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)

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)

Care ethics takes as central the discerning of needs in those being cared for and attempts to meet those needs. Perceptive caring agents are more likely to be able to identify needs in those for whom they are caring. The identification of needs is no small matter, not least in teaching encounters. This paper modestly proposes that at least some of the needs a caring agent should attempt to meet are a function of the identity of the patient of caring (...) action. Taking Nel Noddings’ account of care ethics as representative, I present it in outline. This leads to the needs-identification problematic. Following this I turn to Soran Reader’s account of needs. I interpret this to offer what I designate as identity as ‘what-ness’. Such an understanding of identity-based needs is a starting point for the caring agent but a more nuanced account, of identity as ‘who-ness’, is argued to be preferable. Identity as ‘who-ness’, as expressed in Paul Ricoeur’s work, advances the discussion, culminating in his concept of the ‘capable human being’. Having brought this aspect of Ricoeur’s thought into conversation with care ethics, I offer an account of identity-based needs conducive to the broader aims of the care ethical project. Finally, I consider what this bolstered account of care ethics might say about a brief and illustrative teaching encounter. (shrink)

A key question in disability studies, philosophy, and bioethics concerns the relationship between disability and well-being. The mere difference view, endorsed by Elizabeth Barnes, claims that physical and sensory disabilities by themselves do not make a person worse off overall—any negative impacts on welfare are due to social injustice. This article argues that Barnes’s Value Neutral Model does not extend to intellectual disability. Intellectual disability is (1) intrinsically bad—by itself it makes a person worse off, apart from a non-accommodating environment; (...) (2) universally bad—it lowers quality of life for every intellectually disabled person; and (3) globally bad—it reduces a person’s overall well-being. While people with intellectual disabilities are functionally disadvantaged, this does not imply that they are morally inferior—lower quality of life does not mean lesser moral status. No clinical implications concerning disability-based selective abortion, denial of life-saving treatment, or rationing of scarce resources follow from the claim that intellectual disability is bad difference. (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 liberal political theory, meaningful work is conceptualised as a preference in the market. Although this strategy avoids transgressing liberal neutrality, the subsequent constraint upon state intervention aimed at promoting the social and economic conditions for widespread meaningful work is normatively unsatisfactory. Instead, meaningful work can be understood to be a fundamental human need, which all persons require in order to satisfy their inescapable interests in freedom, autonomy, and dignity. To overcome the inadequate treatment of meaningful work by liberal political (...) theory, I situate the good of meaningful work within a liberal perfectionist framework, from which standpoint I develop a normative justification for making meaningful work the object of political action. To understand the content of meaningful work, I make use of Susan Wolf’s distinct value of meaningfulness, in which she brings together the dimensions of objectivity and subjectivity into the ‘bipartite value’ of meaningfulness (BVM) (Wolf, Meaning in life and why it matters, 2010). However, in order to be able to incorporate the BVM into our lives, we must become valuers, that is, co-creators of values and meanings. This demands that we acquire the relevant capabilities and status as co-authorities in the realm of value. I conclude that meaningful work is of first importance because it is a fundamental human need, and that society ought to be arranged to allow as many people as possible to experience their work as meaningful through the development of the relevant capabilities. (shrink)

In the presence of anthropogenic climate change, gross environmental degradation, and mass abject poverty, many political theorists currently debate issues such as people's right to water, the right to food, and the distribution of rights to natural resources more generally. However, thus far many theorists either focus (somewhat arbitrarily) only on one particular resource (e.g. water) or they treat all natural resources alike, meaning that many relevant distinctions within the group of natural resources are overlooked. Hence, the paper will start (...) with an analysis of the various forms which natural resources can take and how this might influence one's conception of resource rights. In so doing, the paper argues that we have to carefully distinguish between the actual physical resources people might control and how we distribute these, and the life-sustaining benefits each and every person draws from sustainable and functioning ecosystems. Based on this distinction, the paper will argue for a right to the benefits of life-sustaining ecosystem services as a universal basic right every person has. Further distributive claims with respect to particular physical resources would thus be limited by the requirements of such a basic right. (shrink)

