"Well-being," "welfare," "utility," and "quality of life," all closely related concepts, are at the center of morality, politics, law, and economics. Griffin's book, while primarily a volume of moral philosophy, is relevant to all of these subjects. Griffin offers answers to three central questions about well-being: what is the best way to understand it, can it be measured, and where should it fit in moral and political thought. With its breadth of investigation and depth of insight, this work holds significance (...) for philosophers as well as for those interested in political and economic theory and jurisprudence. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

In Valuing Health, Dan Hausman argues that well-being is not measurable, at least not in the way that science and policy would require. His argument depends on a demanding conception of well-being and on a pessimistic verdict upon the existing measures of subjective well-being. Neither of these reasons, I argue, warrant as much skepticism as Hausman professes.

In the book Valuing Health, Daniel Hausman sets out a normative framework for assessing social policy, which he calls restricted consequentialism. For the restricted consequentialist, government policy-making not only is, but ought to be, largely siloed in individual government departments. Each department has its own goal linked to a fundamental public value, which it should pursue in a maximizing way. I argue that, first, Hausman’s argument appears to be internally inconsistent: his case for thinking that health policy should default to (...) a form of maximization is plausible only if a much narrower vision of the goals of policy is adopted than Hausman thinks appropriate in the case of education. Secondly, it turns out that none of Hausman’s analysis helps us with the crucial question of how maximization should be constrained by other values—a question that even on Hausman’s account looks to be crucial, and that will be even more important if adopt a broader perspective on the purposes of health policy than Hausman allows. (shrink)

When one faces competing claims of varying strength on public resources for health, which claims count? This paper proposes the following answer. One should count, or aggregate, a person’s claim just in case one could sympathize with her desire to prioritize her own claim over the strongest competing claim. It argues that this principle yields appealing case judgments and has a plausible grounding in both sympathetic identification with each person, taken separately, and respect for the person for whom most is (...) at stake. It also defends this principle against several heretofore unanswered objections. (shrink)

Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call “Aggregate Relevant Claims” satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections.

In his 2015 book, Valuing Health, the philosopher, Daniel Hausman, in referring to experienced utility maximization, touches on the question of whether people accept, and ought to accept, the assumption of health maximization vis-à-vis their own lives. This essay introduces Hausman’s arguments on experienced utility, before outlining the intellectual catalyst for the renewed interest in the maximization of experienced utility as an appropriate ethical rule; namely, the literature that arose in the 1990s that demonstrated that due to the so-called gestalt (...) characteristics, an individual’s retrospective and prospective assessments of an event—i.e. the remembered and decision utilities associated with that event—often systematically differ from the utility that he/she experiences or can reasonably expect to experience during the same event. The essay then touches upon some of the implications that this debate has on assuming that the maximization of quality-adjusted life years is the best way to judge the relative worth of different health profiles. To conclude, it is argued that, although contextual, it is sometimes important to consider in the policy discourse the apparent effects of the gestalt characteristics on remembered and decision utility. (shrink)

Daniel Hausman’s book ‘Valuing Health’ is a valuable contribution to our understanding of QALYs and DALYs and to moving health economics to adopting a broader perspective than that taken in conventional cost-effectiveness analysis. Hausman’s attempt at constructing a public value table for health states without having recourse to data from population preferences studies is also a fascinating read. But I have serious concerns about his resulting table. Hausman’s views on which dimensions of health a benevolent liberal state should care about (...) are essentially not different from what has long been emphasized in health economists’ work on valuations of health outcomes. His table would have been helpful as a sketch if it was the first attempt in health economics to quantify numerically the societal value of different types and degrees of health improvement. But research in the field has gone far beyond that. Multi-attribute utility instruments with much more accurate health classification systems than Hausman’s sketch are now at hand. Available also are models of societal valuations of QALYs that are broadly consistent with general population values, incorporate wider concerns than Hausman’s table does and do not have the questionable numerical properties that characterize Hausman’s sketch. (shrink)

That the maximization of quality-adjusted life years violates concerns for fairness is well known. One approach to face this issue is to elicit fairness preferences of the public empirically and to incorporate the corresponding equity weights into cost-utility analysis (CUA). It is thereby sought to encounter the objections by means of an axiological modification while leaving the value-maximizing framework of CUA intact. Based on the work of Lübbe (2005, 2009a, 2009b, 2010, forthcoming), this paper questions this strategy and scrutinizes the (...) concomitant assumptions concerning the nature of prioritization decisions. Empirical studies indicate that these premises are in fact unwarranted. People chose a certain resource allocation because they perceive it as a fair way to treat the persons concerned, not because it maximizes something valuable, and it is questionable if prioritization decision can be represented as value-maximizing choices at all. This reflection on the fundamental distinction between deontological and consequentialist reasoning bears general implications for the scope of ‘economic imperialism.’. (shrink)

Christopher Boorse's Bio Statistical Theory (BST) defines health as the absence of disease, and disease as the adverse departure from normal species functioning. This paper presents a two-pronged problem for this account. First I demonstrate that, in order to accurately account for dynamic physiological functions, Boorse's account of normal function needs to be modified to index functions against situations. I then demonstrate that if functions are indexed against situations, the BST can no longer account for diseases that result from specific (...) environmental factors. The BST is impaled on either horn of this dilemma and therefore must be dismissed. (shrink)

1 Overview of the problem2 Situationally Specific Normal Functioning and Capacities3 Kingma’s Criticism4 How Normal Responses can be Pathological5 Too Many Pathologies?6 Conclusions.

This essay argues that what is central to Christopher Boorse’s biostatistical theory of disease as statistically subnormal part function (BST) are comparisons of the “functional efficiency” of parts and processes and that statistical considerations serve only to pick out a healthy level of functional efficiency. On this interpretation, the distinction between health and pathology is less important than comparisons of functional efficiency, which are entirely independent of statistical considerations. The clarifications or revisions of the BST that this essay offers are (...) friendly amendments that render moot some of the most prominent criticisms of Boorse’s account. (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...) scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

The book aims to develop a new approach to philosophy of medicine. Much attention is paid to the relative merits of philosophical analysis in the Anglo-Saxon tradition, and phenomenology. Themes considered are cultural bias in philosophy of medicine, regular versus alternative medicine, concepts of health and disease, and the mind-body problem.