The prefix ‘eu’ implies ‘wellness’ or ‘goodness’ and so exposes the supposed ‘spiritual’ dimension of our human existence to moral judgement as to the nature of human virtue. Axiomatically, this frames the person in her social context. Through the concept of eudaimonia this book will not concern itself with the many religious interpretations of spiritual well-being, but with secular interpretations bearing upon the social context through which personal identity and the human ‘self’ are ethically or morally constituted.
We are seeking here to drive the analysis deeper. Recalling Titmuss’ assertion (cited in Chapter 1) that no division can be made between ‘individual’ and ‘social’ need, the distinction between ‘thin’ and ‘thick’ need that we explore in this chapter embraces the axiomatic connectedness of the individual and the social, while nevertheless examining differences in conceptual emphasis. That which is thin and hedonically conceptualised is focused upon individual subjective experiences of needing. That which is thick and eudaimonically conceptualised is focused on the relational and intersubjective context of needing.
Thin needs and hedonic notions of well-being
Mention was made in Chapter 1 of everyday ‘moralistic’ and ‘economistic’ meanings that may attach to human needs. As to the former, these are premised at root on the ‘thin’ morality characterised by Hobbes’ (1651) notion of society as a ‘war of all against all’ and the minimum necessary restraints that should be imposed upon the freedom of the individual in pursuit of her own hedonic well-being. At their most extreme, such meanings may become fundamentally asocial and/or misanthropic. They imply that a failure to achieve self-sufficiency and to meet one’s own needs is morally blameworthy (for example, Smiles, 1859). Understandings of this nature, which may in practice marginalise human need, have a residual influence within social policy; an influence that may gather in significance with the global rise of right-wing populism (Grayling, 2017; and see discussion of ‘supremacist humanism’ in Chapter 2).
As to economistic meanings, we shall see in Chapter 4 that if the human being is regarded as a utilitarian subject or as a market actor her needs may be understood in terms of her objective interests or her subjective preferences, respectively (and see also the discussion of ‘liberal-individualist humanism’ in Chapter 2). These are ‘thin’ understandings in the sense that the human being is abstractly construed as a calculative actor with, at best, incidental regard for her inner feelings or her social identity. Such understandings are premised on assumptions about the nature of utility on the one hand and of human happiness on the other.
From utilitarianism to welfarism
The hedonic approach to human well-being found expression in the 19th century in English utilitarianism. And utilitarianism found its clearest expression in the work of Jeremy Bentham. As Hobsbawm has put it, arithmetic was the fundamental tool of the era and for Bentham and his followers, particularly:
Happiness was the object of policy. Every man’s pleasure could be expressed … as a quantity and so could his pain. Deduct the pain from the pleasure and the net result was his happiness. Add the happiness of all men and deduct the unhappiness, and that government which secured the greatest happiness for the greatest number was the best. (Hobsbawm, 1968: 79)
Such a calculus could by implication justify inflicting disutility (that is, pain) upon any who threatened the happiness of the majority. So it was that in England a Benthamite approach to social policy resulted in the creation of the Victorian workhouse and the principle of ‘lesser eligibility’ (D. Fraser, 2017). The workhouse was deliberately contrived to be a place of wholesome horror compared even to the hardships endured by the poorest self-sufficient labourer. None but the most desperate would seek relief on such terms. In this way the pressure upon the destitute to be self-sufficient was maximised, and the cost of Poor Rates (a tax borne by property owners) was minimised. The misery of the pauper would promote the greater happiness of the population in general (and property owners in particular).
This represents a draconian illustration of utilitarian or ‘consequentialist’ (for example, H. Bochel et al, 2005: 197–8; Fitzpatrick, 2008) social policy. Nonetheless, it encapsulates founding elements of a ‘welfarist’ approach that continues more widely to inform social policy (Jordan, 2008). Welfarism here is taken to refer to a particular kind of thinking that assumes that social policy intervention should be judged by its aggregate effects, rather than the well-being of any particular individual. It is also premised upon certain assumptions about what motivates people: pleasures or rewards provide incentives; pain or punishment provide disincentives. Policy may be used to induce or to reinforce the behaviour most likely to generate beneficial overall outcomes (see, for example, Baddeley, 2017; Thaler & Sunstein, 2008).
The global North in the 20th century witnessed the emergence of welfare states that began to make systematic provision for meeting ‘welfare’ needs, including healthcare, education, housing and social security. But rights to welfare came with strings attached. Entitlement to various kinds of welfare were and can still be subject to the good character, the good behaviour or the healthy lifestyles of recipients; or expressly conditional upon the recipients’ participation in training or work experience, or upon ensuring their children attend school. The extension of state administration into the field of welfare extended its capacity to control people’s lives in the cause of the greater good (Garland, 1981), a development that with the development of Conditional Cash Transfers now extends to parts of the global South (Leisering & Barrientos, 2013).
As we shall see in Chapter 4, the political calculus of utilitarianism has its counterpart in welfare economics, which has attempted to bring neo-classical economics to bear upon the analysis of human well-being; and the principles of cost-effectiveness analysis to bear in public policy making. This has, for example, been especially relevant in healthcare policy, especially when new treatments are generated by technological and medical advances, giving rise to what has been called ‘technical need’ (Forder, 1974). But the cost of such innovation may exceed the resources available. When public access to life-saving procedures is to be rationed, difficult decisions have to be taken.
The best known example of how this might be done is the system of QALYs (Quality Adjusted Life Years) developed amid some controversy in Oregon, US (and once considered for use in the UK) (H. Bochel et al, 2005: 203; A. Williams, 2005). QALYs can be used to evaluate whether the cost of surgery or some other form of healthcare intervention is justified; whether a person’s life is ‘good enough’ to be worth saving. They indicate the length of time a patient can expect to achieve an acceptable quality of life as a result of treatment, however, the measure of quality of life – the Rosser Index – is a classic example of a hedonic calculus. It evaluates degrees of disability in one dimension (ranging from ‘none’ to a ‘state of unconsciousness’) and degrees of distress in another (ranging from ‘none’ to ‘severe’) in order to compute a matrix score (ranging from 1.0 for ‘healthy’ to 0.0 for ‘dead’) (Gudex, 1986; Kind et al, 1982).