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)

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)

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.

The aim of this article is twofold. First, it is argued that while the principle of ‘ought implies can’ is certainly plausible in some form, it is tempting to misconstrue it, and that this has happened in the way it has been taken up in some of the current literature. Second, Kant's understanding of the principle is considered. Here it is argued that these problematic conceptions put the principle to work in a way that Kant does not, so that there (...) is an important divergence here which can easily be overlooked. (shrink)

The purpose of the article is to argue for the significance of a clarified goal of health care for the setting of priorities. Three arguments are explored. First, assessment of needs becomes necessary in so far as the principle of need should guide the priority-setting. The concept of health care need includes a goal component. This component should for rational reasons be identical with the goal of health care. Second, in order to use resources efficiently it is necessary to assess (...) the effects of health care. It is not, however, a question of assessing whether there is an effect but a question of assessing whether there is the right effect. And what constitutes the right effect can only be determined in relation to the goal of the enterprise. Third, the health sector involves several groups of actors such as politicians, administrators, doctors, nurses, physiotherapists, occupational therapists, educationists and patients. It is common knowledge that successful teamwork requires an understanding of a common goal. The article ends with an example of a goal chosen from ethics. (shrink)

What are the limits of well-being? This question nicely captures one of the central debates concerning the nature of the individual human good. For rival theories differ as to what sort of facts directly constitute a person's being well-off. On some views, well-being is limited to the presence of pleasure and the absence of pain. But other views push the boundaries of well-being beyond this, so that it encompasses a variety of mental states, not merely pleasure alone. Some theories then (...) draw the line here, limiting well-being to the presence of the appropriately broadened set of mental states. But still others extend the limits of well-being even further, so that it is constituted in part by facts that are not themselves mental states at all; on such views, well-being is partly constituted by states of affairs that are “external” to the individual's experiences. In this essay, I want to explore some of this debate by focusing on a particular stretch of the dialectic. That is, I want to think hard about a particular connected series of arguments and counterarguments. These arguments – or, at least, the concerns they seek to express – emerge naturally in the give and take of philosophical discussion. Together they make up a rather simple story, whose plot, in very rough terms, is this: first there is an attempt to push the limits of well-being outward, moving from a narrow to a broader conception; then comes the claim that the resulting notion is too broad, and so we must retreat to a narrower conception after all. (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)

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)

The view that the obligation to promote happiness is, as Popper puts it, "in any case much less urgent" than the obligation to eliminate unhappiness we might call the "Negative Doctrine". I know of no plausible form of the Negative Doctrine.

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)

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.