Where a decision has been made to stop futile treatment of critically ill patients on an intensive care unit – what is termed withdrawal of treatment in the UK – yet no doctor is available to perform the actions of withdrawal, nurses may be called upon to perform key tasks. In this paper I present two moral justifications for this activity by offering answers to two major questions. One is to ask if it can be in patients' best interests for (...) nurses to be the key actors in withdrawal of life‐sustaining treatment. The other is to ask if there is any reason that the nursing profession should not undertake such tasks if this is so. Both these questions require the resolution of weighty moral and philosophical issues. Thus, while offering a serious attempt to provide moral justifications for nurses undertaking withdrawal, this paper also invites debate over both the aim of task division between nurses and doctors, and how we might decide what is in the best interests of patients. (shrink)

Pragmatic genealogies seek to explain ideas by regarding them, primarily, not as answers to philosophical questions, but as practical solutions to practical problems. Here I argue that pragmatic genealogies can inform the formation of philosophical canons. But the rationale for resorting to genealogy in this connection is not the familiar one that genealogy renders the concepts of the present intelligible by relating them to the concerns of the past—the claim is rather the reverse one, that genealogy renders the concepts of (...) the past intelligible by relating them to the concerns of the present: past thinkers can be made to speak to us by revealing how their ideas tie in with our concerns, in the sense of helping us to remedy practical problems we still face in some form. (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)

Why did such highly abstract ideas as truth, knowledge, or justice become so important to us? What was the point of coming to think in these terms? This book presents a philosophical method designed to answer such questions: the method of pragmatic genealogy. Pragmatic genealogies are partly fictional, partly historical narratives exploring what might have driven us to develop certain ideas in order to discover what these do for us. The book uncovers an under-appreciated tradition of pragmatic genealogy which cuts (...) across the analytic-continental divide, running from the state-of-nature stories of David Hume and the early genealogies of Friedrich Nietzsche to recent work in analytic philosophy by Edward Craig, Bernard Williams, and Miranda Fricker. However, these genealogies combine fictionalizing and historicizing in ways that even philosophers sympathetic to the use of state-of-nature fictions or real history have found puzzling. To make sense of why both fictionalizing and historicizing are called for, the book offers a systematic account of pragmatic genealogies as dynamic models serving to reverse-engineer the points of ideas in relation not only to near-universal human needs, but also to socio-historically situated needs. This allows the method to offer us explanation without reduction and to help us understand what led our ideas to shed the traces of their practical origins. Far from being normatively inert, moreover, pragmatic genealogy can affect the space of reasons, guiding attempts to improve our conceptual repertoire by helping us determine whether and when our ideas are worth having. (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)

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who (...) should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be. (shrink)

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who (...) should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be. (shrink)

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)

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)

Addressing distributive justice issues in health policy—ranging from the allocation of health system funding to the allocation of scarce COVID-19 interventions like intensive care unit beds and vaccines—involves the application of ethical principles. Should a principle of sustainability be among them? I suggest that while the value of temporal neutrality underlying such a principle is compelling, it is already implicit in the more basic principle of equal treatment. Munthe et al imagine sustainability accompanying four other principles: need, prognosis, equal treatment (...) and cost-effectiveness. Some are spelled out, however, in ways that are ambiguous or incomplete. (shrink)

There are few finalities in philosophy. No one sees this as sharply as David Wiggins, who is always refining and improving his views. Here he has revised and re.

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)

This thesis defends an account of what it is to trust other people, and what gives matters of trust (i.e. situations where we trust/distrust others) a characteristic interpersonal, normative, or moral/ethical importance to us. In other words, it answers what the nature of betrayal (and being susceptible to betrayal) is. -/- Along the way I put forward/defend accounts of the following: the relationship between trust and reliance (chapter 4); an account of reliance itself (chapter 5); trust and distrust as one/two/three-place (...) attitudes (chapter 7); and the ethical/normative significance of trust and betrayal as a matter of attachment security (chapters 6 and 8). -/- In addition to these accounts, the thesis also gives (in chapter 2) a conceptual/historical overview of the dominant paradigm in philosophical understanding of trust: as a form of reliance 'plus' betrayal conditions (a la Baier 1986; Holton 1994; Hawley 2014, among others). It also offers a rebuttal of that dominant paradigm in chapter 3 and 4. Furthermore, it offers an overview of how trust is understood more generally across philosophical and some social scientific/psychological literature (chapter 1). It also offers a rebuttal of the rational choice/game-theoretic understanding of trust and economic rationality a la so-called 'trust games' (chapter 1). This carries the consequence that analysis of trust in these traditions is not really based on anything resembling interpersonal trust, as we would intuitively recognise it. (shrink)

Desires matter. How are we to understand the intentionality of desire? According to the two classical views, desire is either a positive evaluation or a disposition to act: to desire a state is to positively evaluate it or to be disposed to act to realize it. This Ph.D. Dissertation examines these conceptions of desire and proposes a deontic alternative inspired by Meinong. On this view, desiring is representing a state of affairs as what ought to be or, if one prefers, (...) as what should be. Desire involves a deontic manner of representing: a norm of the ought-to-be type features in desire’s intentional mode, as opposed to content. The dissertation is structured in three parts. In order to defend this conception, I formulate three main desiderata for a promising theory of the intentionality of desire in the introduction (§0). The first concerns desire’s direction of fit, i.e. the intuition that the world should conform to our desires. The second concerns the death of desire principle, i.e. the intuition that one cannot desire what one represents as actual. The last pertains to desire’s role in psychological explanations, i.e. the intuition that desires can explain some mental states and be explained by other mental states. The first part examines the main conceptions of desire in light of these desiderata. I argue that the classical pictures of desire do not adequately meet our desiderata. The first chapter is devoted to the evaluative conception (§1), while the second examines the motivational approach (§2). Following these criticisms, I then present the deontic view of desire (§3). In the second part, I defend this conception with the help of three arguments. The main idea is that appealing to norms of the ought-to-be type can satisfy our chief desiderata: the world should conform to norms (world-to-mind direction of fit, §4), norms are grounded on values and in turn ground obligations (explanation, §5), and norms are about non-actual states of affairs (death of desire principle, §6). In the last part, I develop the deontic view to draw a cartography of the various types of desire. Some desires are correct, while others are inappropriate. This distinction is explained by the deontic conception, as it matches that between states of affairs that ought to obtain and states that should not obtain (§7). Two study cases are examined: caprice and the impermissibility of desire aggregation. Intuitively, hopes, wishes, or urges are types of desire. The next chapter presents a typology inspired by the deontic view and the type of norms there are (§8). The last chapter discusses the main objections to the deontic approach (§9). In conclusion, I show the relevance of the deontic view for several debates in philosophy of mind and ethics. Desires are crucial because they are the ‘eye’ of what should be. (shrink)

Many Public Administrations structure their services around the notion of users’ need. However, there is a gap between private, subjectively perceived needs (self-attributed) and needs that are attributed by PA to citizens (heteroattributed). Because of the gap, citizens’ needs are often only partially satisfied by PAs services. This gap is in part due to the fact that the meaning of the word “need” is ambiguous and full of antinomic nuances. The purpose of this paper is to formulate a definition of (...) “need” suitable for citizens’ needs management with respect to PA’s services offering, and to provide an accurate ontological analysis of the notion of “need” and the network of concepts that relate to it. (shrink)