This thesis is the first step in a research project which aims to develop an accurate and robust theory of global justice. The thesis concerns the content of our duties of global justice, under strict compliance theory. It begins by discussing the basic framework of my theory of global justice, which consists in two aspects: duties of minimal wellbeing, which are universal, and duties of fairness and equality, which are associative and not universal. With that in place, it briefly discusses (...) the nature of duties of fairness and equality. I shall argue that they are associative, because they are derived from the form of cooperation at hand; and that there are three kinds of them in our contemporary world: states, local cooperation and trans-state cooperation. It is from their forms of cooperation that these duties are derived. After that, the thesis focuses exclusively on duties of minimal wellbeing. Against the usual account of these duties - the human-flourishing account - I argue for my human-life account. This account argues that the function of these duties is to secure a human life for individuals; and it begins with a Razian conception of wellbeing, which states that the wellbeing of an individual is fundamentally constituted by: (a) the satisfaction of his biological needs, and (b) his success in whole-heartedly pursuing socially defined and determined goals and activities which are in fact valuable. An account of what constitutes a human life is then derived from this conception of wellbeing – it is a life that consists in having a level of wellbeing that is higher than the satisfaction of biological needs, where this is constituted by the pursuit of goals and activities with a sense of what is worth doing; and this in turn consists in: (a) being able to forms ideas of what is worth doing, (b) being able to revise them in light of further reasons, and (c) being able to coordinate one's actions according to them. I then determine the specific objects of duties of minimal wellbeing (means for the satisfaction of biological needs, education, physical security, freedom of belief, association and expression, freedom of non-harmful conduct, and minimal resources), by determining what is involved in securing such a human life for individuals. (shrink)

Robert Nozick's experience machine thought experiment (Nozick's scenario) is widely used as the basis for a ?knockdown? argument against all internalist mental state theories of well-being. Recently, however, it has been convincingly argued that Nozick's scenario should not be used in this way because it elicits judgments marred by status quo bias and other irrelevant factors. These arguments all include alternate experience machine thought experiments, but these scenarios also elicit judgments marred by status quo bias and other irrelevant factors. In (...) this paper, several experiments are conducted in order to create and test a relatively bias-free experience machine scenario. It is argued that if an experience machine thought experiment is used to evaluate internalist mental state theories of well-being, then this relatively bias-free scenario should be used over any of the existing scenarios. Unlike the existing experience machine scenarios, when this new scenario is used to assess internalist mental state theories of well-being, it does not provide strong evidence to refute or endorse them. (shrink)

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, (...) the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (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)

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)

Robert Nozick's experience machine thought experiment is often considered a decisive refutation of hedonism. I argue that the conclusions we draw from Nozick's thought experiment ought to be informed by considerations concerning the operation of our intuitions about value. First, I argue that, in order to show that practical hedonistic reasons are not causing our negative reaction to the experience machine, we must not merely stipulate their irrelevance (since our intuitions are not always responsive to stipulation) but fill in the (...) concrete details that would make them irrelevant. If we do this, we may see our feelings about the experience machine becoming less negative. Second, I argue that, even if our feelings about the experience machine do not perfectly track hedonistic reasons, there are various reasons to doubt the reliability of our anti-hedonistic intuitions. And finally, I argue that, since in the actual world seeing certain things besides pleasure as ends in themselves may best serve hedonistic ends, hedonism may justify our taking these other things to be intrinsically valuable, thus again making the existence of our seemingly anti-hedonistic intuitions far from straightforward evidence for the falsity of hedonism. (shrink)

According to Tom Roberts and Joel Krueger's frustrated pro-attitude account of loneliness, loneliness is primarily characterized as an affective state in which individuals perceive certain social goods as unattainable. The frustration of pro-attitudes, or the desire for social connections, plays a significant role in understanding the nature of loneliness. However, in this article, I argue that the frustrated pro-attitude account falls short in explaining a specific type of loneliness known as clueless loneliness, wherein a person feels lonely without experiencing a (...) salient frustration of pro-attitude. By analyzing five cases of clueless loneliness—the case of desiring the wrong thing, the case of failing to form concrete desires, the case of having an illusion of desire fulfillment, the case of holding self-deceptive beliefs about need fulfillment, and the case of lacking a desire for social goods—I propose a revised account that acknowledges the complexity of loneliness and the potential disconnect between perceived social goods and the actual fulfillment of one's need for connection. My objective in this article is to demonstrate that this revised understanding of loneliness provides a more comprehensive framework for examining the nature of loneliness and its impact on different groups of people within society. (shrink)

A central claim of the Christian faith is that Jesus is not only fully human (and fully God), but that he reveals true humanity to us. This requires that all of our anthropologies, in some way, ground themselves in Christology, providing a ‘Christological anthropology’. Consequently, any Christological anthropology requires some formulation of Christology proper. In light of this, the main contention of the present paper is that one cannot adequately formulate a Christological anthropology without including a pneumatic Christology. The justification (...) for this necessity can be articulated through the concept of fundamental need. The incarnate Logos, Jesus of Nazareth, fundamentally needed the Spirit in the same way that all human persons fundamentally need the Spirit. ‘Fundamental need’, as a technical concept, can help to clarify both the continuity and discontinuity between Jesus’ likeness to all humanity. This does not collapse the ‘who’ of the incarnation into the many ‘who’s’ of humanity since the incarnate Logos always possessed this Spirit as his own Spirit of Sonship, as opposed to how non-divinely hypostasized human persons must receive the Spirit of Sonship by adoption. The distinctiveness and similarity between Jesus and all of humanity can be most clearly seen by paying special attention to the difference between incarnation and indwelling. Thus, by examining incarnation and in-dwelling, as well as introducing fundamental need into theological discourse, the significance of the Spirit for informing both Christology and anthropology will be made clear. (shrink)

