Justice in the Four Principles of Medical Ethics
Justice in medical ethics fundamentally requires providing equitable access to healthcare for all individuals without discrimination, fairly distributing limited resources, and ensuring that treatment decisions are made impartially regardless of a patient's race, socioeconomic status, or ability to pay. 1
Core Components of Justice in Healthcare
Equal Access and Non-Discrimination
Every individual is entitled to obtain the best care available, with resources distributed fairly without any discrimination based on race, color, creed, gender, nationality, or other irrelevant properties. 1
Emergency physicians in the United States have a unique social responsibility to provide necessary emergency care to all patients regardless of ability to pay, serving as healthcare providers of last resort for many who have no other feasible access to care. 1
Healthcare professionals must give emergency patients unconditional positive regard and treat them in an unbiased, unprejudiced way, including those who are poor, intoxicated, have poor hygiene, or hold value systems different from the physician. 1
Physicians must treat perpetrators of violent crime with the same regard as victims, demonstrating impartiality as a core virtue of justice. 1
Fair Distribution of Limited Resources
Justice requires physicians to act as responsible stewards of healthcare resources, making careful judgments about appropriate allocation to maximize benefits and minimize burdens. 1
When resources are limited (such as diagnostics, therapeutics, or personal protective equipment), the best balance should be decided among all stakeholders with appropriate deference to local community values, ideally in advance rather than during individual patient encounters. 1
Expensive nutritional therapies and other treatments should be provided solely when medically indicated, though undertreatment may never result from containing healthcare costs. 1
Treatments that are futile and only prolong suffering or the dying phase must be avoided, as they represent unjust use of limited resources. 1
Addressing Health Inequities
Justice requires ensuring equitable access to healthcare advancements and addressing suboptimal access or outcomes among disadvantaged populations (such as those with HIV, neglected tropical diseases, or those facing stigma). 1
Neglected diseases including parasitic diseases, leprosy, helminthic diseases, malaria, and tuberculosis receive inadequate funding, representing a justice concern in global health resource allocation. 1
Healthcare workers deserve fair access to appropriate precautions to reduce risks of workplace-acquired infection, representing justice in occupational safety. 1
Justice in Global Health Settings
Partnership and Burden Minimization
When engaging in short-term global health activities, justice requires partnering with local leaders to ensure that potential burdens on local communities are minimized and that full costs are calculated and reimbursed. 1
Volunteers must recognize tangible costs (licensure, lodging, food, transportation, safety measures) and intangible burdens (time shifts for local practitioners) and take steps to minimize them. 1
Financial responsibility for protecting volunteer safety and providing medical care to volunteers, including evacuation if necessary, rests with sending organizations rather than host communities. 1
Equitable Implementation
Clinical practice guidelines should account for effect modifiers among disadvantaged populations and for availability of resources, access to care, and costs in relationship to social and economic status. 1
Interventions aiming to be accessible to disadvantaged populations and to reduce inequities have stronger ethical justification and should influence the strength of recommendations. 1
Common Pitfalls in Applying Justice
Allowing financial self-interest to affect patient care violates the principle of justice and must be avoided; physicians must declare any financial interests in services or equipment offered to patients. 2
Failing to recognize when resources are insufficient to provide safe care, or not seeking better alternative services when available, represents a failure of justice. 2
Making disparaging remarks or using gallows humor to ridicule patients based on their social status, mental health, or lifestyle choices violates the impartiality required by justice. 1
Providing care that exceeds one's scope of practice or training level, even when local regulations may be less restrictive, violates justice by creating unequal standards of care. 1