Name der Zeitschrift: Frühmittelalterliche Studien Jahrgang: 46 Heft: 1 Seiten: 1-40.

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

Criminal law commonly requires judges and juries to decide whether defendants acted reasonably. Nevertheless, issues of reasonableness fall into two distinct categories: (1) where reasonableness concerns events and states, including risks of which an actor is conscious, that can be justly assessed without regard to the actor’s individual traits, and (2) where reasonableness concerns culpable mental states and emotions that cannot justly be assessed without reference to the actor’s capacities. This distinction is significant because, while the reasonable person by which (...) category-1 cases are assessed is a disembodied and impersonal ideal that consists of nothing but the uncompromising values of the jurisdiction, the reasonable person by which category-2 cases are measured must necessarily incorporate some of an actor’s individual traits or risk blaming the blameless. Courts and commentators have thus far approached the task of individualizing or subjectivizing reasonableness in category 2 by trying to determine in advance which individual traits are generally relevant and which are not. I propose an alternative approach that, in addition to applying to negligence and voluntary manslaughter cases alike, derives its content from the social practice of blaming. I propose that a reasonable person in category-2 cases consists of every physical, psychological, and emotional trait an actor possesses, with one exception—the exception being that he possesses proper respect for the values of the people of the state as reflected and incorporated in the statute at hand. (shrink)

We are even less aware of our internal organs and the physiological processes that keep us alive. In this fascinating work, Drew Leder examines all the ways in which the body is absent—forgotten, alien, uncontrollable, obscured.

Introduction : a search for icons -- Burke in brief : a "philosophical" primer -- Old seeds, new soil : the land of Paine -- John and J.Q. Adams : federalist persuasions -- Democratic America : the ethos of liberalism -- American Whigs : a conservative response -- The Gilded Age : eclectic interpretations -- Theodore Roosevelt : blazing forward, looking backward -- Woodrow Wilson : confronting American maturity -- Modern times : conjunctions and consensus -- Natural law : a (...) neo-traditionalist revival -- The Cold War : existential threat redux -- Contemporary conservatives : victories and illusions -- Conclusion : a world without fathers. (shrink)

Why is it that some instances of disagreement appear to be so intractable? And what is the appropriate way to handle such disagreements, especially concerning matters about which there are important practical and political needs for us to come to a consensus? In this paper, I consider an explanation of the apparent intractability of deep disagreement offered by hinge epistemology. According to this explanation, at least some deep disagreements are rationally unresolvable because they concern ‘hinge’ commitments that are unresponsive to (...) rational considerations. This explanation, if correct, seems to have troubling implications for how we should respond to deep disagreement. If my position on a topic is not responsive to rational considerations, then what choice have I but to dogmatically hold to that position, and simply dismiss the views of those with whom I disagree? I address this problem by identifying an attitude of intellectual humility that is appropriate to have towards one's hinge commitments, and suggest that this attitude provides the basis for a non-rational, constructive way to resolve deep disagreement. (shrink)

The option of being ‘spiritual but not religious’ deserves much more philosophical attention. That is the aim here, taking the work of Robert Solomon as a starting point, with focus on the particular issues around viewing life as gift. This requires analysis of ‘existential gratitude’ to show that there can be gratitude for things without gratitude to someone for providing things, and also closer attention to the role that metaphor plays in cognition. I consider two main concerns with gift and (...) gratitude thinking, that the nonreligious justification is too instrumentalist in its approach and that viewing life as gift, whether in a religious or nonreligious way, is simply too optimistic. (shrink)

Recent studies of naturalistic face‐to‐face communication have demonstrated coordination patterns such as the temporal matching of verbal and non‐verbal behavior, which provides evidence for the proposal that verbal and non‐verbal communicative control derives from one system. In this study, we argue that the observed relationship between verbal and non‐verbal behaviors depends on the level of analysis. In a reanalysis of a corpus of naturalistic multimodal communication (Louwerse, Dale, Bard, & Jeuniaux, ), we focus on measuring the temporal patterns of specific (...) communicative behaviors in terms of their burstiness. We examined burstiness estimates across different roles of the speaker and different communicative modalities. We observed more burstiness for verbal versus non‐verbal channels, and for more versus less informative language subchannels. Using this new method for analyzing temporal patterns in communicative behaviors, we show that there is a complex relationship between verbal and non‐verbal channels. We propose a “temporal heterogeneity” hypothesis to explain how the language system adapts to the demands of dialog. (shrink)

