IN 1959 and 1960 I gave the Gifford Lectures in the University of St. Andrews. The lectures were called 'Norms and Values, an Inquiry into the Conceptual Foundations of Morals and Legislation'. The present work is substantially the same as the content of the second series of lectures, then advertised under the not very adequate title 'Values'. It is my plan to publish a revised version of the content of the first series of lectures, called 'Norms', as a separate book. (...) The two works will be independent of one another. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

ABSTRACT Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all‐purpose (...) primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need‐based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless‐pit problem. But there is a difference between needing something (first‐order need) and needing to have the ability to need (second‐order need). Even if we disagree about which first‐order need to prioritize, we must accept the importance of satisfying our second‐order need to have the ability to value things. We all have a second‐order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first‐order needs. (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)

The concept of need is promising and alluring because of three factors.

What is the Moral Problem? NORMATIVE ETHICS VS. META-ETHICS It is a common fact of everyday life that we appraise each others' behaviour and attitudes from ...

Since its publication in 1965, Brian Barry's seminal work has occupied an important role in the revival of Anglo-American political philosophy. A number of ideas and terms in it have become part of the standard vocabulary, such as the distinction between "ideal-regarding" and "want-regarding" principles and the division of principles into aggregative and distributive. The book provided the first precise analysis of the concept of political values having trade-off relations and its analysis of the notion of the public interest has (...) also been significant. (shrink)

The needs principle—that certain goods should be distributed according to need—has been central to much socialist and egalitarian thought. It is the principle which Marx famously takes to be that which is to govern the distribution of goods in the higher phase of communism. The principle is one that Marx himself took from the Blanquists. It had wider currency in the radical traditions of the nineteenth century. In the twentieth century it remained central to the mutualist form of socialism defended (...) by Tawney and Titmuss. The principle underlay the development and justification of the modern welfare state—thus the National Health Service is still founded upon the idea that the distribution of medical resources should be determined by medical need, not by ability to pay. One source of the power of the needs principle lies in the fact that it appears to be both a principle of justice and a principle of community or social solidarity. As a principle of justice it is offered as a corrective to the particular forms of unequal distributions of goods that can result from market transactions, and as a principle of community or social solidarity as a corrective to the possessive individualism taken to be the corollary of a market order. (shrink)

Some of the duties of individuals and organisations involve responsiveness to need. This requires knowledge of need, so the epistemology of need is relevant to practice. The prevailing contention among philosophers who have broached the topic is that one can know one’s own needs (as one can know some kinds of desires) by feeling them. The article argues against this view. The main positive claims made in the article are as follows. Knowledge of need, in both first‐person and second‐person cases, (...) is a type of knowledge‐that with no basic epistemological source. Needs, like medical conditions, have signs and symptoms. Knowledge of these, with inference, results in knowledge of need. Finally, it is argued that need is akin to, but not a special case of, metaphysical necessity de re. Some implications of this for the epistemology of need are explained. (shrink)

Absolute needs (as against instrumental needs) are independent of the ends, goals and purposes of personal agents. Against the view that the only needs are instrumental needs, David Wiggins and Garrett Thomson have defended absolute needs on the grounds that the verb ‘need’ has instrumental and absolute senses. While remaining neutral about it, this article does not adopt that approach. Instead, it suggests that there are absolute biological needs. The absolute nature of these needs is defended by appeal to: their (...) objectivity (as against mind-dependence); the universality of the phenomenon of needing across the plant and animal kingdoms; the impossibility that biological needs depend wholly upon the exercise of the abilities characteristic of personal agency; the contention that the possession of biological needs is prior to the possession of the abilities characteristic of personal agency. Finally, three philosophical usages of ‘normative’ are distinguished. On two of these, to describe a phenomenon or claim as ‘normative’ is to describe it as value-dependent. A description of a phenomenon or claim as ‘normative’ in the third sense does not entail such value-dependency, though it leaves open the possibility that value depends upon the phenomenon or upon the truth of the claim. It is argued that while survival needs (or claims about them) may well be normative in this third sense, they are normative in neither of the first two. Thus, the idea of absolute need is not inherently normative in either of the first two senses. (shrink)

In this paper I want to explore certain parallels between the logic of action and the logic of belief or, as it might otherwise be put, between practical and theoretical reasoning and rationality. The parallels will be seen to involve an ontological dimension as well as psychological and linguistic dimensions. It may help to begin by mentioning how I was drawn into an examination of these parallels. This was through becoming convinced of the correctness of an externalist account of reasons (...) for action, having been persuaded of this by, amongst other things, arguments found in Jonathan Dancy’s recent book on the subject, Practical Reality. Externalism about reasons for action appeared to me to be, on reflection, the only view that one could plausibly adopt in conjunction with a libertarian account of free will—the latter being a position which I am now convinced is not only coherent but entirely defensible and indeed correct. Oddly enough, however, recent debates concerning internalist versus externalist accounts of reasons for action tend to have been dominated by moral philosophers, whereas those concerning compatibilist versus libertarian accounts of free will tend to have been dominated by philosophers of action. As a consequence of this, the two debates have been carried on relatively independently of each other—in my view, to the detriment of both. The present paper is part of a larger exercise of trying to bring them together. (shrink)

What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...) distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (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)

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)

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)

The author presents and defends three theses: (1) "the first is that it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology." (2) "the second is that the concepts of obligation, And duty... And of what is morally right and wrong, And of the moral sense of 'ought', Ought to be jettisoned if this is psychologically possible...." (3) "the third thesis is that (...) the differences between the well-Known english writers on moral philosophy from sidgwick to the present day are of little importance." (staff). (shrink)

This book discusses problems of conceptual analysis as well as normative issues of vital contemporary concern.

This major study examines the most fundamental categories in terms of which we conceive of ourselves, critically surveying the concepts of substance, causation, agency, teleology, rationality, mind, body and person, and elaborating the conceptual fields in which they are embedded. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad (...) categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

The germs of the ideas in this book became implanted in me during my experience as a resident in clinical pathology at Boston University Medical Center. At the time, I had inklings that the test results churned out by our laboratories were more than scientific facts. As a philosophically unsophisticated young physician, however, I had no language or framework to analyze what I saw as a deep philosophical problem, a problem largely unrecognized by most physicians. The test results provided by (...) our laboratories were accurate and of great practical importance for patient care. However, most of the physicians who relied on our test results to diagnose and treat their patients either did not have the time or interest to consider the philosophical issues inherent in diagnosis, or, like me, had inadequate means to further analyze them. It was more than ten years later that I began doctoral studies in philosophy, and I was fortunate to find a faculty that was supportive of my efforts to address the problem. This book began as my doctoral dissertation in the Department of Philosophy at Georgetown University. I would like to acknowledge the assistance of my mentor, Robert Veatch, Ph. D. Our conversations during my Georgetown years led me in new and often fascinating directions. I would also like to acknowledge the help of Kenneth Schaffner, M. D., Ph. D. (shrink)

These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions.

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.

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)