How much is enough? Sufficiency and thresholds in health care

An interdisciplinary workshop at the Centre for Ethics, University of Zurich

Jun 7-8, 2012, 9-5 pm, Centre for Ethics, University of Zurich, Zollikerstrasse 115, 8005 Zürich

Speakers: Allen Alvarez (Norwegian University of Science and Technology), Friedrich Breyer (Universität Konstanz), Paula Casal (Universitat Pompeu Fabra), Ruth Faden (John Hopkins University), Carina Fourie (Universität Zürich), Madison Powers (Georgetown University), Harald Schmidt (University of Pennsylvannia), Efrat Ram Tiktin (Bar-Ilan University)

Organizers: Carina Fourie, Annette Rid, Anton Leist (University of Zurich)

To what levels of health or health care are we entitled as a matter of social justice? An intuitively appealing idea is that each person is entitled to ‘enough’. Such a notion of sufficient health or health care could be contrasted to conceptions of justice which promote equal health, give priority to the worst off, or maximize health within the population. Helping individuals to achieve sufficient lifespans seems to be an intuitively more appealing aim of health policy than helping them achieve equal lifespans, for example. And while giving priority to the worst off may be a fair strategy below certain thresholds of health, its appeal might wane if the worst off are actually quite healthy, or what we could potentially call ‘sufficiently’ healthy.

Although sufficiency seems to have much intuitive appeal, egalitarian and prioritarian theories of justice in health tend to dominate debates. It is possible that the appeal of sufficiency is only intuitive and limited to a few examples. Perhaps it simply does not stand up to critical scrutiny. Questions abound, for example: How can we draw non-arbitrary thresholds? How could we ever agree on what would constitute sufficient health or health care? Yet as the application of sufficiency to health is under-explored, it is difficult to gauge its value accurately. To address the gap in ethical research, this two-day workshop aims to clarify and evaluate notions of sufficiency as applied to the fair distribution of health care.

The workshop is dedicated to assessing both the philosophical underpinnings and the practical application of sufficiency and health. The first day of the workshop will focus primarily on theoretical concerns, and aims to answer questions such as:

  • What is sufficiency in health and health care?
  • What challenges does a sufficiency view face in the realm of health and health care?
  • How can we justify setting thresholds in health care?
  • Which priorities, if any, should be set above or below thresholds?

The second day of the workshop will be dedicated to exploring how sufficient thresholds for health care may need to be specified in order to be practically applicable. We aim to answer the following questions:

  • How do we draw the line for establishing which benefits should be included in basic health care packages? Do basic health care packages represent “sufficient” health care?
  • Should we set thresholds of sufficient health care according to marginal effectiveness?
  • Can sufficiency provide an ethical justification for age-based rationing?
  • Are “fair processes” necessary for setting thresholds?

We are grateful for the generous financial support of the Swiss National Science Foundation, the Corti Foundation, the Institute of Biomedical Ethics (UZH), the Research Priority Program in Ethics (UZH), and the University of Zurich, without which this workshop would not have been possible.