Welfare Research Paper Example

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Abstract

The idea of personal welfare and the associated ideas of beneﬁt and harm play central roles in many bioethical settings. This entry introduces these ideas and notes their links to related ideas. It then examines the history and development of Western and Eastern traditions of philosophical and religious thought about welfare or wellbeing. After clarifying some conceptual issues, it presents an overview of rival hedonist, subjectivist, objectivist, and perfectionist accounts of the nature of well-being and examines relations between these accounts. It then considers relations between well-being and happiness, the role of birth and death and posthumous matters in wellbeing, and the various understandings of relations between well-being and the wider domain of ethics.

Introduction

Welfare is a matter of having things go well for oneself or with one’s life, and ill-being is a matter of their going ill. Among welfare’s friends and relations are well-being, happiness, utility, eudaimonia, self-interest, quality of life, fulﬁllment, ﬂourishing, and prudential good. In this entry, the terms “welfare” and “well-being” will be used interchangeably. One’s well-being is advanced by what beneﬁts or is good for one, and is diminished by what harms or is bad for one. Through prudence one seeks to protect and advance one’s well-being, and through imprudence one does the opposite. Through kindness, care, beneﬁcence, and non-maleﬁcence, among other ethical stances, one seeks to protect and advance the well-being of others or to minimize their ill-being. Most credible ethical frameworks give some place to such attitudes, actions, and character traits that are directed at well-being, and some give the prime roles to these. Many philosophical and religious traditions also offer accounts of the nature of well-being itself, plus views about the role of ethical considerations within it.

History And Development

Identiﬁed and examined and examined below are some of the leading conceptions of well-being expressed in the world’s philosophical and religious traditions and bioethical practices. Each body of thought and practice is sketched below in its own terms, and its points of connection and disconnection with other philosophical and religious accounts are then considered.

The West

In Western thought about well-being, the main philosophical traditions are eudaimonism, natural law theory, egoism, utilitarianism, and intrinsic value theory; and the main religious traditions are Christianity, Judaism, and to some extent Islam.

In the eudaimonist tradition of ancient Greece, well-being or happiness or ﬂourishing is nearuniversally taken to be the central ethical concern. Plato (c. 428–347 BCE) discussed a wide range of accounts of well-being (e.g., Fletcher 2016 essay 1). One such account applies to well-being Protagoras’s wider idea that the human being is the measure of the things that are and are not, to generate the idea that what appears to me to be well-being is well-being for me. A different account, taken up in different ways later in the ancient Greek tradition by Epicurus and by Aristippus, is that well-being consists in pleasure or good feelings. A further view is that a life of well-being is one that has certain basic goods in it, and Plato criticizes naive forms of this view that focus on putative goods such as power and wealth. Another distinct view that is perhaps Plato’s own is that the life of well-being is the life of virtuous activity and of wise activity in particular. For his part, Aristotle (384–347 BCE) argued that eudaimonia or well-being is a matter of relations between the features of one’s human life and one’s ergon or function, that the life feature in question is activity of the rational part of one’s “soul” in accord with virtue or excellence of character, and that such activity is good for us one because it is suitably related to one’s characteristic and distinctive human nature (e.g., Fletcher 2016 essay 2). A notable feature of many ancient Greek accounts is their view that substantial elements of ethics or morality feature prominently within well-being itself. In addition to the foregoing this-worldly accounts, Plato also examined whether things are good because the Gods favor them, or whether instead the Gods favor them because they are good.

