THE CONCEPT

OF JUSTICE
The last principle, justice, has both a social and political meaning.
Socially, it means, treating similar kinds of people similarly (this is the so-
called “formal element” of the larger principle). A just physician treats
each patient the same, regardless of his insurance coverage.
Politically, the principle refers to distributive justice, and in medicine, to
the allocation of scarce medical resources.
Distributive justice refers broadly to the distribution of all rights and
responsibilities in society, including, for example, civil and political rights.
PRINCIPLE
OF
JUSTICE
Principle of Justice - It means giving on his due

What is due an individual is determined by

any or all of the following:

1. What he deserves by right, either his natural rights or rights

granted him by law or prior undertakings, independent of
the claims of others (non-comparative justice) example: the
right of life.
2. Balancing of competing claims of other persons against an
individual’s claim according to some morally relevant
property or merit (comparative justice, fairness) example:
giving a donated kidney to the one who needs it most.
3. Acting uprightly in any action bearing on others.
 It is unjust not to give a person
what is his due. It is equally unjust to
burden or to reward someone for
something that is not his due: for
example to oblige an individual to
be a subject for research which is no
direct benefit to himself.
1. Formal Principle of Justice

As attributed to Aristotle, the formal

principle of justice states that equals
ought to be treated equally and
unequals may be treated unequally
2. Material Principles of Justice

Material principles identify a relevant

property such as need, effort, or
merit as the basis of which burdens
and benefits should be distributed
and excludes other properties as
irrelevant.
 PARADIGMS OF JUSTICE
Tobin describes 4 paradigms of
Justice as
1. Utilitarian. Justice as whatever brings about the
greatest good of the greatest number.
2. Egalitarian. Justice as the equal distribution of
goods and services
3. Libertarian. Justice as the lack of restraints on
individual liberty.
4. “Natural Law”. Justice as doing to others what one
would have them do to oneself.
IMPLICATIONS OF THE PRINCIPLE OF JUSTICE

These implications can be derived from the principle

of justice:

1. Each individual should receive what his due

by right such as:
a. life
b. information needed for decision making
c. confidentiality of private information
2. Benefits should be justly distributed among
individuals such as:
a. minimum health care
b. equal opportunities for a scarce resource

3. Each individual should share in the burden of

health and science such as:
a. caring for his own health
b. caring for the health of others
c. participating in the health/science progress
VIOLATIONS OF THE PRINCIPLE OF JUSTICE
The following are the violations of the principles of justice:

1. Denying/withholding a benefit to which a person has a

right. Example: withholding life saving medications
from one who needs them.
2. Distributing a minimum health benefit unequally.
Example: providing selected individuals with available
safe water.
3. Imposing an unfair burden on an individual. Example:
using the underprivileged as research subjects.
NON- VIOLATIONS OF THE PRINCIPLE OF
JUSTICE
The following are the non-violations of the principles of justice:
1. The patient chooses to give up what is due.
Example: He asks not to be told of the risks
involved in a recommended treatment.
2. The patient has lost his right to what is due.
Example: Because smokers refuse to care for
their health, they might be considered
responsible for their chronic lung diseases and
lose their right to at least, free health care.
3. The patient chooses to accept an additional
burden. Example: He volunteers to be a
research subject for a study not directly of
benefit to him.

4. When what appears to be an unjust outcome

results from a just process. Example: In a lottery
among all suitable candidates for an available
kidney, the richest candidate wins.
ROLE OF THE HEALTH PROFESSIONAL
The health professional can apply the principle of
justice by:

1. In delivering health care give each patient

what is due: the available care he needs,
information and confidentiality.
2. Providing equal health care to all patients
without discrimination.
3. Working towards just health care policies such as
the delivery of minimum health care to all
according to their needs.

4. Avoiding giving undue burden to individuals:

abusing the poor by using them as learning
material.
MEANING OF DISTRIBUTIVE JUSTICE
The aspect of justice that pertains to a fair
scheme of distributing society’s benefits and
burdens to its members is termed distributive
justice. In the medical context, the presumed
benefits are receiving medical care and
treatment; the presumed burdens are paying
for care and partaking in experimental
research.
PROBLEM OF DISTRIBUTIVE JUSTICE

Macroallocation deals with decision regarding how

much of society’s resources should be used for health
care as distinct from education, infrastructure,
defense, social welfare, etc. The following questions
should be addressed.
Mesoallocation deals with decisions
regarding many of the healthcare
resources should go to which kind of
services. Questions to answer are:
Microallocation deals with decision regarding
how a scarce resource should be distributed
among individuals with competing claims to
it. Questions to answer are:
TRIAGE is defined as the medical
screening of two patients to determine
their priority for treatment. It is a means
of microallocation. It considers two
principles: formal and substantive or
procedural.
Formal Principle. The formal principle states that scarce
resources should not be wasted but should be used
impartially giving equal weighs to the rights of all whose
lives are in jeopardy. It directs the triage decision maker to
apply evenhandedly whatever rules are deemed right
establishing.

Substantiative or procedural principles. The substantiative

principle proposes the right establishing criteria.
A just society seeks to protect the dignity of its
members and to satisfy their basic needs.

 Society must decide what constitutes a minimum

level of satisfaction consistent with human dignity
and the resources available.
 In making this specification and setting this
minimum, the society is limited and influenced not
only by the needs of the members and the resources
available, but also by the need to keep itself
functioning.
 Resources are always scarce, this direct distribution
involves a judgment evaluating various sorts of basic
needs and various ways of satisfying them directly.
 Adequate humane health care should include the
care necessary for the individual:

1. To avoid premature death

2. To function in society as a productive member
3. To be free of unnecessary physical pain in life
and death
Distributive Justice
1. Needs –
a just system provides goods to its members on the basis of their
demonstrated need and their inability to satisfy it on their own.
ex. Denying food to a starving person is an attack on his or
her health and life and so on the dignity of that person
It has an intuitive attractiveness but does not consider scarcity of
resources
 Social Priorities- costs of basic goods, including health care, must be
considered when dealing with scarce resources.
 No society can provide everything that everyone
needs, let alone what everyone wants.
 Ethicaldistribution, must provide for PRIORITIES and a
system of ALLOCATING RESOURCES
2. Distribution thru Rationing –
not everyone can have everything she or he wants.
It means limiting consumption and parceling out the
goods that can be consumed.
Distributive Justice

In health care, basic needs such as the preservation of meaningful life

must take precedence over mere wants and desires and acquired
needs.
Ex. Saving the leg of an otherwise functional diabetic woman has
precedence over a treatment that might or might not prolong her life,
and might or might not improve the comfort of a functioning individual
who already has a fatal condition.
 Allocation of Resources by the Patient
Patient makes decisions about the allocation of
his resources among all needs, including those
of the family