – particularly Mahāyāna Buddhist traditions – should advocate the development or use of pharmaceutical enhancements if a consequence of their use is further insight into our self‐nature or the reduction or alleviation of dukha. (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)

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since (...) patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)