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Background: Multiple principles are relevant in priority setting, two of which are often considered particularly important. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. This principle is intimately linked to the goal of health maximization and standard cost-effectiveness analysis (CEA). According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. This principle is often linked to an idea of equity. Together, the two principles accord with prioritarianism; a view which can motivate non-standard CEA. Crucial for the actual application of prioritarianism is the trade-off between the two principles, and this trade-off has received scant attention when the worse off are specified in terms of lifetime health. This paper sheds light on that specific trade-off and on the public support for prioritarianism by providing fresh empirical evidence and by clarifying the close links between the findings and normative theory. Methods: A new, self-administered, computer-based questionnaire was used, to which 96 students in Norway responded. How respondents wanted to balance quality-adjusted life years (QALYs) gained against benefiting those with few lifetime QALYs was quantified for a range of different cases. Results: Respondents supported both principles and were willing to make trade-offs in a particular way. In the baseline case, the median response valued a QALY 3.3 and 2.5 times more when benefiting someone with lifetime QALYs of 10 and 25 rather than 70. Average responses harbored fundamental disagreements and varied modestly across distributional settings. Conclusion: In the specific context of lifetime health, the findings underscore the insufficiency of pure QALY maximization and explicate how people make trade-offs in a way that can help operationalize lifetime prioritarianism and non-standard CEA. Seen through the lens of normative theory, the findings highlight key challenges for prioritarianism applied to priority setting. ; publishedVersion

Principles of sufficiency are widely discussed in debates about distributive ethics. However, critics have argued that sufficiency principles are vulnerable to important objections. This article seeks to clarify the main claims of sufficiency principles and to examine whether they have something distinctive and plausible to offer. The article argues that sufficiency principles must claim that we have weighty reasons to secure enough and that once enough is secured the nature of our reasons to secure further benefits shifts. Having characterized sufficientarianism in this way, the article shows that the main objections to the view can be avoided; that we can examine the plausibility of sufficiency principles by appealing to certain reasons that support a shift; and that we should be optimistic about the prospects for sufficientarianism because many of our strongest reasons seem to be of this sort. This shift, I claim, is the overlooked grain of truth in sufficientarianism. © Cambridge University Press 2012.

The thesis aims at developing new, alternative approaches and methods based on suggestions and ideas originating from moral philosophy and philosophical decision theory. More precisely, the thesis aims at investigating the rationality of transport policy decisions, including goal-setting and performance evaluation. Paper I discusses rationality in road safety policy. Problematic features are identified and discussed. The paper argues that the Swedish road safety goal is rational, since it is action-guiding and achievement-inducing. This follows by observing that the goal satisfies the criteria of precision, evaluability, approachability, and motivity. The paper states that previous accusations of irrationality have been unnecessarily imprecise, since no reference is made to independently developed criteria of rational goal-setting. Paper II discusses the Swedish transport policy goals, and the role of social welfare in rational policy decisions. Goals often come into conflict and trade-offs must be rationally and consistently managed. Policy decisions are outcomes of political processes. In the case of policy goals and decisions, the agent is society. This introduces the problematic concept of social welfare, which itself is an ambiguous goal with many meanings. Whether a decision is rational or not depends on whose perspective one takes on – that of society as a whole or that of the actual decision makers. Paper III aims at investigating six different procedures for resolving goal conflicts: weighted average, lexicographic preference, conditional lexicographic preference, absolute restriction, generalised prioritarianism, and partial comparability. Criteria for selection, according to the respective procedures, are formulated and summarised in a table. The six procedures are contrasted with respect to their tendency to rule out possible sets of alternatives as being not choiceworthy. ; QC 20101123