Western religious traditions have substantially engaged with the main threads of ancient Greek thought about well-being (e.g., Fletcher 2016 essay 7). Themes established by ancient Greek philosophical debate indeed recur inﬂuentially and repeatedly through subsequent Western thought about well-being. There are echoes of Protagoras, for example, in the renaissance subjectivism that Shakespeare famously gave to Hamlet (Hamlet, c. 1599: Act 2, Scene 2): “there is nothing either good or bad, but thinking makes it so… nothing is really good or bad in itself.” The core subjectivist idea that well-being is having in one’s life things toward which one has a pro-attitude (e.g., Parﬁt 1984; Grifﬁn 1986; Railton 2003; Sumner 1996) is also the predominant account of well-being in contemporary western philosophy. The rival objectivist tradition heavily predominated in ancient Greek philosophy, and it also has a modest number of contemporary proponents. It holds that well-being is a matter of having certain good things in one’s life, whether or not one has, and indeed whether or not anyone has, any pro-attitude to those things (e.g., Parﬁt 1984; Grifﬁn 1986; Hurka 2011; Fletcher 2016 essay 12). Hedonists too can trace ancient Greek lineage for their view that well-being is a matter of having pleasure or pleasantness in one’s life and of not having pain or displeasure or unpleasantness in one’s life (e.g., Parﬁt 1984; Grifﬁn 1986; Feldman 2004; Crisp 2006; Fletcher 2016 essays 3 and 9). Perfectionists have similarly strong ancient Greek ancestry for their view that well-being is a matter having in one’s life things that express or develop or perfect one’s individual or group nature (e.g., Fletcher 2016 essays 10 and 15).

Some accounts of well-being are not easy to classify in terms of the above distinction between objectivism and subjectivism. Consider, for example, the divine will thesis that what is good for one is to live in accord with God’s plan for one. This implies that what is good for one is what a certain suitable person favors and that makes it a close relative of subjectivism. Yet its rejection of the subjectivist idea that one is authoritative about one’s own good pushes it instead towards objectivism.

The East

In the East, it is generally harder than in the West to distinguish the philosophical from the religious traditions of thought about well-being. Confucian, Buddhist, Daoist (e.g., Fletcher 2016 essay 5), and Hindu traditions are among those that are inﬂuential.

A central feature of the thought of Confucius (551–479 BCE) is its concern with the everyday affairs of practical living, and a central context that he addressed is that of well-ordered relationships within a stable community (e.g., Fletcher 2016 essay 4). Important to this orientation is a conception of virtues as qualities essential or at least helpful for facing the basic challenges people confront in their ordinary lives. In such settings, there is no clear need to distinguish virtues from prudential goods, and only limited point in separating out a life of virtue that embodies a Confucian communal orientation from a life of high prudential good. On a Confucian account, no prudentially good life could lack well-ordered and loving relationships within a stable community, and this implies that virtue and happiness are closely connected. On the later Confucian account of Mencius (391–308 BCE), if we develop certain tendencies that we can ﬁnd in our nature, we can achieve a ﬂourishing life, and a central feature of our nature is that we are moral animals. In these respects, Mencius’s account has signiﬁcant afﬁnities with the perfectionist and morality-involving view of well-being of Aristotle and most other ancient Greek philosophers.

The tradition of Buddhism (e.g., Fletcher 2016 essay 6) had its ﬁrst expression in the thought of the Buddha in India in the ﬁfth-century BCE. According to Buddhist conceptions of karma and rebirth, the moral quality of one’s life inﬂuences one’s future well-being in current and future lives. All lives in the cycle of rebirth are importantly deﬁcient in well-being, because they involve suffering, yet this cycle can also be escaped through attaining enlightenment. Buddhist virtues such as loving kindness have the well-being of others as their object, and insight into the nature of these virtues can consequently give insight into Buddhist conceptions of well-being. According to the Buddhist “no-self” thesis, on the other hand, there is no distinct personal entity that has identity through time. This presents a challenge to any conception of well-being that requires such entities and to any wider account of ethics that gives a role to any such conception of well-being. Various Buddhist views about this are made possible through that tradition’s distinction between ultimate and conventional truth, which might allow the latter but not the former status to belief in a persisting self who is the subject of individual well-being. The no-self thesis might be thought to offer some personal relief because it implies that ills such as suffering are fundamentally not one’s own, but it also seems to imply that goods such as pleasure and knowledge are fundamentally not one’s own either. Buddhist and Hindu belief in the cycle of rebirth illustrates also the point that further complexities about well-being need consideration if one does not follow the widespread contemporary western philosophical practice of treating one’s death as the permanent cessation of one’s existence. Further challenges to many understandings of well-being are presented by the Buddhist idea that it is possible to generate nirvana through attaining enlightenment and thus by escaping the cycle of rebirth. Nirvana is said to be a state without perception, action, or consciousness. If all constituents of well-being involve some such mental elements, then even if attainment of nirvana makes for a better state of the universe, it does not do so by making any contribution to anyone’s well-being.

