Best interests and sufficient benefit: The ethics of hard decisions in healthcare

Dr ben davies

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.


Project outputs

Sufficiency and Health(care) Workshop

University of Oxford | 14 and 15 June 2023

This two-day workshop brings together a range of academics working on the relationship between health, healthcare, and the idea of sufficiency. Speakers will discuss topics including sufficiency's relationship to discrimination, suffering, climate change, and resource scarcity, with a view to exploring the prospects for sufficientarianism moving from theory to healthcare practice.

Speakers and talks: 

  • Efrat Ram-Tiktin, Bar-Ilan. Sufficiency of capabilities under moderate and severe scarcity of resources
  • Dick Timmer, Dortmund. Sufficientarianism in the allocation of health resources
  • Joshua Parker, Lancaster. Subsistence, sufficiency, and healthcare emissions
  • Ben Davies, Oxford. Pain: Sufficiency’s missing dimension?
  • Thomas Schramme, Liverpool. Widening the scope of sufficientarianism
  • Lasse Nielsen, Southern Denmark. Sufficientarianism, discrimination and health care priorities
  • Adam Ehlert, Uppsala. Double threshold prioritarianism: Some problems and solutions

Open Access Publications

Davies, B., (2023), 'Healthcare priorities: The ‘young’ and the ‘old’', Cambridge Quarterly of Health Care Ethics, Vol: 32 (2): 174-185 [PMC10425921]

Davies, B., (2023), 'Medical need and health need', Clinical Ethics, Vol: 18(3): 287-291 [PMC10444630]

Davies, B., (2023), 'A new paradox for welfare subjectivism', Analysis, Vol: 83(4): 673-682 [PMC10826881]

Davies, B., (forthcoming), 'What do ‘humans’ need? Sufficiency and pluralism', Ethics, Policy and Environment

Moriarty, C. and Davies, B., (2024), 'Feeding infants: choice-specific considerations, parental obligation, and pragmatic satisficing', Ethical Theory and Moral Practice, Vol: 27(2): 167-183 [PMC11076201]

Park, J. and Davies, B., (forthcoming), 'Rationing, responsibility and vaccination during Covid-19: A conceptual map',  American Journal of Bioethics

Blog posts

Healthcare ethics has a gapPractical Ethics in the News (13 June 2022)
The new relevance of rationing,  Practical Ethics in the News (3 January 2023)
Healthcare allocation for limited budgets,  Practical Ethics in the News (10 March 2023)