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)

According to the Welfare Diffusion Objection, we should reject Prioritarianism because it implies the ‘desirability of welfare diffusion’: the claim that it can be better for there to be less total wellbeing spread thinly between a larger total number of people, rather than for there to be more total wellbeing, spread more generously between a smaller total number of people. I argue that while Prioritarianism does not directly imply the desirability of welfare diffusion, Prioritarians are nevertheless implicitly committed to certain (...) principles for comparing different-number populations which, together with the Prioritarian same-person axiology, imply the desirability of welfare diffusion. (shrink)

According to the Leveling Down Objection, some, if not all, egalitarians must concede that leveling down can make things better in a respect—in terms of equality. I argue, first, that if this is true, then it is hard for such egalitarians to avoid the even more disturbing result that leveling down can be better all-things-considered. I then consider and reject two attempts to take this particular sting out of being an egalitarian. The first is Tom Christiano’s argument that the egalitarian (...) is not forced to concede that the leveled down state is better with respect to equality, on the grounds that if equality with respect to any X matters, e.g. welfare, then value must be assigned to X, rendering the leveled down state inferior even with respect to equality. This is insufficient, I argue, to justify his requirement that Pareto-inferior states cannot be better with respect to equality. The second, offered by both Ingmar Persson and Campbell Brown, is to argue that prioritarianism—a central rival to egalitarianism—is also subject to the Leveling Down Objection. Persson and Campbell fail, I claim, because their arguments turn on increases in measures in leveled down states that have no value on the prioritarian view. (shrink)