Conceptual Clarification

Some issues about well-being arise whichever substantive account one has about the nature of well-being. Such conceptual matters are considered below.

The nature of well-being, debated among perfectionists, hedonists, subjectivists, and objectivists alike, is distinct from the matter of which stances it is ethically best to take toward wellbeing. Questions of the latter sort include the epistemic issue of who is the best judge of one’s own good, the moral issue of whose say should have most inﬂuence on practical decision-making when one’s own good is at stake, and the political issue of how public policy should treat the various rival conceptions of individual good or wellbeing. In general, it is a mistake to attribute to any theory of the nature of well-being, such as objectivism or subjectivism or perfectionism or hedonism, any view about any such epistemic or moral or political issue. For example, objectivism about well-being on its own does not have implications either for or against paternalism. To generate such practical implications, one needs to combine an account of the nature of well-being with further views about well-being’s justiﬁcatory connections to belief or morality or policy.

Accounts of well-being tend implicitly to take able human adults as the central cases, and their credible application to very young humans is not always assured. There are several rival views about what scope of accounts of well-being should have (e.g., Fletcher essays 30 and 31). One possible view, taken by most perfectionists, is that all human beings are covered by one account of well-being, leaving open the possibility that nonhuman beings are covered by one or more other accounts. A different view is that any subject of well-being must meet certain general conditions such as sentience, but then a single theory of well-being covers all beings that meet such conditions. A third view is that one theory of well-being covers all human and nonhuman entities whatsoever that can meet its substantive conditions, which subjectivism states to be desire fulﬁllment conditions, hedonism states to be capabilities for pleasant or unpleasant mental states, and objectivism states to be capabilities for pleasure or knowledge or friendship or autonomy or achievement.

Perfectionism, hedonism, objectivism, and subjectivism are accounts of well-being’s noninstrumental constituents. They aim to pick out those things in our lives, or features of our lives overall, that are in themselves good for us, setting aside any good that they cause or prevent or enable or block or cost. A thing’s instrumental good or bad is instead that which is due to something further that it causes or prevents or enables or blocks. Goods such as money seem to be instrumental goods only, while such goods as pleasure seem to be noninstrumental goods and typically instrumental goods too. It seems impossible for any one feature to be noninstrumentally both good and bad for us, but it is possible and commonplace for a thing to be instrumental in both good and bad for one. One’s overall or all-things-considered good includes both one’s noninstrumental good and one’s instrumental good. Some might claim, for example, that self-knowledge is noninstrumentally good, while also allowing that there can be circumstances in which the burdens of acquiring or living with self-knowledge make it bad overall for one. Normative-ethical inquiry is apt for examining what is noninstrumentally good, and empirical inquiry is apt for investigating what is instrumentally good.

On relations between well-being and morality, one sort of issue concerns what place if any morality has within well-being. Some (e.g., Railton 2003) argue that there is such a thing one’s nonmoral good, and that it can be part or the whole of a nonmoral basis for morality. A rival idea that has many ancient and modern sources in both the East and the West is that one’s well-being is morality-involving (e.g., Darwall 2002; Fletcher 2016 essays 1–7, Feldman 2004 pp. 120–123). Another issue about relations between well-being and morality concerns what place if any well-being has morality. Welfarism about morality is the idea that considerations of well-being fundamentally explain all moral evaluations. Utilitarianism and egoism about morality are two different examples of welfarist accounts. Most accounts of morality accept the more modest claim that considerations of well-being have some explanatory role to play in some moral evaluations. Kantian accounts imply the rival view that well-being has no central explanatory role in moral evaluation, with such roles played instead by agency, freedom, reason, and respect.

