In this major book Martha Nussbaum, one of the most innovative and influential philosophical voices of our time, proposes a kind of feminism that is genuinely international, argues for an ethical underpinning to all thought about development planning and public policy, and dramatically moves beyond the abstractions of economists and philosophers to embed thought about justice in the concrete reality of the struggles of poor women. Nussbaum argues that international political and economic thought must be sensitive to gender difference as (...) a problem of justice, and that feminist thought must begin to focus on the problems of women in the third world. Taking as her point of departure the predicament of poor women in India, she shows how philosophy should undergird basic constitutional principles that should be respected and implemented by all governments, and used as a comparative measure of quality of life across nations. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

A consideration of current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental health problems, phenomenological conceptions of health and illness, allocation of health care resources and medical ethics.

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...) is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

This book explores the various aspects of social justice--to each according to his rights, to each acording to his desert, and to each according to his need--comparing the writings of Hume, Spencer, and Kropotkin. Miller demonstrates that there are radical differences in outlook on social justice between societies, and that these differences can be explained by reference to features of the social structure.

"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)

The concept of need is often proposed as providing an additional or alternative criterion to cost-effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the (...) relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others. (shrink)

In recent years there has been a good deal of discussion of equality’s place in the best account of distribution or distributive justice. One central question has been whether egalitarianism should give way to a principle requiring us to give priority to the worse off. In this article, I shall begin by arguing that the grounding of equality is indeed insecure and that the priority principle appears to have certain advantages over egalitarianism. But I shall then claim that the priority (...) principle itself is ungrounded and that the priority principle should itself give way to a sufficiency principle based — indirectly, via the notion of an impartial spectator — on compassion for those who are badly off. (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or (...) meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

Do any needs defensibly make claims on anyone? If so, which needs and whose needs can defensibly do this? What are the grounds for our responsibilities to meet others' needs, when we have such responsibilities? The distinguished contributors to this volume consider these questions as they evaluate the moral force of needs. They approach questions of obligation and moral importance from a variety of different theoretical perspectives, including contractarian, Kantian, Aristotelian, rights-based, egalitarian, liberal, and libertarian perspectives.

This paper is a plea for hedonism to be taken more seriously. It begins by charting hedonism's decline, and suggests that this is a result of two major objections: the claim that hedonism is the 'philosophy of swine', reducing all value to a single common denominator, and Nozick's 'experience machine' objection. There follows some elucidation of the nature of hedonism, and of enjoyment in particular. Two types of theory of enjoyment are outlined-intemalism, according to which enjoyment has some special 'feeling (...) tone'. and externalism, according to which enjoyment is any kind of experience to which we take some special attitude, such as that of desire. lnternalism-the traditional view--is defended against current externalist orthodoxy. The paper ends with responses to the philosophy of swine and the experience machine objections. (shrink)

This essay examines several possible rationales for the egalitarian judgment that justice requires better-off individuals to help those who are worse off even in the absence of social interaction. These rationales include equality (everyone should enjoy the same level of benefits), moral meritocracy (each should get benefits according to her responsibility or deservingness), the threshold of sufficiency (each should be assured a minimally decent quality of life), prioritarianism (a function of benefits to individuals should be maximized that gives priority to (...) the worse off), and mixed views. A case is made for adopting either prioritarianism or a mixed view that gives priority both to the worse off and to the more responsible and deserving. (shrink)

The concept of "need" has been analyzed by numerous modern philosophers. While they usually view need as a necessary condition for avoiding harm, Morals Based on Needs gives "basic needs" a clarifying new definition in terms of "necessary and sufficient condition for an acceptable life". Ohlsson investigates the connections between needs and moral norms creating a new foundation for ethics.

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)

abstract The argument that scarce health care resources should be distributed so that patients in ‘need’ are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this (...) account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting‐point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs‐based priority setting to social welfare maximisation. (shrink)

This ambitious and lively book argues for a rehabilitation of the concept of 'human needs' as central to politics and political theory. Contemporary political philosophy has focused on issues of justice and welfare to the exclusion of the important issues of political participation, democratic sovereignty, and the satisfaction of human needs, and this has had a deleterious effect on political practice. Lawrence Hamilton develops a compelling positive conception of human needs: the evaluation of needs must be located within a more (...) general analysis of institutions, but can in turn help to justify forms of coercive authority that are directed toward the transformation of political and social institutions and practices. His argument is animated throughout by provocative and original discussions of topics such as autonomy, recognition, rights, civil society, liberalism and democracy, and will interest a wide range of readers in political and social philosophy, political theory, law, development and policy. (shrink)

This article investigates what notions of “just health care” are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care were found. The main (...) idea was the notion of “equal treatment according to need”, the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel. (shrink)