The Quality of Life (Wider Studies in Development Economics)

526 Pages·1993·4.28 MB·English

by  Martha Nussbaum

The Quality of Life
Edited by
Martha Nussbaum and Amartya Sen
A study prepared for the World Institute for Development Economics
Research (WIDER) of the United Nations University
CLARENDON PRESS · OXFORD
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First published 1993
1. Quality of life—Congresses. 2. Public welfare—Congresses.
3. Human services—Congresses. 4. Social values—Congresses.
I. Nussbaum, Martha Craven, 1947-. II. Sen, Amartya Kumar.
III. World Institute for Development Economics Research.
IV. Series.
HN25.Q33 1992 306—dc20 91-42030
ISBN 0-19-828797-6 (Pbk)
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Foreword

These papers derive from a conference that took place at the WIDER in
Helsinki in July 1988. It was organized by Martha Nussbaum and
Amartya Sen. The organizers wish to thank Dolores E. Iorizzo for her
invaluable role in looking after every phase of the conference and the
preparation of this volume of essays, and would also like to
acknowledge the help received from Iftekar Hossain and Richard L.
Velkely.
An important part of WIDER'S mandate-symbolized indeed in the
acronym 'WIDER'-was to engage in interdisciplinary research. What is
meant by the 'quality of life', and what is required in terms of social
policy for improving it, has been a common preoccupation of both
economics and philosophy, and an obvious focus of WIDER's work was
a conference that would bring scholars together from both these
disciplines. At the aggregative level, economists work with a crude
measure of per capita income as indicative of human welfare, and a
number of questions are begged here which require closer
investigation. Similarly, at the micro level, the notion of maximizing an
individual's utility underlies much of conventional demand theory. But
this raises two questions: is utility measurable? And is utility the right
thing to be measuring, when we are interested in assessing the quality
of human lives?
Philosophers have been debating both these issues from a variety of
points of view, providing sophisticated new perspectives on them. At
the aggregative level, they have been critical of the single crude
measure provided by per capital income, insisting that we need to
consider the distribution of wealth and income as well, and that we
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need to assess a number of distinct areas of human life in determining
how well people are doing. There have been a number of different
proposals about how this should be done, and the most prominent of
these are represented in the papers in this volume. At the individual
level, the notion of measurable utility has been criticized in several
difficult ways. Even those philosophers who would still defend utility as
the best measure of quality of life argue that this notion must be
refined in a number of ways, especially by discounting preferences that
are formed in an inappropriate manner. Others have more profoundly
criticized the notion of utility, suggesting that we should instead
measure people's capabilities, that is, whatever they are able to do
and to be in a variety of areas of life. Again, several prominent
approaches to these questions are represented in this volume.
The introduction to the present volume by Martha Nussbaum and
Amartya Sen focuses in greater detail on the way in which contributors
to the conference have analysed these issues. My purpose in this
foreword is to look, as it were, beyond the conference to see how far
the objective of getting the two disciplines together was in fact
achieved, namely, encouraging debate between philosophers and
economists on the issue of improving the quality of life, and, more
specifically, encouraging further co-operative inquiries between
members of
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both disciplines so as to lead up to results assimilable by policy-
makers. The conference, and its resulting papers, show that some
economists are in fact becoming more sensitive to the importance of
facing fundamental philosophical questions about their starting points.
This sensitivity needs to become far more widespread. Especially in the
area of development, it is becoming increasingly clear that an
adequate approach to complex economic problems cannot be found if
these questions are avoided. On the other hand, it is clear that
philosophers are also becoming aware of the importance of linking
their foundational and theoretical inquiries to an understanding of
complex practical problems. Once again, such awareness needs to
become more widespread; and such practical inquiries need to be
informed by a concern for the entire world, not only for a small group
of privileged and developed nations, which are frequently the point of
reference for philosophical discussions of distributive justice. The
examples in this volume of Finnish and Swedish approaches to the
formulation of public policy-in which social scientists examine activities
and not just satisfactions, and measure achievements in a plurality of
distinct areas of living-point toward the sort of benefit that can be
expected for both sides, if economists and philosophers continue and
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develop further the type of co-operative effort begun in this
conference.
Such co-operation is perhaps especially necessary in two areas, on
which the conference focused: the area of health, and the area of
gender justice. Reflection about the complex decisions public policy
must make concerning health, and the distribution of the goods
connected with health, reveals the need to think about the whole issue
of life quality in a way that goes beyond conventional crude economic
measures. The assessment of women's quality of life is an area of
special urgency in the developing world. For here, because of the ways
in which people's desires can be limited and warped by a lifetime of
deprivation and lack of education, so that expectations adjust to
substandard living conditions, one frequently sees a very large gap
between utility (construed as satisfaction) and a woman's actual ability
to function in a variety of important ways. And one also sees the need
to press philosophical questions about tradition and cultural relativity,
in order to determine whose beliefs and judgements should be the
source of the measures to be used by policy-makers. These two issues
are the focus of continuing interdisciplinary research at WIDER, which
will lead to the production of a further volume on human capabilities
and gender justice, and to a research programme on the ethical
implications of health policy.
Lal Jayawardena, Director, WIDER, 27 August 1990
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Contents
List of contributors ix