Milton Friedman was one of the most influential and controversial actors in the debates on Corporate Social Responsibility (CSR) and, more generally, in the 20th century public debate. Through an inquiry on the concept of CSR and Friedman's moral theory, our thesis examines his position on CSR. In doing so, we contribute to the clarification of the neoliberal moral theory and conception of CSR. Milton Friedman's basic moral theory has rarely been studied in detail, which partly explains the lack of consensus on Friedman's conception of CSR. We begin this thesis by clarifying the concept of social responsibility and by defending a moralized version of this concept. We then propose two readings of Friedman's writings on CSR. We argue that the main message of these writings is that the efficient realization of a wide range of societal projects requires that individuals rationally pursue their conception of the good within an institutional framework consisting of coercive and non-coercive rules. Finally, we compare several readings of Friedman's moral and political theory and argue in favour of the superiority of a left-wing reading of this theory. Combined with our concept of social responsibility, this reading implies that the members of a society like ours behave in a socially responsible way by ensuring that they accomplish (at least some of) the actions that are (1) beyond the law and (2) required by an opportunity prioritarianism. ; Milton Friedman fut un des acteurs les plus influents et les plus controversés du débat sur la responsabilité sociale des entreprises et, plus généralement, du débat public du second 20ème siècle. Au moyen d'une enquête consacrée au concept de responsabilité sociale ainsi qu'à la théorie morale de Friedman, notre thèse examine sa position au sujet de la responsabilité sociale des entreprises. Ce faisant, nous contribuons à l'élucidation de cet incontournable des débats contemporains qu'est le néolibéralisme. La théorie morale fondamentale de Milton Friedman a été très peu étudiée en détail et cette carence de la littérature académique explique en partie que celle-ci soit divisée sur la question de savoir quelle est la conception friedmanienne de la RSE. L'ambiguïté du concept de responsabilité sociale y est également pour beaucoup et cette thèse commence par défendre un concept de responsabilité sociale. Nous proposons ensuite deux lectures des écrits consacrés par Friedman à la RS des entreprises et, en fait, des individus. Nous soutenons que le message principal de ces écrits est que la réalisation efficace d'une vaste gamme de projets de société requiert que les individus poursuivent rationnellement leur conception du bien au sein d'un cadre institutionnel composé de règles coercitives et non-coercitives visant notamment la mise en œuvre du mécanisme du marché. Enfin, nous confrontons plusieurs lectures d'ensemble de la théorie morale et politique de Friedman et nous argumentons en faveur de la supériorité d'une lecture de gauche de cette théorie. Combinée à notre concept de responsabilité sociale, cette lecture implique que les membres d'une société politique comme la société belge actuelle se conduisent de manière socialement responsable en prenant soin de conformer (au moins jusqu'à un certain point) leur conduite extra-légale aux réquisits d'un prioritarisme des opportunités de bien-être. ; (FILO - Philosophie) -- UCL, 2016

Milton Friedman was one of the most influential and controversial actors in the debates on Corporate Social Responsibility (CSR) and, more generally, in the 20th century public debate. Through an inquiry on the concept of CSR and Friedman's moral theory, our thesis examines his position on CSR. In doing so, we contribute to the clarification of the neoliberal moral theory and conception of CSR. Milton Friedman's basic moral theory has rarely been studied in detail, which partly explains the lack of consensus on Friedman's conception of CSR. We begin this thesis by clarifying the concept of social responsibility and by defending a moralized version of this concept. We then propose two readings of Friedman's writings on CSR. We argue that the main message of these writings is that the efficient realization of a wide range of societal projects requires that individuals rationally pursue their conception of the good within an institutional framework consisting of coercive and non-coercive rules. Finally, we compare several readings of Friedman's moral and political theory and argue in favour of the superiority of a left-wing reading of this theory. Combined with our concept of social responsibility, this reading implies that the members of a society like ours behave in a socially responsible way by ensuring that they accomplish (at least some of) the actions that are (1) beyond the law and (2) required by an opportunity prioritarianism. ; Milton Friedman fut un des acteurs les plus influents et les plus controversés du débat sur la responsabilité sociale des entreprises et, plus généralement, du débat public du second 20ème siècle. Au moyen d'une enquête consacrée au concept de responsabilité sociale ainsi qu'à la théorie morale de Friedman, notre thèse examine sa position au sujet de la responsabilité sociale des entreprises. Ce faisant, nous contribuons à l'élucidation de cet incontournable des débats contemporains qu'est le néolibéralisme. La théorie morale fondamentale de Milton Friedman a été très peu étudiée en détail et cette carence de la littérature académique explique en partie que celle-ci soit divisée sur la question de savoir quelle est la conception friedmanienne de la RSE. L'ambiguïté du concept de responsabilité sociale y est également pour beaucoup et cette thèse commence par défendre un concept de responsabilité sociale. Nous proposons ensuite deux lectures des écrits consacrés par Friedman à la RS des entreprises et, en fait, des individus. Nous soutenons que le message principal de ces écrits est que la réalisation efficace d'une vaste gamme de projets de société requiert que les individus poursuivent rationnellement leur conception du bien au sein d'un cadre institutionnel composé de règles coercitives et non-coercitives visant notamment la mise en œuvre du mécanisme du marché. Enfin, nous confrontons plusieurs lectures d'ensemble de la théorie morale et politique de Friedman et nous argumentons en faveur de la supériorité d'une lecture de gauche de cette théorie. Combinée à notre concept de responsabilité sociale, cette lecture implique que les membres d'une société politique comme la société belge actuelle se conduisent de manière socialement responsable en prenant soin de conformer (au moins jusqu'à un certain point) leur conduite extra-légale aux réquisits d'un prioritarisme des opportunités de bien-être. ; (FILO - Philosophie) -- UCL, 2016