Hypotheses regarding the selective pressures driving the threefold increase in the size of the hominid brain since Homo habilis include climatic conditions, ecological demands, and social competition. We provide a multivariate analysis that enables the simultaneous assessment of variables representing each of these potential selective forces. Data were collated for latitude, prevalence of harmful parasites, mean annual temperature, and variation in annual temperature for the location of 175 hominid crania dating from 1.9 million to 10 thousand years ago. We also (...) included a proxy for population density and two indexes of paleoclimatic variability for the time at which each cranium was discovered. Results revealed independent contributions of population density, variation in paleoclimate, and temperature variation to the prediction of change in hominid cranial capacity (CC). Although the effects of paleoclimatic variability and temperature variation provide support for climatic hypotheses, the proxy for population density predicted more unique variance in CC than all other variables. The pattern suggests multiple pressures drove hominid brain evolution and that the core selective force was social competition. (shrink)

Much has been made of the so-called “speculative turn” in contemporary philosophy. For some, this turn marks the “end of phenomenology” and the dawn of a new empiricism in European philosophy. For others, it amounts to nothing more than a renewal of the straw-person accusation of psychologism against phenomenology. In truth, it is neither. Instead, this article argues that while at times mutually critical of one another, speculative materialism and phenomenology are best understood as parallel projects with shared trajectories and (...) aims, common concerns, and even comparable methods. The bene????it of reading these two apparently divergent camps as parallel projects is that it allows phenomenology to understand the diversity of its own history anew and, in light of this, to draw from speculative realism as a resource for rethinking its objectives and methods in its pursuit of a robust post-Kantian realism. (shrink)

One of the most persistent and poignant human experiences is the sensation of longing--a restlessness perhaps best described as the unspoken conviction that something is missing from our lives. In this study, Drew M. Dalton attempts to illuminate this experience by examining the philosophical thought of Emmanuel Levinas on longing, or what Levinas terms "metaphysical desire." Metaphysical desire, according to Levinas, does not stem from any determinate lack within us, nor does it aim at a particular object beyond us, (...) much less promise any eventual satisfaction. Rather, it functions in the realm of the infinite where such distinctions as inside and outside or one and the other are indistinguishable, perhaps even eliminated. As Levinas conceives such longing, it becomes a mediator in our relation to the other--both the human other and the divine Other. -/- Dalton follows the meandering trail of Levinas's thought along a series of dialogues with some of the philosophers within the history of the Western tradition who have most influenced his corpus. By tracing the genealogy of Levinas's notion of metaphysical desire--namely in the works of Plato, Heidegger, Fichte, Schelling, and Otto--the nature of this Levinasian theme is elucidated to reveal that it is not simply an idealism, a "hagiography of desire" detached from actual experience and resulting in a disconnect between his phenomenological account and our own lives. Rather, Levinas's account of metaphysical desire points to a phenomenology of human longing that is both an ethical and religious phenomenon. In the end, human longing is revealed to be one of the most profound ways in which a subject becomes a subject, arising to its "true self," and hearing the call to responsibility placed upon it by the Other. -/- Throughout, Dalton explicates the nuance of a number of key Levinasian terms, many of which have been taken from the Western philosophical tradition and reinscribed with a new meaning. Eros, the "Good beyond being," shame, responsibility, creation, the trace, the il y a, and the holy are discovered to be deeply tied to Levinas's account of metaphysical desire, resulting in a conclusion regarding longing's role in the relationship between the finite and the Infinite.". (shrink)

Bodily pain and distress come in many forms. They can well up from within at times of serious illness, but the body can also be subjected to harsh treatment from outside. The medical system is often cold and depersonalized, and much worse are conditions experienced by prisoners in our age of mass incarceration, and by animals trapped in our factory farms. In this pioneering book, Drew Leder offers bold new ways to rethink how we create and treat distress, clearing (...) the way for more humane social practices. Leder draws on literary examples, clinical and philosophical sources, his medical training, and his own struggle with chronic pain. He levies a challenge to the capitalist and Cartesian models that rule modern medicine. Similarly, he looks at the root paradigms of our penitentiary and factory farm systems and the way these produce distressed bodies, asking how such institutions can be reformed. Writing with coauthors ranging from a prominent cardiologist to long-term inmates, he explores alternative environments that can better humanize—even spiritualize—the way we treat one another, offering a very different vision of medical, criminal justice, and food systems. Ultimately Leder proposes not just new answers to important bioethical questions but new ways of questioning accepted concepts and practices. (shrink)

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women (...) who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. (shrink)