Martha Nussbaum and Amartya Sen 1

G. A. Cohen 9

Amartya Sen 30
Commentators on Cohen and Sen: Christine M.
Korsgaard and Wulf Gaertner 54

Robert Erikson 67
Commentator: Bengt-Christer Ysander 84

Erik Allardt 88

Dan Brock 95
Commentator: James Griffin 133

3
Hilary Putnam 143
Commentator: Lorenz Krüger 158

Michael Walzer 165
Commentator: Ruth Anna Putnam 178

Thomas Scanlon 185
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Commentator: Sissela Bok 201

Charles Taylor 208
Commentator: Martha Nussbaum 232

Martha Nussbaum 242
Commentator: Susan Hurley 270

Julia Annas 279
Commentator: Margarita M. Valdés 297

Onora O'Neill 303
Commentator: Martha Nussbaum 324

John E. Roemer 339
Commentator: Paul Seabright 358

B. M. S. van Praag 362
Commentator: Siddiq Osmani 386

Paul Seabright 393
Commentator: Derek Parfit 410

Christopher Bliss 417
Commentator: Amartya Sen 437
Index 445
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List of Contributors
ERIK ALLARDT, President of Finnish Academy, Professor of
Sociology
University of Helsinki
Helsinki
Finland
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JULIA ANNAS, Professor of Philosophy
Department of Philosophy
Columbia University
New York City
USA
CHRISTOPHER BLISS, Nuffield Reader in International Economics
of the University of Oxford
Nuffield College
Oxford
England
SISSELA BOK Professor of Philosophy
Department of Philosophy
Brandeis University
Waltham, MA
USA
DAN BROCK, Professor of Philosophy and Professor of Human
Values in Medicine
Department of Philosophy
Brown University
Providence, RI
USA
G. A. COHEN, Chichele Professor of Social and Political Theory at
the University of Oxford, and Fellow of All Souls College
All Souls College
Oxford
England
ROBERT ERIKSON, Professor of Sociology
SOFI
University of Stockholm
Stockholm
Sweden
WULF GAERTNER, Professor of Economics
Department of Economics
University of Osnabrück
Federal Republic of Germany
JAMES GRIFFIN, Reader in Philosophy at the University of Oxford,
and Fellow of Keble College
Keble College
Oxford
England
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SUSAN HURLEY, University Lecturer and Fellow in Philosophy
St Edmund Hall
Oxford University
5
Oxford
England
CHRISTINE M. KORSGAARD, Professor of Philosophy and General
Studies in the Humanities
Department of Philosophy
Harvard University
Cambridge, MA
USA
LORENZ KRÜGER, Professor of Philosophy, University of Göttingen
Göttingen
Federal Republic of Germany
MARTHA C. NUSSBAUM, University Professor and Professor of
Philosophy, Classics and Comparative Literature
Department of Philosophy
Brown University
Providence, RI
USA
ONORA O'NEILL, Principal
Newnham College
Cambridge
England
SIDDIQ OSMANI, Senior Research Fellow
WIDER
Helsinki
Finland
DEREK PARFIT
All Souls College
Oxford
England
HILARY PUTNAM, Walter Beverley Pearson Professor of Modern
Mathematics and Mathematical Logic
Department of Philosophy
Harvard University
Cambridge, MA
USA
RUTH ANNA PUTNAM, Professor of Philosophy
Department of Philosophy
Wellesley College
Wellesley, MA 02181
USA
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JOHN E. ROEMER, Professor of Economics and Director of the Program
on Economy, Justice, and Society
Department of Economics
6
University of California at Davis
Davis, CA
USA
THOMAS SCANLON, Professor of Philosophy
Department of Philosophy
Harvard University
Cambridge MA
USA
PAUL SEABRIGHT
Fellow of Churchill College
Cambridge
England
AMARTYA SEN, Lamont University Professor and Professor of
Economics and of Philosophy
Harvard University
Cambridge MA
USA
CHARLES TAYLOR, Professor of Political Science and of Philosophy
Department of Political Science
McGill University
Montreal, Quebec
Canada
MARGARITA M. VALDÉS
Institute for Philosophical Research
Universidad Nacional Autonoma de México
Mexico
BERNARD M. S. van PRAAG, Professor of Economics
Faculty of Economic Sciences
Erasmus University of Rotterdam
Rotterdam
The Netherlands
MICHAEL WALZER, Professor at the School of Social Studies
Institute for Advanced Study
Princeton, NJ
USA
BENGT-CHRISTER YSANDER, Professor of Economics
Department of Economics
University of Uppsala
Uppsala
Sweden
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7
Introduction
Martha Nussbaum and Amartya Sen

