Health Care Analysis

, Volume 23, Issue 1, pp 73–87 | Cite as

Challenges for Principles of Need in Health Care

Original Article

Abstract

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.

Keywords

Distributive justice Health Health care need Prioritarianism Sufficientarianism Well-being 

References

  1. 1.
    Arneson, R. (1999). Egalitarianism and responsibility. Journal of Ethics, 3, 225–247.CrossRefGoogle Scholar
  2. 2.
    Braybrooke, D. (1998). The concept of needs, with a heartwarming offer of aid to utilitarianism. In G. Brock (Ed.), Necessary goods. Our responsibility to meet others’ needs (pp. 57–72). Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  3. 3.
    Brock, D. W. (2002). Priority to the worse off in health-care resource prioritization. In R. Rosamond, M. P. Battin, & M. Silvers (Eds.), Medicine and social justice. Essays on the distribution of health care (pp. 362–372). New York: Oxford University Press.Google Scholar
  4. 4.
    Brock, G. (Ed.). (1998). Necessary goods: Our responsibility to meet others’ needs. Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  5. 5.
    Casal, P. (2007). Why sufficiency is not enough. Ethics, 117, 296–326.CrossRefGoogle Scholar
  6. 6.
    Copp, D. (1998). Equality, justice, and the basic needs. In G. Brock (Ed.), Necessary goods. Our responsibility to meet others’ needs (pp. 113–134). Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  7. 7.
    Crisp, R. (2002). Treatment according to need: Justice and the British National Health Service. In R. Rosamond, M. P. Battin, & M. Silvers (Eds.), Medicine and social justice. Essays on the distribution of health care (pp. 134–143). New York: Oxford University Press.Google Scholar
  8. 8.
    Crisp, R. (2003). Equality, priority, and compassion. Ethics, 113, 745–763.CrossRefGoogle Scholar
  9. 9.
    Crisp, R. (2006). Hedonism reconsidered. Philosophy and Phenomenological Research, 3, 619–645.CrossRefGoogle Scholar
  10. 10.
    Culyer, A. J., & Wagstaff, A. (1993). Equity and equality in health and health care. Journal of Health Economics, 12, 431–457.PubMedCrossRefGoogle Scholar
  11. 11.
    Daniels, N. (2008). Just health: Meeting health needs fairly. New York: Cambridge University Press.Google Scholar
  12. 12.
    Ekerstad, N., Löfmark, R., Andersson, D., & Carlsson, P. (2011). A tentative consensus-based model for priority setting: An example from elderly patients with myocardial infarction and multi-morbidity. Scandinavian Journal of Public Health, 39, 345–353.PubMedCrossRefGoogle Scholar
  13. 13.
    Elhauge, E. (1994). Allocating health care morally. California Law Review, 82, 1449–1544.PubMedCrossRefGoogle Scholar
  14. 14.
    Elmersjö, C.-Å., & Helgesson, G. (2008). Notions of just health care at three Swedish hospitals. Medicine, Health Care and Philosophy, 11, 145–151.CrossRefGoogle Scholar
  15. 15.
    Frankfurt, H. G. (1987). Equality as a moral ideal. Ethics, 98, 21–43.CrossRefGoogle Scholar
  16. 16.
    Frankfurt, H. G. (1998). Necessity and desire. In G. Brock (Ed.), Necessary goods. Our responsibility to meet others’ needs (pp. 19–32). Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  17. 17.
    Frederick, S., & Loewenstein, G. (1999). Hedonic adaptation. In D. Kahneman, E. Diener, & N. Schwarz (Eds.), Well-being: The foundations of hedonic psychology (pp. 302–329). New York: Russell Sage.Google Scholar
  18. 18.
    Griffin, J. (1986). Well-being: Its meaning, measurement, and moral importance. New York: Oxford University Press.Google Scholar
  19. 19.
    Hamilton, L. A. (2003). The political philosophy of needs. New York: Cambridge University Press.CrossRefGoogle Scholar
  20. 20.
    Hasman, A., Hope, T., & Østerdal, L. P. (2006). Health care need: Three interpretations. Journal of Applied Philosophy, 23, 145–156.PubMedCrossRefGoogle Scholar
  21. 21.
    Hope, T., Østerdal, L. P., & Hasman, A. (2010). An inquiry into the principles of needs-based allocation of health care. Bioethics, 9, 470–480.Google Scholar
  22. 22.
    Howard, D. H. (2001). Hope versus efficiency in organ allocation. Transplantation, 72, 1169–1173.PubMedCrossRefGoogle Scholar
  23. 23.
    Miller, D. (1976). Social justice. Oxford: Clarendon Press.Google Scholar
  24. 24.
    Mårtensson, J., Carlsson, P., Arvidsson, E., Frank, L., Lindström, K., & Borgquist, L. (2006). Experiences of, knowledge about and attitudes towards prioritizationsan interview study with personnel from primary care (In Swedish: Erfarenhet, kunskap och inställning till prioriteringaren intervjustudie med personal från primärvården). CMT Rapport 2006:3. Linköping: University of Linköping. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-34033. Accessed 24 October 2012.
  25. 25.
    Nordenfelt, L. (1987). On the nature of health. Dordrecht: D. Reidel Publishing Company.CrossRefGoogle Scholar
  26. 26.
    Nordenfelt, L. (2003). On the evolutionary concept of health: Health as natural function. In L. Nordenfelt & P.-E. Liss (Eds.), Dimensions of health and health promotion (pp. 37–56). Amsterdam: Rodopi Press.Google Scholar
  27. 27.
    Nussbaum, M. (1998). Aristotelian social democracy. In G. Brock (Ed.), Necessary goods. Our responsibility to meet others’ needs (pp. 135–156). Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  28. 28.
    Nussbaum, M. (2000). Women and human development: The capabilities approach. New York: Cambridge University Press.CrossRefGoogle Scholar
  29. 29.
    Ohlsson, R. (1995). Morals based on needs. New York: University Press of America Inc.Google Scholar
  30. 30.
    Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. Lancet, 373, 423–431.PubMedCrossRefGoogle Scholar
  31. 31.
    Schramme, T. (2007). The significance of the concept of disease for justice in health care. Theoretical Medicine and Bioethics, 28, 121–135.PubMedCrossRefGoogle Scholar
  32. 32.
    Swedish Health Care Act. (1982:763), 2 §.Google Scholar
  33. 33.
    Swedish Government Bill Prop. (1996/97:60). Prioritizations within health care (Prioriteringar inom hälso-och sjukvården). Stockholm: Department of Health and Welfare.Google Scholar
  34. 34.
    Wakefield, J. C. (1992). The concept of mental disorder. On the boundary between biological facts and social values. American Psychologist, 4, 373–388.CrossRefGoogle Scholar
  35. 35.
    Walzer, M. (1983). Spheres of justice: A defence of pluralism and equality. New York: Basic Books.Google Scholar
  36. 36.
    Wiggins, D. (1985). Claims of need. In D. Wiggins (Ed.), Needs, values, truth (3rd ed., pp. 1–58). New York: Oxford University Press.Google Scholar
  37. 37.
    Wiggins, D. (1998). What is the force of the claim that one needs something? In G. Brock (Ed.), Necessary goods. Our responsibility to meet others’ needs (pp. 33–56). Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  38. 38.
    Williams, B. (1962). The idea of equality. In P. Laslett & W. G. Runciman (Eds.), Philosophy, politics, and society (pp. 110–131). Oxford: Basil Blackwell.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.LIME, Stockholm Centre for Healthcare EthicsKarolinska InstitutetStockholmSweden

Personalised recommendations