Abstract
This paper develops and defends the claim that the promotion of human well-being is a philosophical basis or rationale for health services. It first sketches a case for this thesis, then defends it against various objections arising from the contrary position, here dubbed The Sceptical View. Later sections of the paper elaborate on the meaning of ‘well-being’, the nature of well-being, and the scope of appropriate health service concern with well-being. In particular, distinctions are made between ‘thick’ and ‘thin’ well-being, and between well-being and its various measures. These discussions generate further defences of the philosophical centrality of human well-being to health services.
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References
Beauchamp, T. L. and Childress, J. F. (1979).Principles of Bio-medical Ethics, ch. 3–6, Oxford University Press, New York.
Noddings, N. (1984).Caring: A Feminine Approach to Ethics and Moral Education, University of California Press, Berkeley and Los Angeles.
Rawls, J. (1971).A Theory of Justice, ch. 11, Oxford University Press, Oxford.
Nozick, R. (1974).Anarchy, State and Utopia, ch. 4, Basic Books, New York.
Aristotle,Nicomachean Ethics, 1095a16–20.
Vlastos, G. (1991).Socrates, Cambridge University Press, Cambridge, p. 203. In scholarly disputes about the appropriate English translation for ‘eudaimonia’, ‘happiness’ has traditionally been favoured over ‘well-being’. The main grounds for this—that ‘well-being’ is a little stiff and formal in ordinary English, and that it lacks adverbial and adjectival forms (see Vlastos, p. 201)—are not philosophically deep, even if they are philologically decisive.
J. S. MillOn Liberty ch. 1, paragraph 11. Mill typically reserves the concept of well-being for the most general and comprehensive notion of life's going well for an individual person. Thus, for example, the title of Chapter III ofOn Liberty is ‘Of individuality, as one of the elements of well-being’.
See, for example, Buchanan, I. (1994). The purposeprocess gap in health promotion.Health Care Analysis 2(1), 31–35.
However strong the social determinants of individual well-being might be, conceptual space must be left for the evident possibility that one individual can benefit or flourish, whilst other socially or culturally adjacent individuals do not.
To put the reasons summarily, there is no single sensation of pleasure. Pains are also very diverse, and they are different in kind from pleasures. For a more developed dismissal of simple hedonism, see, for example, Ryle, G. (1969). Pleasure. In,Moral Concepts, ed. by J. Feinberg, Oxford University Press, London; Sprigge, T. (1988).The Rational Foundation of Ethics, ch. 5, Routledge, London; Griffin, J. (1986).Well-being: Its Meaning, Measurement, and Moral Importance, ch. 1, Clarendon Press, Oxford.
At least on the standard interpretation of Mill. More recently, some philosophers have argued that Mill in fact thought there were also non-hedonistic constituents of well-being. See Berger, F. (1984).Freedom, Justice, and Happiness, University of California Press, Berkeley and Los Angeles.
See, for example, Griffin, J. (1986).Well-being Part I, Clarendon Press, Oxford.
Interestingly, the ancients suffered from no such delusions. The ubiquitous modern idea that self-judgment infallibly determines one's best interest seems not to have struck the ancient Greek thinkers as a view even worth objecting to.
A notable exception is Seedhouse, D. (1986).Health: The Foundations for Achievement, John Wiley, Chichester.
It might be claimed that information about the impact of health services on human well-being is so inaccessible and unreliable, if not actually undiscoverable, that it is not a useful practical yardstick against which to measure any such services. This is at best an exaggeration. We know, for example, that many health services quite predictably reduce deaths from accident, injury, or disease. Some immunisation programmes, campaigns to increase usage of cycle helmets, and appendectomies, for example, save lives. Life is a necessary condition of well-being, and most lives are worth living, so these and many other life-saving health services have a predictably positive impact on human well-being. Reliable pain-relieving medication is an even simpler example, since it is plausible that, other things being equal, the less pain one suffers from, the greater is one's well-being.
Amartya Sen has made much the same point against Rawlsian reliance on the notion of primary goods. See Sen, A. (1992).Inequality Re-examined ch. 5, Russell Sage, New York.
I wish to thank the editor of this journal and an anonymous referee for their valuable comments on a previous draft of this paper.
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Moore, A. Well-being: A philosophical basis for health services. Health Care Anal 2, 207–216 (1994). https://doi.org/10.1007/BF02251021
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DOI: https://doi.org/10.1007/BF02251021