'And he said, Now, this schoolroom is a Nation. And in this nation,
there are fifty millions of money. Isn't this a prosperous nation? Girl
number twenty, isn't this a prosperous nation, and a'n't you in a
thriving state?'
'What did you say?' asked Louisa.
'Miss Louisa, I said I didn't know. I thought I couldn't know whether it
was a prosperous nation or not, and whether I was in a thriving state
or not, unless I knew who had got the money, and whether any of it
was mine. But that had nothing to do with it. It was not in the figures
at all,' said Sissy, wiping her eyes.
'That was a great mistake of yours,' observed Louisa.
(Charles Dickens, Hard Times)

When we inquire about the prosperity of a nation or a region of the
world, and about the quality of life of its inhabitants, Sissy Jupe's
problem still arises: How do we determine this? What information do
we require? Which criteria are truly relevant to human 'thriving'? Girl
number twenty quickly discerns that just knowing how much money is
available for a given number of people (the analogue of GNP per
capita, still widely used as a measure of quality of life) will not take us
very far. For we also need, at the very least, to ask about the
distribution of these resources, and what they do to people's lives.
The problem is actually more complex still. For if we are really to know
much about the 'thriving' of Sissy Jupe and her fellow citizens, we
need to know not only about the money they do or do not have, but a
great deal about how they are able to conduct their lives. We need
surely to know about their life expectancy (think of the miners of
Coketown in Dickens's novel, who keep their families from 'want and
hunger', but go to a premature death). We need to know about their
health care and their medical services. We need to know about
education-and not only about its availability, but about its nature and
its quality (it seems likely that Mr Gradgrind's school may actually
diminish the 'thriving' of its pupils). We need to know about labour-
whether it is rewarding or grindingly monotonous, whether the
workers enjoy any measure of dignity and control, whether relations
between employers and 'hands' are human or debased. We need to
know what political and legal privileges the citizens enjoy, what
freedoms they have in the conduct of social and personal relations. We
need to know how family relations and relations between the sexes are
structured, and how these structures foster or impede other aspects of
human activity. We need, perhaps above all, to know how people are
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enabled by the society in question to imagine, to wonder, to feel
emotions such as love and gratitude, that presuppose that life is more
than a set of commercial relations, and that the human being-unlike
the steam engines of Coketown-is an 'unfathomable mystery',
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not to be completely 'set forth in tabular form'. In short, to think well
about Sissy's problem, we seem to need a kind of rich and complex
description of what people are able to do and to be-a description that
may be more readily available to the reader of Dickens's novel than to
those who confine their reading to the narrowly technical and financial
documents favoured by Sissy's teachers.
Economists, policy-makers, social scientists, and philosophers are still
faced with this problem of measurement and assessment. They need
to know how people are doing in many different parts of the world,
and they need to know what is really involved in asking that question.
When they face the problem well, they face it, so to speak, with
wonder (to use, deliberately, the word least tolerated in Mr Gradgrind's
school); with a sense, that is, of the profound complexity of assessing
a human life, and with a desire to admit, at least initially, the widest
possible range of accounts of how one might go about this, of what
indicators one might trust.
Of course, it is possible to wonder not at all-to stick to a mechanical
formula that is easy to use and which has been used before. The
unasked question does not have to be answered. This volume is an
attempt to ask questions and to propose and examine some possible
