Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

According to the Welfare Diffusion Objection, we should reject Prioritarianism because it implies the ‘desirability of welfare diffusion’: the claim that it can be better for there to be less total wellbeing spread thinly between a larger total number of people, rather than for there to be more total wellbeing, spread more generously between a smaller total number of people. I argue that while Prioritarianism does not directly imply the desirability of welfare diffusion, Prioritarians are nevertheless implicitly committed to certain (...) principles for comparing different-number populations which, together with the Prioritarian same-person axiology, imply the desirability of welfare diffusion. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)