Measurement of well-being is an issue in various areas of practice. Researchers might measure 5-year survival rates, for example, when comparing the harms or beneﬁts to participants from the different interventions in two arms of a clinical trial. Those researchers might or might not think bare duration of survival is a constituent of well-being, but they do typically think it is a good measure or proxy for wellbeing in such settings. Similar points also apply to other measures of well-being in various settings, including Quality Adjusted Life Years (QALYs), Disability Adjusted Life Years (DALYs), and various self-report measures of quality of life or life satisfaction. The 5-year survival measure has objectivist character, while self-reported life satisfaction is a subjectivist measure. Since these need only be proxies or measures, those who use them need not thereby commit to any objectivist or subjectivist theory of well-being.

One view about relations between health and well-being is that health is just an all-purpose means to well-being and thus a key instrumental good, but is not good in itself or noninstrumentally. A rival view is that health is a noninstrumental good and also one among other instrumental goods. In a 1984 document, the World Health Organization stated the further rival view that health and well-being are one and the same because health is: “a state of complete mental, physical and social wellbeing.”

A further big-picture issue (e.g., Fletcher 2016 essay 28) is whether well-being is largely or wholly a matter of experiences, activities, relationships, and so forth within one’s life, or is also or instead a matter of whole-of-life features, such as the overall shape or trajectory or narrative of one’s life.

Ethical Dimension

Hedonism

Hedonism claims that for things to go well for oneself or with one’s life is for one to get pleasure and to avoid pain or displeasure. This implies that only mental states or properties, and indeed just these “hedonic” ones, are constituents of one’s well-being. Hedonists themselves have diverse views about the nature of pleasure and displeasure. One account implies that pleasure and displeasure states or properties are distinguished by their experiential or phenomenal or felt character (e.g., Crisp 2006; Fletcher 2016 essays 16 and 17). Another is that they are attitudes that have objects (e.g., Feldman 2004). A further option is that some pleasures and displeasures are phenomenal and others are attitudinal. Another view is that all pleasures and displeasures are both phenomenal and attitudinal; for example, that they are attitudes that have felt character. Hedonism about well-being has substantial pedigree traceable back to at least Plato’s fourth-century-BCE dialogue Protagoras at lines 251b–c and remains active in contemporary theorizing about well-being. One inﬂuential charge against hedonism is that not all instances of pleasure are constituents of wellbeing. More prominent still is the charge that matters other than pleasure, perhaps including understanding oneself and one’s world, performing successful actions, self-authorship, and having loving or caring relations with others, are constituents of well-being and cannot be boiled down just to matters of pleasure.

Subjectivism

Desire theory claims that well-being is a matter of getting in one’s life what one desires. The wider subjectivist view is that well-being is a matter of getting in one’s life those things toward which one has a certain pro-attitude (e.g., Railton 2003; Sumner 1996; Fletcher 2016 essay 11). This basic subjectivist idea can be developed in many ways, but the leading shared thought is that we individuals are in some way each authoritative about our own well-being. Stated more formally, the subjectivist idea is that one’s own favorable regard for a thing is necessary, or sufﬁcient, or both, for it to be a constituent of one’s well-being. While an objectivist might claim that knowledge, friendship, achievement, and pleasure are good in themselves for anyone who has them under any conditions, subjectivism implies that being an object of one’s favor is always a condition on being a constituent of one’s well-being. Subjectivism is typically though not essentially a monist view about the conditions for well-being. Two critical responses to subjectivism are that some things one favors are not good for one and that one does not favor all the things that are good for one. One way for subjectivists to respond is to say that one’s good is a matter of what would be desired for one by a better informed and more imaginative variant of oneself (e.g., Railton 2003). Two follow-up issues are whether such idealization would ﬁx all problems that our actual and nonidealized stances generate and is consistent with subjectivism’s basic thought that each of us is authoritative regarding our own well-being. Most individuals are also capable of many different sorts of pro-stance, and these can disagree with one another, so subjectivists should say which pro-stance does their job of accounting for wellbeing and why it is that pro-stance and not some other.

