Dr. Efrat Ram-Tiktin

My main research interest is the interface between political philosophy—with an emphasis on the theories of distributive justice—and bioethics. The question that occupied me in my doctoral thesis was whether it is possible to formulate a unified theory of distributive justice in the domain of health that can provide guidance in achieving a just allocation of resources. In other words, my research goal was to develop a theory (which I called the “Sufficiency of Basic Human Functional Capabilities”) that would guide policy makers in prioritizing the inclusion of new medical technologies in the National Health Services Basket. The main innovation of the research lies in the attempt to create a unified theory of justice in the domain of health, that is to provide an account whose specific applications are derived from the fundamental values of a theory of justice and from the nature of the good being proposed for distribution. I claimed that such a theory would overcome the problems that I identified in the various solutions presented in the literature. Thus, on the one hand, there are general theories that are too vague to apply in the domain of health and on the other hand the theories that present practical guidelines for prioritization do not explain which values they are derived from. This research also suggested two possible contributions to the literature on distributive justice. The first is the extension of Frankfurt’s sufficiency principle in two directions: a) the delineation of the sufficiency threshold in a non-arbitrary manner, and b) the articulation of the two principles of number and benefit-size weighted sufficiency that determine the order of prioritization above and below the threshold. The second is the articulation of nine key systems of health-related basic human functional capabilities that replace Nussbaum’s list of ten basic human capabilities.

During the years following my PhD, I developed additional aspects of the theory beyond those discussed in my thesis. These efforts took the theory in two main directions: The first is the advantage of the Sufficiency of Capabilities principle in healthcare relative to the dominant and competing ideals in the literature (such as Fair Equality of Opportunity in health as presented by Norman Daniels and Luck Egalitarianism in health as presented by Shlomi Segal and others). The second is the advantage of Amartya Sen and Martha Nussbaum’s capability approach, and my version of that approach, over other liberal positions, such as that of John Rawls, in dealing with the tension between respecting cultural diversity, including the respect of an individual’s freedom of conscience, and the implementation of universal principles of justice.

My interest in the interface between political philosophy, bioethics and applied ethics has led me to investigate and write about three more specific topics. The first is whether the enhancement of an individual’s moral capacity through bio-medical interventions is desirable and what are the warning signs we should be aware of in this endeavor. In this context, I have made the claim that egalitarians are mistaken in claiming that this endeavor would lead to political inequality. Rather, our concern and efforts should be directed toward the possibility that moral bioenhancement would have negative effects on fair equality of opportunity. The second is the ethics of extreme circumstances. The research of this topic has sought to present and justify the principles of justice that should form the basis of an algorithm for prioritizing between patients (i.e. triage) in situations of a severe shortage of resources following natural disasters. The third attempts to identify the legitimate mechanisms of intervention that can be used by state institutions in the preservation and advancement of public health. In this context, I came out in opposition to the prevailing position of the leading health organizations on two matters. First, I claimed that our focus should be on population health rather than public health, since the latter relates to methods of intervention that promote population health and hence has instrumental value, while the former is good in itself (though it also has instrumental value in achieving other ends, such as the population’s prosperity). Second, and more importantly, public health is a public good (non-rival and non-excludable) while population health meets the criteria of a common good (rival and non-excludable) and therefore is at risk of depletion in the absence of state regulation. This more accurate perspective on population health and public health can be used to evaluate interventions by the state that affect the individual’s positive freedom. I presented a number of arguments which showed why interventions such as nudges (namely, a method used to encourage an individual to make choices that improve his situation) do not compromise the individual’s freedom but in fact advance it if we analyze the two aspects that give freedom its value (i.e. Sen’s opportunity and process aspects of freedom).

In 2015, I completed a joint project together with Professor Gil Siegal which examined the uniqueness of Israeli bioethics as manifested in legislation, court rulings and the professional norms of healthcare workers as compared to the bioethics that has developed in other Western countries. The project’s findings and conclusions were presented in a book we edited, which was published by Mossad Bialik and the Ono Academic College.

Three additional articles on applied ethics that deal with the issue of posthumous use of gametes for reproduction, an issue that has led to a stormy debate in recent years. In this research, which was carried out jointly with Dr. Roy Gilbar, I proposed a new perspective on the issue. While most writers on this subject have focused on individual rights in order to deal with the problems that arise from these medical procedures (and concluded that the parents of the deceased have no moral claim to use of their son’s sperm), we proposed a new theoretical framework to examine the issue which focuses on the value of social solidarity and an understanding of the individual’s autonomy as relational autonomy, rather than individualistic autonomy which is based on the approach of ontological individualism. In another article on this issue, which supports the position of parents who wish to make posthumous use of their son’s sperm, we proposed a critical examination of court rulings handed down in Israel and Australia.

In 2018, I was awarded a research grant by the Israel Science Foundation to develop a unified theory of justice in education. Here again, I intend to propose a theory which, by examining the good to be distributed and the internal value of childhood, will be able to suggest principles for the just allocation of resources in formal and informal education. So far, two articles on the internal and instrumental value of childhood in the development of an authentic “self” and authoritative agency have been completed.