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Social justice and public health
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
Conceptions of justice tend to be understood in distributive, relational, and/or procedural terms. As the name suggests, distributive justice concerns itself with how and why benefits and burdens are distributed among members of society. Accounts of distributive justice commonly answer two questions: (1) Distribution of what? (that is, the valuable goods or “currency” of justice, sometimes referred to as the “distribuendum” or “distribuans”); and (2) distribution according to what rule or pattern?
Priorities in Healthcare 1
Published in Rui Nunes, Healthcare as a Universal Human Right, 2022
This perspective of distributive justice and its democratic accountability is responsible for the scope and limits of healthcare services. Particular entitlements to healthcare, namely expensive innovative treatments and medicines, may be fairly restricted as long as this decision is socially accountable and imposed by financial restrictions of the system (Nunes 2003). This framework has been used, for instance, in rationing pharmaceuticals in an accountable way (Teagarden et al. 2003) as the process facilitates a broader public discussion about fair limit setting (Daniels et al. 2003).
Justice and Democracy
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
The basis of justice, for many people, refers to fairness, but there are a number of recognized contexts. Social justice is the notion that everyone deserves equal economic, political, and social opportunities regardless of race, gender, or religion. Distributive justice refers to the equitable allocation of assets in society. Environmental justice is the fair treatment of all people with regard to environmental burdens and benefits. Restorative or corrective justice seeks to make whole those who have suffered unfairly. Retributive justice seeks to punish wrongdoers objectively and proportionately. And procedural justice refers to implementing legal decisions in accordance with fair and unbiased processes. Legal and political systems that maintain law and order are desirable, but they cannot sustain either unless they also achieve justice.
Unilateral ECMO Withdrawal and the Argument From Distributive Justice
Published in The American Journal of Bioethics, 2023
While Childress and colleagues at times focus on the specific case of Mr. J and whether “it is possible that these resources could be better spent to improve another ECMO candidate’s chances for lung recovery,” they rightly note that “distributive justice arguments are best directed not towards individual clinicians or single patients, but towards healthcare institutions or governmental actors whose obligations lie with the broader public” (Childress et al. 2023, 8). While there are, indeed, some theorists who conceptualize distributive justice as applying to discrete individual decisions (Cohen 2002), most recognize that distributive principles actually apply to the ways in which societal institutions distribute benefits and burdens (Rawls 1999). One good reason for focusing on institutions rather than individual cases in the hospital is that a focus on individual cases runs too high a risk of violating the ideal of formal justice—the ideal of treating like cases alike. Once one recognizes the site of distributive justice to be institutional, the question then becomes not what should be done about Mr. J, but rather, what policies should institutions adopt in order to guide clinicians and ethicists in determining what ought to be done about patients like Mr. J? With a clear policy in place, the role of the clinical ethicist and of the hospital ethics committee is to ensure that the policy is being applied impartially and consistently.
Bioethics Theory-Building for Public Health
Published in The American Journal of Bioethics, 2021
Public health ethics needs conceptual resources that do not abstract away from difference, explicating how identity functions to shape perceptions and generate investment in distinct forms of social order (Mills 2004). Equating justice with distributive justice (as opposed to social justice) is more likely to devise solutions that neglect institutional conditions, social processes, and relationships of power (Young 1990, 15–38). In contrast, nonideal social theories that center around power have generated important contributions to theorizing about adaptive preferences, patriarchy, white supremacy, and counternarratives (Mills 2004). These notions enable members of oppressed groups to name their experiences more aptly and provide policymakers with framings to envision different alternatives.
Balanced Ethics Review: A Guide for Institutional ReviewBoard Members
Published in Psychiatry, 2018
Whitney is committed to the ethical principle of justice. This principle, when referring to distributive justice, holds that we should treat people equally. Its other meaning, as in the law, is to treat people fairly. This need for equality may exist regardless of the consequences and even if the net gain to most may be less. This value priority of justice over utility is best illustrated by practices we have adopted in the United States in regard to kidney transplants. Our scheme for deciding which patients will receive the limited resource of a kidney takes into account not only what outcomes will most benefit all; it also takes into account how this can be done in a way that will treat different patient groups as equally as possible (Petrini, 2012; Ross, Parker, Veatch, Gentry, & Thistlethwaite, 2012; Wilkinson & Dittmer, 2016). For decades it has been well recognized, likewise, that research burdens and risks should be shared. Burdens should not be borne more by one group of research participants than others (Savulescu, 2015). This need for justice was violated most infamously by the research on syphilis conducted on African American men at Tuskegee (Lerner & Caplan, 2016; Paul & Brookes, 2015).