Many philosophers have suggested that claims of need play a special normative role in ethical thought and talk. But what do such claims mean? What does this special role amount to? Progress on these questions can be made by attending to a puzzle concerning some linguistic differences between two types of 'need' sentence: one where 'need' occurs as a verb, and where it occurs as a noun. I argue that the resources developed to solve the puzzle advance our understanding of (...) the metaphysics of need, the meaning of 'need' sentences, and the function of claims of need in ethical discourse. (shrink)

The values-based approach to welfare holds that it is good for one to realize goals, activities, and relationships with which one strongly (and stably) identifies. This approach preserves the subjectivity of welfare while affirming that a life well lived must be active, engaged, and subjectively meaningful. As opposed to more objective theories, it is unified, naturalistic, and ontologically parsimonious. However, it faces objections concerning the possibility of self-sacrifice, disinterested and paradoxical values, and values that are out of sync with physical (...) and emotional needs. This paper revises the values-based approach, emphasizing the important—but limited—role consciously held values play in human agency. The additional components of human agency in turn explain why it is important for one’s values to cohere with one’s fixed drives, hard-wired emotional responses, and nonvolitionally guided cognitive pro- cesses. This affords promising responses to the objections above. (shrink)

In order to demedicalize the ethics of pre-exposure prophylaxis as HIV prevention, I consider the social effects on men who have sex with men. The Centers for Disease Control and Prevention considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side effects, drug resistance (...) and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention. (shrink)

Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, ‘value’ refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of (...) using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley’s “agential flourishing” theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations. (shrink)

Although previous treatments of affective injustice have identified some particular types of affective injustice, the general concept of affective injustice remains unclear. This article proposes a novel articulation of this general concept, according to which affective injustice is defined as a state in which individuals or groups are deprived of “affective goods” which are owed to them. On this basis, I sketch an approach to the philosophical investigation of affective injustice that begins by establishing which affective goods are fundamental, and (...) then considers which subsidiary goods—such as freedoms, resources, opportunities, and forms of recognition—may be necessary for the provision of those fundamental affective goods. Drawing from and developing ideas in the extant literature, I argue that two such fundamental affective goods include subjective well-being and emotional aptness. I then show that by analyzing deprivations of the subsidiary goods that enable a person to pursue and attain subjective well-being and emotional aptness, it is possible to shed new light on the cases of affective injustice that have been described in the extant literature, while also identifying other kinds of cases that have not been theorized to the same extent. (shrink)

Desire satisfactionists are united by their belief that what makes someone well-off is the satisfaction of their desires. But this commitment obscures a number of underlying differences, since there are several theoretical choice points on the way to making this commitment precise. This article is about two of the most important choice points. The first concerns an epistemic requirement on well-being. Suppose that one's desire that P is satisfied. Must one also know (or believe, or justifiably believe) that one's desire (...) that P is satisfied in order to benefit from P? If so, there is an epistemic requirement on well-being. The second concerns the time at which one benefits. Well-being is a temporal phenomenon: given that one benefits from the satisfaction of one's desire that P, when does one benefit? Perhaps one benefits at the times at which one desires P, or the times at which P obtains, or both. I defend a view I call “concurrent awareness desire satisfactionism”: one benefits only at times at which both one desires P and P obtains (concurrence) and one benefits only if one is aware that one's desire is satisfied (awareness). I motivate this view by showing how it gives us solutions to many of the canonical problems facing desire satisfactionism. Then I put the two parts of the view together and explore some of its further implications. Ultimately, I conclude that well-being is an organic unity composed of a desiderative component, an epistemic component, and a worldly component, none of which are valuable on their own, but which are valuable when they are related in the right way. (shrink)

There is growing philosophical interest in “affective injustice”: injustice faced by individuals specifically in their capacity as affective beings. Current debates tend to focus on affective injustice at the psychological level. In this paper, I argue that the built environment can be a vehicle for affective injustice — specifically, what Wildman et al. (2022) term “affective powerlessness”. I use resources from ecological psychology to develop this claim. I consider two cases where certain kinds of bodies are, either intentionally or unintentionally, (...) deprived of access to goods affording the development and maintenance of their subjective well-being: hostile architecture and masking practices in autism. This deprivation, I argue further, leads to a significant weakening and diminishment of their spatial agency, hinders their well-being, and in so doing gives rise to a pervasive experience of affective powerlessness. By drawing attention to these themes, I show that an ecological approach helpfully supplements existing approaches. It highlights how affective injustice can emerge via the way bodies are positioned in space, and the central role that built environments play in determining this positioning. (shrink)

There are roughly two philosophical literatures on “happiness,” each corresponding to a different sense of the term. One uses ‘happiness’ as a value term, roughly synonymous with well-being or flourishing. The other body of work uses the word as a purely descriptive psychological term, akin to ‘depression’ or ‘tranquility’. An important project in the philosophy of happiness is simply getting clear on what various writers are talking about: what are the important meanings of the term and how do they connect? (...) While the “well-being” sense of happiness receives significant attention in the contemporary literature on well-being, the psychological notion is undergoing a revival as a major focus of philosophical inquiry, following on recent developments in the science of happiness. This entry focuses on the psychological sense of happiness (for the well-being notion, see the entry on well-being). The main accounts of happiness in this sense are hedonism, the life satisfaction theory, and the emotional state theory. Leaving verbal questions behind, we find that happiness in the psychological sense has always been an important concern of philosophers. Yet the significance of happiness for a good life has been hotly disputed in recent decades. Further questions of contemporary interest concern the relation between the philosophy and science of happiness, as well as the role of happiness in social and political decision-making. (shrink)

Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have good reason to believe (...) that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children? (shrink)