Best interests and sufficient benefit: The ethics of hard decisions in healthcare
Dr Ben Davies
Research Fellowship, ‘Best interests and sufficient benefit: The ethics of hard decisions in healthcare’
Grant: WT221220/Z/20/Z | Duration: 36 months (Aug 2021 - July 2024)
We all want healthcare to serve our best interests, and the best interests of our families. But budget constraints and other practical obstacles mean this is often not achievable.
When it comes to allocating resources, decisionmakers value ‘efficacy’: producing the greatest total benefit overall with a set budget. But it is also important to consider ‘equity’: how benefits are distributed among a population. The idea of best interests is of limited help here (since not everyone’s best interests can be met), and so we must consider other ways to think about what is fair in allocating health resources.
The idea of best interests is also of limited help in cases where people disagree on what is best for critically ill infants. Recent years have seen various high profile cases where carers and health providers disagree fundamentally on whether an infant patient’s best interests involves palliative care, or the pursuit of novel, often untested treatments.
This project explores whether the idea of "sufficiency" can help with these hard decisions by grounding a view of justice that is less demanding than best interests, and which better captures the idea of equity as it exists in healthcare practice. Sufficiency-based approaches emphasise the moral importance of ensuring that people have ‘enough’, emphasising the importance of thresholds in making decisions. Thresholds already play key roles in many healthcare systems, but their justification is not always well articulated. The project thus aims to explore the potential for a ‘sufficiency’ threshold approach in healthcare which is theoretically rigorous; inclusive of various groups sometimes neglected by philosophy and healthcare practice, such as those with severe disabilities; and democratically justifiable in a pluralistic society.
Davies, B., (forthcoming), 'Healthcare priorities: The ‘young’ and the ‘old’', Cambridge Quarterly of Health Care Ethics, Vol: first view 10 November 2022 [PMC to follow]