Objectivism

Objectivism claims that certain things are good pro tan-to (i.e., “as far as that goes”) and others are bad pro tan-to for anyone in any circumstances, whether or not she or he favors the good things or disfavors the bad (e.g., Parﬁt 1984 p. 499; Fletcher 2016 essay 12). Candidate objective goods include pleasure, knowledge, friendship, autonomy, and achievement. Most objectivists think there is a basic plurality of objective goods, but monist objectivism is also possible. With the exception of its universalist rejection of any subjectivist condition, objectivism can even be a particularist thesis that the existence and the polarity or valence of well-being always depends on the full and variable particulars of the case. “Intrinsic good” objectivism claims that certain features of the intrinsic nature of knowledge or pleasure or achievement make any of its instances good for anyone who has it. Perfectionist objectivism instead grounds well-being on some objective relation between the good thing in question and the nature of the individual who has it. A key task for objectivists is to spell out which things these putative objective goods are, and which features of their intrinsic nature, or of their relation to their subjects’ nature, make these and only these things objective goods. Some leading allegations against objectivism are that it is an alienating theory, it cannot account for reasons of well-being or for individual variation or authority, and it is arbitrary or has implausible metaphysical implications or is just a shapeless heap of goods rather than a theory. Objectivists make various responses to these charges.

Perfectionism

Perfectionists claim the constituents of well-being are those things that stand in a certain relation to one’s nature as an individual or as a member of a certain group (e.g., Hurka 1993; Nussbaum 2011; Finnis 2011; Fletcher 2016 essays 10 and 15). They are diverse in how they specify this relation, and candidates include the expression, development, realization, or perfection of one’s nature. They are diverse too in their views about which aspects of one’s nature are the relevant ones. Some emphasize the nature of each individual (e.g., Fletcher 2016 essay 14), others emphasize the shared nature of a certain group to which one belongs, such as the group of human beings or of persons. Another sort of diversity among perfectionists sees some focus on what is distinctive or unique, and others on what is characteristic or essential, to the nature of the relevant individual or group. Objectivist perfectionism, prevalent in ancient Greek eudaimonist accounts (e.g., Fletcher 2016 essay 15), implies that one has the nature one has and has or lacks the welfare-making relation to that nature, independently of any positive stance one has or would have toward either these things or that nature. One sort of subjectivist perfectionism instead claims that addition to human well-being is a matter of being an object of natural human desire. One criticism of perfectionism is that there are some unattractive features or mixed blessings that are characteristic or distinctive of us, such as a tendency to violence or a capability to light ﬁres, making development or expression of such things an unattractive prudential ideal. Another criticism is that while the rival hedonist and subjectivist and objectivist accounts of well-being can also straightforwardly offer parallel accounts of ill-being, the perfectionist idea of developing or expressing or perfecting one’s nature is harder to transform into a parallel account of one’s ill-being.

Relations Among Theories Of Well-Being

Objectivism and subjectivism are sharply rival accounts; but perfectionist and hedonist views can additionally be either subjectivist or objectivist, or instead indeterminate and thus agnostic on that issue. Hybridization among the four sorts of theory is also possible (e.g., Fletcher 2016 essay 13). One sort of hybrid claims that at least two different types of theory each supply a necessary condition and that meeting all these necessary conditions is also sufﬁcient, for well-being. A hybrid of this sort between objectivism and subjectivism would claim that any constituent of one’s well-being must be an objective good that one has, such as knowledge or friendship or pleasure, toward which one must also have a certain pro-stance. A different sort of hybrid view claims that at least two different types of theory each supply a sufﬁcient condition for well-being and that meeting at least one of these is also necessary. Such a hybrid between hedonism and perfectionism would claim that the life of well-being must either be pleasurable or develop its subject’s distinctive or characteristic nature. The ideal hybrid is that which keeps its parents’ strengths and drops their weaknesses.

Well-Being And Happiness

In recent centuries, the long tradition of philosophical and religious reﬂection and theorizing about well-being has been joined by substantial work in other disciplines and multidisciplinary settings, on happiness, utility, the quality of life, and the standard of living. One helpful distinction that can be applied across all these various inquiries is between those undertaken from the outset as inquiries into empirically discernable psychological and social matters, and those undertaken from the outset as normative inquiries into what is prudentially ideal or desirable or valuable or reason-giving. In recent decades, a lot of work has engaged these different well-being-related inquiries with one another, made hybrids among them, or acted on a meta-thesis that rejects the idea that there is any important distinction between these two forms of inquiry. There is now also good work that both surveys and substantially contributes to this diverse and active ﬁeld of inquiry (e.g., Tiberius 2008; Haybron 2008; Fletcher 2016 essays 32 and 40).