Certain restrictions on public funding for assisted reproductive technology (ART) are articulated and defended by recourse to a distinction between medical infertility and social infertility. We propose that underlying the prioritization of medical infertility is a vision of medicine whose proper role is to restore but not to improve upon nature. We go on to mark moral responses that speak of investments many continue to make in nature as properly an object of reverence and gratitude and therein (sometimes) a source (...) of moral guidance. We draw on the work of Ludwig Wittgenstein in arguing for the plausibility of an appeal to nature in opposition to the charge that it must contain a logical fallacy. We also invite consideration of the moral plausibility of some appeal to nature. Finally, we examine what follows in the case of ART. Should medicine respect as natural limits that should not be overcome: the need for a man and a woman in reproduction; menopause; and even declining fertility with age? We must first ask ourselves to what degree we should defer to nature in the conduct of medicine, at least in the particular if not the general case. This will involve also asking ourselves what we think is natural and in what instances and spirit might we defy nature. Divergent opinions and policies concerning who should receive ART treatment and public funding are more easily understood in view of the centrality, complexity and fundamental nature of these questions. (shrink)

Much previous work in artificial intelligence has neglected representing time in all its complexity. In particular, it has neglected continuous change and the indeterminacy of the future. To rectify this, I have developed a first‐order temporal logic, in which it is possible to name and prove things about facts, events, plans, and world histories. In particular, the logic provides analyses of causality, continuous change in quantities, the persistence of facts (the frame problem), and the relationship between tasks and actions. It (...) may be possible to implement a temporal‐inference machine based on this logic, which keeps track of several “maps” of a time line, one per possible history. (shrink)

Very few thinkers have traveled the heretical path that François Laruelle walks between philosophy and non-philosophy. For Laruelle, the future of philosophy is problematic, but a mutation of its functions is possible. Up until now, philosophy has merely been a utopia concerned with the past and only provided the services of its conservation. We must introduce a rigorous and nonimaginary practice of a utopia in action, a philo-fiction—a close relative to science fiction. From here we can see the double meaning (...) of the watchword, a tabula rasa of the future. This new destination is imposed by a specifically human messianism, an eschatology within the limits of the Man-in-person as antihumanist ultimatum addressed to the History of Philosophy. This book elucidates some of the fundamental problems of non-philosophy and takes on its detractors. (shrink)

Much has been made of the so-called “empirical turn” of “speculative materialism” with thinkers like Quentin Meillassoux championing the material sciences as a new route to absolute reality. According to Meillassoux, the material sciences “provide philosophers access once again to the great outdoors, the absolute outside,” of reality in-itself. One might expect from such encomia the attempt to engage with the products of contemporary science in order to develop a new metaphysics; but, Meillassoux spends almost no time in this way, (...) focusing instead on the form and methods of the material sciences over their actual accomplishments. As a result, his praise rings hollow and his metaphysics remains undeveloped. This paper examines what would happen if we were to take seriously his claims that a new metaphysics be developed from a scientific accounting of material reality by surveying the conclusions of contemporary physics. The paper ends by contrasting such a new speculative and materialistic metaphysics with the speculative nihilism of Ray Brassier. (shrink)

In this important book, Drew Khlentzos explains the antirealist argument from a realist perspective. He defends naturalistic realism against the antirealist challenge, and he considers the consequences of his defense for our understanding of realism and truth. Khlentzos argues that the naturalistic realist view that the world exists independently of the mind must take into consideration what he calls the representation problem: if the naturalistic realist view is true, how can mental representation of the world be explained?He examines this (...) major antirealist challenge in detail and shows that many realists have dismissed it because they have not understood its nature. He sees it as a philosophical puzzle: the antirealist challenge, if sound, does not prove that there are no objects that exist independently of the mind, but that there is no rational basis for thinking that there are; we have good reason to believe in the naturalistic view, but we have no way of knowing how it could be true. Khlentzos surveys the antirealist arguments of Michael Dummett, Hilary Putnam, and Crispin Wright and suggests a realist answer. He argues for a radically nonepistemic conception of truth, and against pragmatist, intuitionist, verificationist, and pluralist alternatives. He examines and rejects some current versions of physicalism and functionalism, and offers an original version of the correspondence theory of truth. (shrink)

