Preliminary Distinctions Egalitarianism is a contested concept in social and political thought. One might care about human equality in many ways, for many reasons. An egalitarian might rather be one who maintains that people ought to be treated as equals—as possessing equal fundamental worth and dignity and as equally morally considerable.
The first part of the essay will discuss the capability approach and compare this to the welfarist and non-welfarist approaches. The second part will look into how these approaches fit into health economics and their importance in informing policy makers when decision is to be taken on policy formulation and implementation.
This notion the capability approach was developed by the economist and philosopher named Sen Amartya who was dissatisfied with the welfare economics in making social policy decisions. His concern was the fact that the utilitarianism considered individual preferences only and does not include other non-utility information such as rights e.
Also there has been further development by another philosopher Martha Nussbaum. What the capability approach considers important is that individuals should have the freedom to be able to make choices on how to live their lives.
This is very important in that these levels are not imposed but based on choice. A health example, occurs when a patient A does not have contraception because she has no access to contraceptive services and a patient B does not have contraception despite having access, but objects based on religious grounds being of the Catholic faithpatients A and B have the same functionings but B has a greater capability.
It is very important to differentiate between functionings and capabilities as they play different roles in different analysis He also described a distinction between well-being and agency goals of an individual.
There is no definitive list of capabilities. Thus Robeynsp 96 comments, "the capability approach thus covers all dimensions of human well-being".
Due to this extensive coverage of the capability approach it will therefore be very difficult to make a definitive list and Sen have explicitly refused from being forced into making a list. He has always argued that capabilities will depend on the context of its usage, though this has made other scholars see this as a limitation of the capability.
She also argued that a set of list will avoid the situation where any capability can be seen as valuable even if it is used to cause harm to others. In response to these criticisms Sen said that it was not an issue of listing important capabilities that is relevant but endorsing a predetermined list of capabilities.
An example of this is the human development index HDI which has been used by the United Nations UN since and adopted concepts from the capability approach. The selected functionings are life expectancy at birth, education adult literacy and education enrolment ratesand standard of living.
The human development has been criticised as being limited to three capabilities used in the HDI and Sen concluded that the selection of a list can be done by a democratic process according the purpose for which it is required as the list can be affected by many factors such as social, cultural and demographic settings.
Some work has been undertaken by some scholars on this but not without problems. Robeyns tried to make three distinct categories by which capabilities can be selected.
She distinguished between small and large-scale projects where there can debate in small groups and deliberation at conferences respectively.
And large-scale policy design, which is yet to happen. Robeyns also gave four criteria that all list should meet, 1 explicit formulation, be made explicit, discussed and defended, 2 methodological justification, clarify and scrutinise the method that the list came from, 3 looking at different levels of generality by making 2 lists as constraints may change over time and 4 exhaustion and non-reduction, in which all important elements are included in the list.
Robeyns further stated that these criteria should serve as check and balance so therefore anyone using them should consider the context so as to avoid bias that may result from their own background.
So how do we value the set of capabilities chosen?
The answer to this is the use of aggregation, which can be at the individual level where it will decided if there is a need to aggregate and what weight should be attached. This is referred to as intrapersonal aggregation, and the second type known as interpersonal is where the data is aggregated over the individuals.
The question is then how will a trade-off be done against different capabilities, because this can lead to loss of vital information which is the reason Nussbaum argued that the government should be able to give its citizens a minimum threshold of her ten capabilities instead of trading them against each other.
Similarly other scholars have argued against trade-offs as they view different capabilities as different entities that cannot be sacrificed for another.
It can seen that the literature of the capability approach remains largely conceptual and many scholars have attempted to put this theory into practice and one such is the study carried out by Anand et al developed a capability questionnaire which contained about 60 capability indicators from the British Household Panel Survey BHPS.
Alkire had argued that the vital and pertinent question was the probability of selecting a list of acceptable capabilities but Anand et al argued that it was probable but their results were incomplete.
But Coast et al went further and developed another method known as Investigating Choice Experiments for the preferences of older people CAPability instrument ICECAP capability index for older people in which they used 5 attributes and 4 outcomes, the attributes were attachment, security, role, enjoyment and control.
They used best-worst scaling method in which individuals were asked to make a choice between what they thought were the best or the worst and were not asked to make trade-offs so it can be concluded that it was their values and not preferences that was elicited.
The process by which capabilities should be selected is still unclear, which will always be a strong limitation as Robeyns p comments, "it is not clear how these processes of public reasoning and democracy are going to take place, and how we can make sure that minimal conditions of fair representation are guaranteed".
The welfarist object to this claim saying that any behaviour that falls short of utility maximisation even, if there is a commitment is a deviation from the welfarist approach.
DEVELOPMENT AS CAPABILITY EXPANSION Amartya Sen* CONTENTS Page The capability approach can he contrasted not merely with commodity-based systems of evaluation, but also with the utility-based assessment. The utilitarian notion of value, which is invoked (Oxford,. Amartya Sen. Martha Craven Nussbaum (/ ˈ n ʊ s b ɔː m /; born May 6, ) is an American philosopher and the current Ernst Freund Distinguished Service Professor of Law and Ethics at the University of Chicago, where she is jointly appointed in the Law School and the Philosophy torosgazete.com has a particular interest in ancient Greek and Roman philosophy, political philosophy, feminism, and ethics. Amartya Sen was born in a Bengali Baidya family in Santiniketan in West Bengal, Sen published Poverty and Famines: An Essay on Entitlement and Deprivation Sen further advanced and redefined the capability approach in his book Development as Freedom.
An almost exclusive focus on outcomes in evaluating policies and neglecting rights, duties e. Another key feature is individual sovereignty, which claims that individual are the best judges of their own welfare and as long as there can be an improvement with one individual without another being made worse there is improvement in societal welfare, but Coast et alp were quick to criticise this notion in policy terms saying that in any decision in health care where resources needs to be allocated to one group it has to be done at the expense of another.
This notion rejects paternalism i. The final assumption of the welfarist approach is the separation of efficiency and equity. Sen proposed that the focus on utility should be looked at a broader perspective which took into account the quality of the utility i.
The extra-welfarists argued that the most important outcome is not utility but non-utility parameters such as focus on the equity weights, characteristics, capabilities e. In other words they argued that the health outcome was the most relevant for conducting normative analysis within the health care setting.
However, there is some limitations, and first is the focus only on health whereas capability approach advocates the use of different features of capability. This makes it one-dimensional when compared with the multidimensional aspects of the capability approach e.
The third concern is that extra-welfarism assumes consequentialism and admits limited concern for equity weights because the maximisation of health is seen as the end result, whereas the capability approach is more concerned about equity and distribution.this is that Sen’s version of the capability approach is the broader and more general framework in comparison to Nussbaum’s, albeit she has done much more work on the approach in the last five to ten years.
2 The Capability Approach: Its Development, Critiques and Recent Advances By David A. Clark* Over the last decade Amartya Sen™s Capability Approach (CA) has emerged as .
Traveller type "A" Free Trader Beowulf, mesh model by JayThurman (Cyberia23); This section is basically a rough outline of Rick Robinson's Interstellar Trade: A torosgazete.com'd probably be better off reading the full article but some people want executive summaries.
2 The Capability Approach: Its Development, Critiques and Recent Advances By David A. Clark* Over the last decade Amartya Sen™s Capability Approach (CA) has emerged as the. Indian Economist and Philosopher, Amartya Sen' View of Justice.
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