Births, Deaths, And Afters

Most accounts of well-being focus on goods and bads in life, or of life as a whole. Further important well-being-related issues arise about life’s start, end, and afterglow.

It is widely thought that death typically harms the one who dies and that this is because it deprives one of some of life’s goods (e.g., Fletcher 2016 essay 26). But when one’s prospects are sufﬁciently bleak, this deprivation-based view tends instead to imply that death beneﬁts the one who dies. In such cases, death instead “deprives” the individual of things that are bad overall when taken collectively. A further complexity concerns whether the bare matter of being alive is prudentially good even when that life’s informed subject has a contrary view. If death is life’s permanent cessation, then additional perplexing issues also arise about when any harm or beneﬁt of death occurs, and to whom it occurs.

Life’s start too is a focus of well-being-related debate (e.g., Fletcher 2016 essay 35). Is it a beneﬁt to the one who is thus caused to exist? If so, then is this because of the beneﬁcial features in life or of life that it makes possible? On such an account, might there then also be some cases in which causing someone to exist instead harms that one, by giving her or him life prospects that are sufﬁcient bleak overall? Finally, some have also made the puzzling claim that being caused to exist can be an overall harm to that individual even if her or his life is one of positive well-being overall.

If the good or the bad of life’s beginning and of life’s end allows the foregoing wide range of potential judgments, then wider ethical issues also arise. For example, might an ethic of “ﬁrst do no harm” have more revisionary ethical implications in certain start-of-life and end-of-life contexts than is usually thought? At least since Aristotle, there has also been debate – even among those who think there is never any such thing for an individual as life after death – about whether certain things that happen after one’s death can make a difference to how well one’s life went for one (e.g., Fletcher 2016 essay 26). Consider, for example, the view that achievement is in itself good for its agent. On this view, it seems that whether one achieves and what one achieves, and thus also what level of well-being one achieves, can depend on how one’s actions play out after one has died. This seems to be so in the possible case in which your engineering work around the foundations of the Tower of Pisa stabilizes and secures that building against collapse, but some of those crucial ground shifts occur only after you have died. On the other hand, those who think there is a sharp separation between agency and well-being, or that only the internal feel of our mental states can in itself make any difference to one’s well-being, will tend instead to think that no such posthumous development can make any difference to one’s well-being.

Well-Being And Ethics

There are two main issues about relations between well-being and ethics. One issue is the role of ethics in well-being, and the other is the role of well-being in ethics.

Plato and Aristotle each argued that virtuous activity has a central place within well-being. Aquinas and some other Western religious thinkers had similar thoughts and so have numerous others subsequently. Several Eastern traditions, including those of Buddhism, Daoism, and perhaps Confucianism, prominently articulate kindred views. A rival understanding that has gained prominence in recent Western philosophical thought is that one’s well-being is instead a nonmoral matter. One motivation for this rival understanding is a naturalistic or reductionist wish to ground morality on a nonmoral basis and to regard well-being a prominent part of that basis. Another source of attraction of the idea that one’s good is nonmoral is a wish to head off the threat of circularity facing any view that takes well-being to be partly a matter of morality and morality also to be partly a matter of well-being.

Perfectionists, hedonists, subjectivists, objectivists, and others debate the nature of well-being. That issue is distinct from the epistemic issue of who is the best judge of one’s good, the moral issue of whose say should hold sway in practical decision-making about one’s good, and the political issue of how those who make public policy should treat the various rival conceptions of individual or personal good. On the epistemic issue, every theory of wellbeing except the simplest forms of subjectivism can allow that each of us is fallible and can be mistaken about our own good, just as we are each fallible about pretty much every other signiﬁcant matter. Each theory of well-being can also allow that, with important qualiﬁcations and exceptions, each of us is the best judge of our own good. When each of us is indeed the best judge of our own good, that is one count in favor of giving our say about this matter more practical inﬂuence than anyone else’s say. But even when one is fully competent and informed, this still might not carry the ethical day, because one’s own well-being might not be the only ethically signiﬁcant consideration in the case, and one might also not be the only agent or subject in the case.