In this important book, Drew Khlentzos explains the antirealist argument from a realist perspective. He defends naturalistic realism against the antirealist challenge, and he considers the consequences of his defense for our understanding of realism and truth. Khlentzos argues that the naturalistic realist view that the world exists independently of the mind must take into consideration what he calls the representation problem: if the naturalistic realist view is true, how can mental representation of the world be explained? He examines (...) this major antirealist challenge in detail and shows that many realists have dismissed it because they have not understood its nature. He sees it as a philosophical puzzle: the antirealist challenge, if sound, does not prove that there are no objects that exist independently of the mind, but that there is no rational basis for thinking that there are; we have good reason to believe in the naturalistic view, but (given the antirealist arguments) we have no way of knowing how it could be true. Khlentzos surveys the antirealist arguments of Michael Dummett, Hilary Putnam, and Crispin Wright and suggests a realist answer. He argues for a radically nonepistemic conception of truth, and against pragmatist, intuitionist, verificationist, and pluralist alternatives. He examines and rejects some current versions of physicalism and functionalism, and offers an original version of the correspondence theory of truth. (shrink)

Universal Basic Income (UBI) can serve as a beneficial public policy to reduce poverty and inequality, yet a great challenge is how to fund it. This article offers a roadmap for fully funding UBI in a manner that: eliminates poverty; bolsters the middle-class; eliminates the stigma and government bureaucracy of social welfare programs; reduces ever-expanding inequality; initiates a path to meeting climate change goals; reduces speculation; and increases fairness and opportunity in the tax code. As stand-alone policies, these revenue proposals (...) are valuable correctives in their own right. If the entire package of UBI and funding sources were in effect, society (and American capitalism) would be on a more stable, equitable, and environmentally sustainable footing. (shrink)

If we lack deep free agency, like that supposed by metaphysical libertarianism, should we view life as meaningless, pointless, or not worth living? Here I present a new argument in support of meaning-compatibilism, or the view that life can indeed be meaningful without our having deep free agency. I show that this argument secures meaning-compatibilism more effectively than an argument provided by Derk Pereboom. In the process, we learn that Susan Wolf’s hybrid theory of meaning in life is not equipped (...) to handle the question of meaning-compatibilism, which a broader approach to meaning in life should help us to grasp. On the alternative approach I present, judgments about meaning in life involve a sensitivity to whether giving up on life, or “agency defeat”, is justified. I argue that, so long as we are able to exist in reality, giving up on life is difficult to justify, and even without deep free agency, we do indeed exist in reality. (shrink)

Like the Copernican revolution which initiated the Modern project, there has been a thermodynamic revolution in the empirical sciences in the last two centuries. The aim of this paper is to show how we might draw from this revolution to make new and startling metaphysical and ethical claims concerning the nature and value of reality. To this end, this paper employs Aristotle’s account of the relation of the various philosophies and sciences to one another to show how we might assert (...) a new theory of being, moral value, and practical action from the primacy of entropic decay asserted in the contemporary mathematical sciences. This paper proceeds to show how, from what the contemporary sciences have concluded concerning the primacy of entropic decay within reality, unbecoming might be forwarded as a new account of the essence of existence: i.e., the first cause and motivating principle of reality’s formal, material, efficient, and final nature. The paper concludes by arguing that a new and surprising account of universal ethical value and normative duty can be deduced from such a metaphysics of decay. (shrink)

With an emphasis on self-study and the connections between the personal and the professional domain, the authors reflect upon their teaching practice on a postgraduate theatre-based course using the research methodology of a/r/tography. The aim was to develop understanding of teacher/student roles and how these can affect learning. Through researcher reflexivity, focus groups and questionnaires, data were captured from students/participants responding to a video of the researcher’s solo performance work. The research presents itself through three a/r/tographic renderings. First, the experience (...) of seeing tutors in unfamiliar roles is considered. Second, the impact of witnessing tutors taking risks as a performer and being vulnerable is discussed and, lastly, the work illuminates new ways of opening up as teachers. The authors explore how the student’s/participant’s perception of them as tutors seemed to change after witnessing them as artists and how this impacted upon student’s learning for their own assessed performance pieces. (shrink)

Pain is far more than an aversive sensation. Chronic pain, in particular, involves the sufferer in a complex experience filled with ambiguity and paradox. The tensions thereby established, the unknowns, pressures, and oscillations, form a significant part of the painfulness of pain. This paper uses a phenomenological method to examine nine such paradoxes. For example, pain can be both immediate sensation and mediated by complex interpretations. It is a certainty for the experiencer, yet highly uncertain in character. It pulls one (...) to the present but also projects one outward to a feared or desired future. Chronic pain can seem located in the body and/or mind; interior to the self, or an alien other; confined to a particular point and/or radiating everywhere. Such fundamental paradoxes, existential and epistemological, can challenge those living with long-term pain. (shrink)

This paper employs Ruth Millikan’s biosemantic theory of representation to develop a proposal about the function of ethical claims and judgments. I propose that ethical claims and judgments (or ethical ‘affirmations’) have the function of simultaneously tracking the morally salient features of social situations and directing behavior that coordinates in a collectively beneficial way around those features. Thus, ethical affirmations count as a species of what Millikan labels ‘Pushmi-Pullyu’ representations that simultaneously have a descriptive and a directive direction of fit. (...) This proposal supports a version of motivational internalism that can accommodate a surprising range of actual failures of motivation. I also briefly situate this proposal in the metaethical literature, contrasting it with other hybrid views incorporating elements of cognitivism and expressivism. (shrink)

This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine.

