What kind of life best ensures human welfare? Since the ancient Greeks, this question has been as central to ethical philosophy as to ordinary reflection. But what exactly is welfare? This question has suffered from relative neglect. And, as Stephen Darwall shows, it has done so at a price. Presenting a provocative new "rational care theory of welfare," Darwall proves that a proper understanding of welfare fundamentally changes how we think about what is best for people.Most philosophers have assumed that (...) a person's welfare is what is good from her point of view, namely, what she has a distinctive reason to pursue. In the now standard terminology, welfare is assumed to have an "agent-relative normativity." Darwall by contrast argues that someone's good is what one should want for that person insofar as one cares for her. Welfare, in other words, is normative, but not peculiarly for the person whose welfare is at stake. In addition, Darwall makes the radical proposal that something's contributing to someone's welfare is the same thing as its being something one ought to want for her own sake, insofar as one cares. Darwall defends this theory with clarity, precision, and elegance, and with a subtle understanding of the place of sympathetic concern in the rich psychology of sympathy and empathy. His forceful arguments will change how we understand a concept central to ethics and our understanding of human bonds and human choices. (shrink)

I argue that it can be morally permissible to coerce people into doing what is good for their own health. I discuss recent initiatives in New York City that are designed to take away certain unhealthy options from local citizens, and argue that this does not impose on them in unjustifiable ways. Good paternalistic measures are designed to promote people's long-term goals, and to prevent them from making short-term decisions that interfere with reaching those, and New York's attempts to ban (...) the sale of sugary drinks larger than 16 ounces and the use of trans fats fall within those parameters. Given our tendency to cognitive bias, we need help in making choices that truly instantiate our values. (shrink)

Despite being co-opted by economists and politicians for their own purposes, ‘welfare’ traditionally refers to well-being, and it is in this sense that L. W. Sumner understands the term. His book is a clear, careful, and well-crafted investigation into major theories of welfare, accompanied by a one-chapter defense of “welfarism,” the view that welfare is the only foundational value necessary for ethics. Sumner himself is attracted to utilitarianism, but he makes no commitment to it in this work, which will be (...) of interest to many moral philosophers. (shrink)

This article sketches how liberal principles can be coherently set alongside the stewardship responsibilities of regulators. It indicates how this bears on the legitimacy of public health interventions in general and interventions of the kind associated with New York City’s public health programme in particular. The key idea is that stewardship responsibilities relate to the essential infrastructural conditions for human well-being; these conditions need to be protected because they are the staging for all human activity. Liberal principles, by contrast, presuppose (...) that the basic conditions for human well-being are in place; and, given this presupposition, they present a view about how humans should live, about how they should interact and transact and about how they should flourish. Where regulators are guided by a liberal ethic, they act illegitimately if they try to dictate how individuals should lead their lives; but, acting under their stewardship jurisdiction, regulators may legitimately intervene if they are trying to protect the conditions that are essential for any kind of human life. The article concludes by suggesting that while it is a good thing that New York City’s policies provoke debate about the legitimacy of public health interventions, it is the infrastructural conditions, and not the superstructural activities, that are the regulatory priority. (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)

Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (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)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

In this book, T. M. Scanlon offers new answers to these questions, as they apply to the central part of morality that concerns what we owe to each other.

Bentham's best-known book stands as a classic of both philosophy and jurisprudence. The 1789 work articulates an important statement of the foundations of utilitarian philosophy — it also represents a pioneering study of crime and punishment. Bentham's reasoning remains central to contemporary debates in moral and political philosophy, economics, and legal theory.

Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such as the study of (...) modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. In Health Justice, Sridhar Venkatapuram takes up the problem of identifying what claims individuals have in regard to their health in modern societies and the globalized world. Recognizing the social bases of health and longevity, Venkatapuram extends the ‘Capabilities Approach’ of Amartya Sen and Martha Nussbaum into the domain of health and health sciences. In so doing, he formulates an inter-disciplinary argument that draws on the natural and social sciences as well as debates around social justice to argue for every human being’s moral entitlement to a capability to be healthy. An ambitious integration of the health sciences and the Capabilities Approach, Health Justice aims to provide a concrete ethical grounding for the human right to health, while advancing the field of health policy and placing health at the centre of social justice theory. With a foreword by Sir Michael Marmot, chair of the WHO Commission on the Social Determinants of Health. (shrink)

Sarah Conly defends paternalistic public health policies, such as New York City’s soft drink ban, on the grounds that they promote values that people accept but have difficulty realizing, owing to their cognitive biases. In this commentary, I criticize Conly’s defense of the soft drink ban and offer my own view of the justification for paternalistic food and beverage policies. I propose that paternalistic government restrictions on food and beverage choices should address a significant health problem pertaining to a specific (...) type or class of food or beverage. There should also be substantial evidence that the restrictions are likely to be effective at dealing with the problem and that alternative ways of dealing with it, which do not involve coercion, are likely to be ineffective. (shrink)

It will be seen how in place of the wealth and poverty of political economy come the rich human being and rich human need. The rich human being is simultaneously the human being in need of totality of human life-activities — the man in whom his own realization exists as an inner necessity, as need. Marx, Economic and Philosophical Manuscripts of 1844 Svetaketu abstained from food for fifteen days. Then he came to his father and said, `What shall I say?' (...) The father said: `Repeat the Rik, Yagus, and Saman verses.' He replied, `They do not occur to me, Sir.' The father said to him... `Go and eat! Then wilt thou understand me.' Then Svetaketu ate, and afterwards approached his father. And whatever his father asked him, he knew it all by heart.... After that, he understood what his father meant when he said: `Mind, my son, comes from food, breath from water, speech from fire.' He understood what he said, yea, he understood it. Chandogya-Upanishad, VI Prapathaka, 7 Kanda When you love a man you want him to live and when you hate him you want him to die. If, having wanted him to live, you then want him to die, this is a misguided judgment. `If you did not do so for the sake of riches, you must have done so for the sake of novelty.' Confucius, Analects, Book 12. 10. (shrink)

So-called theories of well-being (prudential value, welfare) are under-represented in discussions of well-being. I do four things in this article to redress this. First, I develop a new taxonomy of theories of well-being, one that divides theories in a more subtle and illuminating way. Second, I use this taxonomy to undermine some misconceptions that have made people reluctant to hold objective-list theories. Third, I provide a new objective-list theory and show that it captures a powerful motivation for the main competitor (...) theory of well-being (the desire-fulfilment theory). Fourth, I try to defuse the worry that objective-list theories are problematically arbitrary and show how the theory can and should be developed. (shrink)

Introduction to one of the most important, controversial, and suggestive works of moral philosophy ever written.

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

Dan Haybron presents an illuminating examination of well-being, drawing on important recent work in the science of happiness. He shows that we are remarkably prone to error in judgements of our own personal welfare, and suggests that we should rethink traditional assumptions about the good life and the good society.

Utilitarianism, the great reforming philosophy of the nineteenth century, has today acquired the reputation for being a crassly calculating, impersonal philosophy unfit to serve as a guide to moral conduct. Yet what may disqualify utilitarianism as a personal philosophy makes it an eminently suitable guide for public officials in the pursuit of their professional responsibilities. Robert E. Goodin, a philosopher with many books on political theory, public policy and applied ethics to his credit, defends utilitarianism against its critics and shows (...) how it can be applied most effectively over a wide range of public policies. In discussions of such issues as paternalism, social welfare policy, international ethics, nuclear armaments, and international responses to the environment crisis, he demonstrates what a flexible tool his brand of utilitarianism can be in confronting the dilemmas of public policy in the real world. (shrink)