One complexity about the place of well-being in morality concerns whether all harms and beneﬁts are morally important in all contexts (e.g., Beauchamp 2013). This issue also bears on whether one’s own say should hold the most sway in practical decision-making involving one’s well-being. To illustrate these general points, consider the account associated with bioethicist Edmund Pellegrino, according to which the end or goal of medicine is and is only the healing and perhaps the palliation of illness and disease. On such an account, it is morally inappropriate for medical practice to act for any other sort of beneﬁt or against any other sort of harm than these. These restrictedscope conceptions of medical beneﬁcence and non-maleﬁcence would also restrict the scope of ethical justiﬁcation for medical provision of some services, perhaps including those for fertility control and enhancement, cosmetic surgery, or to serve patient requests to hasten death. On the Pellegrino-style account of medicine’s end or goal, if a patient requests medical treatment to provide beneﬁt or prevent harm beyond healing or palliation of illness or disease, then a doctor who declines this request need not necessarily be engaging in any form of paternalistic decision-making.

Welfarism about morality is the claim that any moral evaluation is fundamentally to be explained in terms of welfare or well-being (e.g., Sumner 1996; Fletcher 2016 essay 34). Utilitarianism, egoism, and eudaimonism about morality are three different forms of welfarism. Kant’s theory is a contrasting nonwelfarist account, in which our agency and reason and freedom are central, and according to which morality is not a matter of well-being but is instead the basis of our worthiness to have well-being.

Seeking not to adjudicate between Kantian, utilitarian, eudaemonist, egoist, and other rival general accounts of morality, many ethical thinkers focus on mid-level moral principles or duties or rules or virtues (e.g., Beauchamp 2013). These include, but on many accounts are not limited to, well-being-directed moral considerations such as kindness, benevolence, beneﬁcence, and non-maleﬁcence. Some claim that mid-level ethical considerations are prima facie (“on the face of it”) considerations that might on occasion be silenced or even reversed themselves in their valence or polarity by other factors in the case. Others claim they are ethical considerations pro tanto (“as far as that goes”) that on occasion are overridden though not silenced or reversed by other more important considerations. A third and less common “absolutist” view is that there is at least one moral factor that always overrides all others in any case in which it is at stake and thus carries the overall moral conclusion.

Beneﬁcence is the stance of acting for another’s beneﬁt, and non-maleﬁcence is the stance of acting against another’s harm. On one wider ethical conception, adopted for example in the long-standing medical-ethical ethos of “ﬁrst do no harm,” non-maleﬁcence has some ethical priority over beneﬁcence. On a rival ethical conception, adopted for example by proponents of utilitarianism, there is fundamental ethical neutrality between considerations of non-maleﬁcence and those of beneﬁcence.

A relative of the welfarist idea that all moral evaluations are ultimately to be explained in terms of well-being is the idea that the only basic mid-level moral considerations are well-being directed. Those who hold that autonomy is itself a constituent of individual well-being can take this view, but many advocates of autonomy instead hold this factor to be independent of well-being. Many ethical thinkers also hold both that there are ethical considerations of justice and that not all of these can be captured by considerations of wellbeing. But here as elsewhere there are also determined welfarists about morality who argue otherwise.

Conclusion

This entry has canvassed many conceptions of well-being from Western and Eastern traditions of thought and practice. Its account is illustrative rather than complete, as there are some major traditions that space considerations prevent it from considering. Debate over the nature of well-being is distinct from debate about who is the best judge of well-being, about how wellbeing is connected to morality, about how those who make public policy can best treat the plurality of reasonable conceptions of well-being, and about how well-being is best measured for various purposes in various settings. These other wellbeing-related matters are brieﬂy canvassed also above.

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