Adaptation to illness, and its relevance for distribution in health care, has been the subject of vigorous debate. In this paper I examine an aspect of this discussion that seems so far to have been overlooked: that some illnesses are difficult, or even impossible, to adapt to. This matters because adaptation reduces suffering. Illness severity is a priority setting criterion in several countries. When considering severity, we are interested in the extent to which an illness makes a person worse-off. I (...) argue that no plausible theory of well-being can disregard suffering when determining to what extent someone is worse-off in terms of health. We should accept, all else equal, that adapting to an illness makes the illness less severe by reducing suffering. Accepting a pluralist theory of well-being allows us to accept my argument, while still making room for the possibility that adaptation is sometimes, all things considered, bad. Finally, I argue that we should conceptualize adaptability as a feature of illness, and thereby account for adaptation on a group level for the purposes of priority setting. (shrink)

ABSTRACT:Current literature in moral and political philosophy is rife with discussion of adaptive preferences. This is no accident: while preferences are generally thought to play an important role in a number of normative domains, adaptive preferences seem exceptions to this general rule—they seem problematic in a way that preference-respecting theories of these domains cannot adequately capture. Thus, adaptive preferences are often taken to be theoretically explanatory: a reason for adjusting our theories of the relevant normative domains. However, as I shall (...) argue here, the relentless focus on the phenomenon of preference adaptation is a mistake. While I do not take a stand on whether typical examples of adaptive preferences are or are not problematic, I argue here that if they are problematic, it cannot be because they are adaptive. (shrink)

In this paper, I explore a fundamental but under-appreciated distinction between two ways of understanding the desire-satisfaction theory of well-being. According to proactive desire satisfactionism, a person is benefited by the acquisition of new satisfied desires. According to reactive desire satisfactionism, a person can be benefited only by the satisfaction of their existing desires. I first offer an overview of this distinction. I then canvass several ways of developing a general formulation of desire satisfactionism that would capture the reactive view, (...) and argue that all come with significant costs. (shrink)

Many economists and social theorists hypothesize that most societies could soon face a ‘post-work’ future, one in which employment and productive labor have a dramatically reduced place in human affairs. Given the centrality of employment to individual identity and its pivotal role as the primary provider of economic and other goods, transitioning to a ‘post-work’ future could prove traumatic and disorienting to many. Policymakers are thus likely to face the difficult choice of the extent to which they ought to satisfy (...) individual citizens’ desires to work in a socioeconomic environment in which work is in permanent decline. Here I argue that policymakers confronting a post-work economy should discount, or at least consider problematic, the desire to work because it is very likely that this desire is an adaptive preference. An adaptive preference is a preference for some state of affairs within a limited set of options formed under unjust conditions. The widespread desire for work has been formed under unjust labor conditions to which individuals are compelled to submit in order to meet material and ethical needs. Furthermore, the prevalence of the ‘work dogma’ in contemporary societies precludes nearly all individuals from seeing alternatives to work as live options. (shrink)