We agree with Archer that human sex differences in aggression are well explained by sexual selection, but note that explanations of human behaviors are not logically mutually exclusive from explanations and therefore should not be framed as such. We discuss why this type of framing hinders the development of both social learning and evolutionary theories of human behavior.

Courts and commentators have struggled for years to identify rules to explain and justify certain widely-shared intuitions about impossibility attempts, and they have proposed rules variously based upon (1) what mistakes actors make, (2) what intentions actors possess, and (3) what conduct actors perform. None of the proposals fully succeeds, however, and none is able to explain the widely-shared intuition, which underlies Sandy Kadish's inventive hypothetical regarding Mr. Law and Mr. Fact, that some attempts based upon mistakes of law are (...) just as blameworthy as attempts based upon mistakes of fact. I propose an alternative rule that, I believe, not only explains where and why people possess widely-shared intuitions regarding impossibility attempts (including regarding Mr. Law and Mr. Fact), but also explains where and why people have conflicting intuitions. I argue that widely-shared intuitions of blameworthiness and non-blameworthiness regarding impossibility attempts are a function, respectively, of whether informed citizens of the jurisdiction that enacted the statutory offense that the defendant allegedly attempted to commit widely believe or disbelieve that he would have been a threat to interests that the statute seeks to protect - a determination, in turn, that is a function of whether they widely believe or disbelieve that he would have committed the offense under counterfactual circumstances that they fear could have obtained. (shrink)

Opening a new debate on ethical reasoning after Kant, Drew Dalton addresses the problem of the absolute in ethical and political thought. Attacking the foundation of European philosophical morality, he critiques the idea that in order for ethical judgement to have any real power, it must attempt to discover and affirm some conception of the absolute good. Without rejecting the essential role the absolute plays within ethical reasoning, Dalton interrogates the assumed value of the absolute. -/- Dalton brings some (...) of the most influential contemporary philosophical traditions into dialogue with each other: speculative realists like Badiou and Meillassoux; phenomenologists, including Husserl, Heidegger, and Levinas; German Idealists, especially Kant and Schelling; psychoanalysts Freud and Lacan; and finally, post-structuralists, specifically Foucault, Deleuze, and Ranciere. The relevance of these thinkers to concrete socio-political problems is shown through reflections on the Holocaust, suicide bombings, the rise of neo-liberalism and neo-nationalism, as well as rampant consumerism and racism. -/- This book re-defines ethical reasoning as that which refuses absolutes and resists what Milton's devil in Paradise Lost called the “tyranny of heaven.” Against traditional ethical reasoning, Dalton sees evil not as a moral failure, but as the result of an all too easy assent to the absolute; an assent which can only be countered through active resistance. For Dalton, resistance to the absolute is the sole channel through which the good can be defined. (shrink)

A provocative and entirely new account of ethical reasoning that reconceives the traditional understanding of ethical action negatively -/- In this radical reconsideration of ethical reasoning in contemporary European philosophy, Drew M. Dalton makes the case for an absolutely grounded account of ethical normativity developed from a scientifically informed and purely materialistic metaphysics. Expanding on speculative realist arguments, Dalton argues that the limits placed on the nature of ethical judgments by Kant’s critique can be overcome through a moral evaluation (...) of the laws of nature—specifically, the entropic principle that undergirds the laws of physics, chemistry, and biology. In order to extract a moral meaning from this simple material fact, Dalton scrutinizes the presumptions of classical accounts and traditional understandings of good and evil within the history of Western philosophy and ultimately asserts that ethical normativity can be reestablished absolutely without reverting to dogmatism. -/- By overturning our assumptions about the nature and value of reality, The Matter of Evil: From Speculative Realism to Ethical Pessimism presents a provocative new model of ethical responsibility that is both logically justifiable and scientifically sound. Dalton argues for “ethical pessimism,” a position previously marginalized in the West, as a means to cultivate an account of ethical responsibility and political activism that takes seriously the unbecoming of being and the moral horror of existence. (shrink)

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...) Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)