Journal of Practical Ethics

This article considers some different views of fairness and whether they conflict with the use of a version of Cost Effectiveness Analysis (CEA) that calls for maximizing health benefits per dollar spent. Among the concerns addressed are whether this version of CEA ignores the concerns of the worst off and inappropriately aggregates small benefits to many people. I critically examine the views of Daniel Hausman and Peter Singer who defend this version of CEA and Eric Nord among others who criticize it. I come to focus in particular on the use of CEA in allocating scarce resources to the disabled.

This essay contends that the constitutive elements of well-being are plural, partly objective, and separable. The essay argues that these elements are pleasure, friendship, significant achievement, important knowledge, and autonomy, but not either the appreciation of beauty or the living of a morally good life. The essay goes on to attack the view that elements of well-being must be combined in order for well-being to be enhanced. The final section argues against the view that, because anything important to say about well-being could be reduced to assertions about these separable elements, the concept of well-being or personal good is ultimately unimportant.

The principle of assistance says that the global rich should help the global poor because they are able to do so, and at little cost. The principle of contribution says that the rich should help the poor because the rich are partly to blame for the plight of the poor. This paper explores the relationship between the two principles and offers support for one version of the principle of assistance. The principle of assistance is most plausible, the paper argues, when formulated so as to identify obligations that arise from the needs of particular identifiable members of the global poor, not from impersonal rules or values. Under that formulation, the principle can explain why knowledge of the circumstances faced by individual members of the global poor can have such a marked effect upon the willingness of the global rich to provide help, and can offer a better grounded motivational basis for helping the global poor. These are real advantages, the paper argues, and ones that cannot be matched by stories that focus upon the ways in which the global rich contribute to global poverty.