answers. By examining the arguments for and against a variety of
different accounts of how to measure quality of life, it aims to generate
a more complex understanding of alternative positions and their
respective merits. The original motivation for this project lay in our
perception that these issues were being debated in several different
fields whose communication with one another was unfortunately slight.
Most social scientists and economists would agree with Sissy Jupe that
GNP per capita is a crude and incomplete measure of quality of life;
and yet such measures continue to be widely used when public policy
is made. Again, philosophers have for some time been debating the
merits of measuring the quality of human life in terms of utility
(whether understood as happiness or as the satisfaction of desires or
preferences). Some philosophers continue to defend this general
approach-though usually with considerable qualification, producing
utilitarianisms with complex and subtle restrictions on the nature of
the preferences that may be taken into account. Others have
concluded that the whole utilitarian approach should be rejected-to be
replaced, perhaps, by an account of the many different kinds of
activity that actually make up a 'thriving' human life. (Such a
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programme can take various forms and some of these are explored in
the papers by Cohen, Sen, Brock, Scanlon, and Nussbaum.) The
philosophical debates have not had much impact on the making of
public policy in much of the world; nor have they been particularly
noticed in the standard works in economics. Our hope was that by
getting the participants in these debates together and encouraging
further debate among them, we might advance the state of the
question, encourage further co-operative inquiries, and present the
debate in a form accessible not only to professionals in these academic
disciplines but also to policy-makers and the general public.
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Lives and Capabilities
The papers in Part I address the general questions we have already
described, examining how we may try to find adequate criteria for
assessing the quality of life. Cohen's and Sen's papers both discuss the
'capability approach' presented by Sen, but Cohen also examines a
number of other approaches, including, among others, utilitarian
calculations, the Rawlsian focus on primary goods, and Dworkin's use
of resources. After criticizing these approaches, Cohen argues for
concentrating on what he calls 'midfare', which is fairly close to the
idea of functionings used in the 'capability' literature.
The life that a person leads can be seen as a combination of various
doings and beings, which can be generically called functionings. These
functionings vary from such elementary matters as being well
nourished and disease-free to more complex doings or beings, such as
having self-respect, preserving human dignity, taking part in the life of
the community, and so on. The capability of a person refers to the
various alternative combinations of functionings, any one of which
(any combination, that is) the person can choose to have. In this
sense, the capability of a person corresponds to the freedom that a
person has to lead one kind of life or another. Cohen's paper discusses
why one has to go in this direction (rather than staying with the
traditional concerns: incomes, utilities, resources, primary goods), but
he ends by questioning whether the freedom-type idea of capability is
the precisely correct alternative. Sen presents the capability approach
and its rationale, and also attempts to answer Cohen's critique (along
with a few other criticisms presented elsewhere).
The papers by Erikson and Allardt discuss some methods and
strategies for measuring the quality of life that have been used by
Scandinavian social scientists for a long time. Their approach has
much in common with that of focusing on functionings and capabilities,
and the actual measurement techniques used have obvious relevance
for the use of the capability approach. The philosophical underpinnings
of the capability approach, on the other hand, provide some defence of
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