The focus of this thesis is needs in the context of health care priority setting. The notion of needs has a strong standing in health care policy; however, how the idea should be understood more specifically and how it should guide decisions about priority setting remain contentious issues. The aim of this thesis is to explore how needs should be characterised in health care priority setting. This matter is approached by, first, exploring and developing the conceptual structure of health care needs, and second, discussing and suggesting solutions to normative questions that arise when needs are characterised as a distributive principle. In the first article, the conceptual structure of needs in general and health care needs in particular is explored, and it is argued that a specific characterisation of health care needs is required. In the second article, the notion of health care needs is explored in relation to preferences for health care within the context of shared decision-making. The paper further discusses a number of queries that arise in the intersection between what the patient needs and what the patient wants. The third article discusses how a principle of need should handle questions about interpersonal aggregation. The paper characterises a principle of need which strikes a reasonable balance between giving priority to the worst off and the distribution of benefits with regard to interpersonal aggregation. The fourth article discusses how a principle of need should account for the fact that patients often are badly off due to several conditions rather than one single condition. It is argued that how badly off patients are should be understood as a function of how badly off these patients are when all of their conditions (for which they need health care) are considered. The frame story provides the terminological, theoretical, contextual, and methodological background for the discussion undertaken in this thesis. The conclusions of the articles are brought together and the discussion extended in the concluding discussion by sketching a number of conditions of adequacy for the concept and principle of need relevant for health care priority setting. ; Den här avhandlingen fokuserar på behov och behovsprinciper inom hälso- och sjukvården. Behov har länge haft en stark ställning inom hälso- och sjukvården men det är omdiskuterat hur begreppet ska förstås mer specifikt och framförallt hur det ska vara vägledande för prioriteringar inom hälso- och sjukvården. Syftet med den här avhandlingen är att karakterisera behov för sådana prioriteringar. Avhandlingen tar sig an detta syfte utifrån två ansatser. För det första, genom att undersöka och utveckla den begreppsliga strukturen hos vårdbehov och, för det andra, genom att diskutera samt ge förslag på lösningar på ett antal normativa frågor som uppstår när vårdbehov skall karakteriseras som en fördelningsprincip. I den första artikeln undersöks begreppen behov och vårdbehov utifrån den allmänfilosofiska diskussionen om behov. I artikeln karakteriseras begreppet vårdbehov på ett sätt som gör det lämpligt för prioriteringar inom hälsooch sjukvården. I den andra artikeln utforskas begreppet vårdbehov i relation till önskemål om vård inom ramen för delat beslutsfattande. I artikeln diskuteras också ett antal frågeställningar som aktualiseras i relation till den spänning som kan uppstå mellan patientens behov å ena sidan och patientens önskemål å andra sidan. I den tredje artikeln behandlas frågan om hur en behovsprincip bör hantera frågor som rör sammanvägning av olika personers behov. I artikeln karakteriseras och försvaras en behovsprincip som balanserar prioritet till de sämst ställda och hur hälsovinster bör fördelas. I den fjärde artikeln förs en diskussion om hur en behovsprincip bör göra reda för det faktum att patienter ofta lider av samsjuklighet snarare än av ett enskilt tillstånd. I artikeln drivs tesen att hur dåligt ställt en patient har det bör förstås som en funktion av hur dåligt ställt patienten har det när alla patientens tillstånd (för vilka patienten behöver vård) har tagits i beaktande, snarare än hur dåligt ställt patienten har det med avseende på det specifika tillstånd för vilket patienten skall behandlas. I kappan ges den terminologiska, kontextuella, teoretiska och metodologiska bakgrunden för diskussionen i avhandlingen. I en avslutande diskussion förs slutsatserna från artiklarna samman och diskussionen utvidgas genom att skissera ett antal adekvansvillkor för begreppet vårdbehov och behovsprinciper i vården. ; I den tryckta versionen är det ena serienamnet felaktigt. I den elektroniska versionen är detta ändrat till korrekt "Linköping Dissertations on Health and Society"