Sweatshop labor is often cited as an example of the worst and most pervasive form of exploitation today, yet understanding what is meant by the charge has proven surprisingly difficult for philosophers. I develop an account of what I call “Needs Exploitation,” grounded in a specification of the duty of beneficence. In the case of sweatshop labor, I argue that employers face a duty to extend to employees a wage sufficient to meet their basic needs. This duty is limited by (...) the degree of the employees’ dependence on the employer for basic needs and a reasonability standard where the employer may remain within a range of well-being between deficiency and luxury. (shrink)

This book offers an original account of a distinctly republican theory of social and global justice. The book starts by exploring the nature and value of Hegelian recognition theory. It shows the importance of that theory for grounding a normative account of free and autonomous agency. It is this normative account of free agency which provides the groundwork for a republican conception of social and global justice, based on the core-ideas of freedom as non-domination and autonomy as non-alienation. As the (...) author argues, republicans should endorse a sufficientarian account of social justice, which focuses on the nature of social relationships and their effects on people's ability to act freely and realize their fundamental interests. On the global level, the book argues for the cosmopolitan extension of the republican principles of non-domination and non-alienation within a multi-level democratic system. In so doing, the book addresses a major gap in the existing literature, presenting an original theory of justice, which combines Hegelian recognition theory and republican ideas of freedom, and applying this hybrid theory to the global domain. Fabian Schuppert creates a grand synthesis uniting neo-republican insights on freedom with Hegelian recognition theory. The result is an account of agency that arises from the idea of non-domination whose aim it is to safeguard individual freedom. When combined with Hegelian recognition theory a social focus also emerges. This amalgam comments on many of the major disputes concerning global justice from a cosmopolitan perspective. Because of the broad scope and the many contemporary discussions engaged this book will be of keen interest to scholars as well as a welcome addition to the classroom. (shrink)

Needs matter; but not all needs do. Needs range from the urgent and dire to the insignificant and even trivial. Given this, a central task for the needs theorist is to give some account of which ne...

1. Conferences on the subject of need are lamentably rare. All the more honour then for this one to the Royal Institute of Philosophy (an organisation long dedicated to saving philosophy’s better self from its worse), to the Philosophy Department at Durham, and to Soran Reader, the organizer and editor.1. Conferences on the subject of need are lamentably rare. All the more honour then for this one to the Royal Institute of Philosophy (an organisation long dedicated to saving philosophy’s better (...) self from its worse), to the Philosophy Department at Durham, and to Soran Reader, the organizer and editor. (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)

One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting (...) point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything. (shrink)

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)

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)

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)

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not mean that everyone will have (...) whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA’s requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of “essential benefits”, arguing that the “essential health benefits package” in the ACA should be one that optimally satisfies the basic needs of the people covered. (shrink)

Denise Meyerson has recently argued that the adaptational account of false consciousness must appeal to a psychological element, contrary to explicit declarations of its proponents. In order to explain why the rulers genuinely hold ideological beliefs, one must take them to desire to think well of themselves. She concludes that the desire to think well of oneself causes the ideological beliefs. The article defends the adaptational account from Meyerson's attempt to ground it in the psychology of the rulers. Meyerson is (...) wrong both in thinking that the desire in question is explanatorily necessary and in thinking that its explanatory role would consist in its causing ideological beliefs. (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)

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient’s autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that our answer (...) to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing. (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)

Statements of need are used promiscuously by caretakers and children. The term may refer to mere wants (desire), to wants that have become socialized into secondary needs, to needs inferred by adults based on interpretations of future adaptive requirements, as well as to fundamental needs required for a child's well-being. It is important to distinguish the various uses of the term, first, because need carries an imperative-it would be unethical to frustrate a child's basic needs. Second, when confounding meanings, there (...) is the risk that what appears as an expression of concern-'you need to'-is more arbitrarily coercive than benevolent. Because even genuine needs are multiple and often in tension (protection and independence), separating meanings does not necessarily determine appropriate responses. Caretakers are advised to critically refine and reflect their need statements and, when balancing, remain faithful to the fundamental human need for autonomy. (shrink)