Challenges for Principles of Need in Health Care

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.

Principles of Need and the Aggregation Thesis

“…[12,13,27,41,44,45]. some common ground: to give some kind of special normative weight to people who are worse off [24,25]. The claim that need principles share a special concern for the worse off should not be confused with Absolute Priority, the implausible view that one should always give absolute priority to the worst off.…”

“…It has been suggested that a principle of need is best understood as a priority or a sufficiency principle, or some combination of the two [8,24,25,32]. In this section we shall sketch the basis for these distributive principles.…”

“…Although need principles may be interpreted in various ways, they all ascribe some special normative importance to being badly off [24,25]. However, such a common ground has no clear implications for how a plausible principle of need should relate to the aggregation of benefits across individuals.…”

Characterising Needs in Health Care Priority Setting

“…On the contrary, Juth (2015) argues that the choice of theory makes quite a big difference with regard to priority setting decisions since different theories would give priority to different kinds of conditions.…”

“…That needs relevant for moral philosophy take this formal structure is fairly uncontroversial (see Crisp 2002;Daniels 1995;Frankfurt 1984;Griffin 1986;Hope et al 2010;Juth 2015;Liss 1993;McLeod 2011;Miller 2012;Ohlsson 1995;Reader 2005;Reader & Brock 2004;Thomson 1987;Wiggins 1987;von Wright 1982). 11 However, even though writers may agree on this formal structure they may disagree about several substantial questions, as we shall see in the following.…”