Commentary on "How Should We Measure Need?"

Max Marshall's carefully crafted paper raises the interesting question of the epistemology of need. "Need" is an objective concept, in the sense that one can have a need without being subjectively aware of it or desiring that it be met. In this sense, then, it is unlike the notion of "conscious desire." In the case of an alleged conscious desire, we would usually accept that the alleged desirer has the final say in whether she does indeed have the desire (though there will be exceptions, such as cases of self-deception).

Marshall suggests that the mistake in the MRC schedule is the assumption that needs are to be assessed from a single point of view. This assumption itself arises from a kind of subjectivism about need, according to which the truth of an ascription of need depends on the person or group making the ascription. If the assumption were not made, we would be left with the possibility of contradiction: I say that patient P has need n; you deny it; and yet we may both be right. Marshall argues, plausibly, that the views of caregivers and patients are also relevant to assessing need, thus denying the subjectivism. His argument implies that an attribution of need is true or false depending on, and only on, whether the need attributed is indeed present. The reason for taking the views of all parties into account is that this is likely to bring us closest to the truth.

One question raised by this attractive account of the epistemology of need concerns well-being. Someone might claim that needs are morally relevant only to the extent that their fulfillment advances the well-being of the person concerned. Who, then, is to decide what constitutes well-being? It has commonly been assumed that the answer to this question in any particular case must be supplied by the person concerned. But Marshall's multi-standpoint epistemology raises the possibility that this notion might be carried across to the assessment of well-being itself.

Let me end by noting another distinction that may be drawn insufficiently clearly in both the MRC schedule and Marshall's paper. This is the difference between a claim of the form 1, "There is a need to give x to P," and a claim of the form 2, "P has a need for x." Consider Marshall's discussion of his second example, just before his conclusion. He claims that it is relevant to assessing the need of a patient whether that patient's behavior is causing stress to caregivers. But this may be relevant only in deciding whether a claim of form 1 is true in this case.

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