Well-Being and Health

This view is developed by Norman Daniels [7] .

See Froberg and Kane [8] and Nord [17]. Some of the preference elicitation techniques are briefly described in note 15.

See Bowling [1].

See Murray [15].

For the sake of simplicity, we assume that the well-being function is additive: w =  h ₁ d ₁ + h ₂ d ₂. Sometimes the same assumption is made in HRQOL measurement when a summary value of quality of life is determined by adding up the scores obtained for different aspects of life. QALYs and DALYs are derived in more complex ways, but this does not affect the argument.

Both the technical term and to a large extent the problem of well-being in contemporary philosophy were introduced by James Griffin [10].

I borrow the notion of goodmakers from Moore [14].

The latter formulation is by Griffin [10: 11]. For other versions of this type of theory, see, for instance, Railton [19] and Brandt [2].

Here I put these problems aside. See, for example, Griffin [10], Scanlon [20], and Sumner [21] for discussions of some of the major controversies.

It may be objected that hedonism can be pluralistic about the components of well-being as well. For instance, hedonists may claim, rather than that conscious experiences are the only good, that all goods must be experienced. This excludes the possibility that a person who has false beliefs about her experiences can benefit from her illusory experiences. (This possibility has seemed to many philosophers a central feature of hedonism, and they have objected to it on this ground.) Hedonists, of course, are free to modify their theory this or some other way.

One criticism of objective list theories is that all they do is to provide a list of components of well-being without an adequate account of their goodmakers. See, for instance, Sumner [21: 45–46].

Griffin argues that if the informed preference (or desire) satisfaction theory is worked out fully, then it becomes indistinguishable from a substantive account of well-being. (See his remarks in Crisp-Hooker [5: 281–285].) He thus believes that familiar distinctions between reason and desire or subjectivity and objectivity are untenable with regard to theories of well-being. Thus, the question whether the items on the list are identified by the proper appreciation of their nature or they are identified by the desires formed on the basis of the proper appreciation of their nature ceases to be salient. See Griffin [11: 32–36].

Qizilbash’s argument is different. He thinks that since Griffin includes minimum material provision—which has only instrumental value—as a sub-item of the components of human existence, we are free to include other necessary conditions of well-being as well. But actually Griffin mentions having the minimum material goods only as an example of what might be indispensable for having the basic capabilities that enable one to act. He lists it neither as an item nor as a sub-item. So introducing instrumentally valued items on the list is a genuine innovation on the part of Qizilbash. See Qizilbash [18: 2011].

In contrast, reliability, which was referred to in the last paragraph, concerns the extent to which the measurement based on some set of indicators produces consistent results. Both are commonly regarded as necessary conditions for sound measurement tools. There are different types of reliability and validity, and different methodologies of establishing them for indicators and measurement procedures. As opposed to other types of validity, establishing content validity is largely a conceptual matter. In the context of health evaluation, validity and reliability are discussed in Froberg and Kane [9].

More precisely, they may be asked to form preferences regarding the time they would be willing to sacrifice to live in a healthy condition rather than with diminished health (time trade-off technique). Or they may be asked to consider the alternatives of living in a diminished health state for some number of years on the one hand, and living in full health for the same number of years but with some probability p of death, on the other, and indicate the value for p at which they would be indifferent between the alternatives (standard gamble technique). In DALYs, variants of the person trade-off technique are used: respondents are asked to trade-off life extensions (or health improvements) for some number of people with some condition and some number of people in full health.