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In what other ways might we attempt to distinguish between needs and wants? Several writers argue that we can objectively distinguish wants and needs by examining the consequences for people of not having their needs or wants met. According to Plant, 'If a man is held to need something, he lacks something and will be harmed by his lack of it ... and getting what he needs will overcome this harm ... This is not so in the case of a particular want or desire. A man may want something for a particular purpose, but not be harmed or ail by his not getting wh at he wants and, conversely a man getting what he wants may harm hirn or cause hirn to ail.

Several writers having acknowledged this problem have tried to find a way around it. Miller attempts to define harm in relation to an individual's 'plan of life'. 'Harm for any given individual', he claims, 'is whatever interferes directly or indirectly with the activities of his plan of life, and correspondingly his needs must be understood to comprise whatever is necessary to allow these activities to be carried out. ,7 Several criticisms can be made of this approach to the definition of need.

Conflicting views exist with the result that doctors use treatments to a varying extent and in varying circumstances. ,15 Operation rates for tonsillectomy, for example, vary widely not only between countries but also between regions within countries. Since there is no evidence to suggest that tonsil related complaints vary from place to place, we can only conclude that a doctor's decision to perform tonsillectomies is partiy based on subjective, non-scientific factors. It is now becoming more widely accepted that medical need, as defined by doctors, is an amalgam of scientific opinion, professional ideology and particular factors wh ich influence individual doctors, rather than an objective, unchanging concept.

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