Introductio Types of justice Philosophical Importance in

n Concept Healthcare

JUSTICE
G R O U P 4
 Introductio Types of justice Philosophical Importance in
n Concept Healthcare

Introductio
n

what is justice?

Justice is an equitable distribution of scarce medical resources . It is

also the clinical decision of who gets what treatment first, for
example a patient with a life-threatening medical emergency.
Medical treatment given to a patient must be solely based on the
medical condition, not by the patient’s economic/social
status/sex/caste region/ religion/colour.
 Introductio Types of justice Philosophical Importance in

Types of n Concept Healthcare

justice
DISTRIBUTIVE JUSTICE
Fair distribution of limited resources among members of society.

LEGAL JUSTICE
Application of legislation by a judge, magistrate or a supreme court
of a country or state, with the objective of protecting victims/patients
and punishing or rehabilitating the perpetrators who have broken

the law.

TYPES OF MEDICAL ETHICS JUSTICE

Respect of people's rights rather than the application of law.These
social rights relate to our society's belief that every individual and
group is entitled to fair and equal rights and participation in social,
educational, health and economic opportunities.

(Pozgar, G.D. (2019). Legal and Ethical Issues for Health Professionals (5th ed.). Jones & Bartlett
Learning.)
Philosophical
Concept
Main Philosophical concepts

Deontology: This ethical teaching emphasises that the practice of medicine must be guided by adherence to clear

01 principles such as respect for free will. This usually means all treatment is to be central to respect for the patient’s

autonomy to make decisions.

Utilitarianism: This philosophy of moral judgment championed by others is measured by the overall results.

02 Utilitarianism is judged by the greatest good for the greatest number of people. This is how moral judgment is

assessed.

Virtual Ethics: This philosophy appears very simplistic and holds that those who are taught to be good will do what is

03
right. Many medical ethicists find these general principles difficult to apply to complex ethical issues in medicine. Thus

it was difficult to evaluate medical cases on ethical issues. Thus over the years the American and the European

counterparts devised several frameworks to judge moral values in the practice of medicine. As a result two main

systems developed on how to evaluate values in medical ethics, Principlism and Casuistry.
Philosophical
Concept
Main Philosophical concepts

Principlism

04 This system was developed by the American Philosopher Tom Beauchamp and American Theologian James
Childress. It involved four principles to which another two were added.

• Beneficence (Salus agroti suprema): A medical practitioner should act in the best interest of the patient
• Non-maleficence (Primum non nocera) first do no harm
• Autonomy (Voluntus aegratisuprema lex): The patient has the right to refuse or choose his treatment.
• Justice (fairness and equality): This concerns the distribution of scare health resources and the decision as to

who gets what treatment. This means distributing burdens and benefits fairly
• Dignity: The patient has a right to dignity and this is usually extended to the person treating the patient
• Truthfulness and honesty: The doctor is to be honest and be truthful to the patient. This has to be strictly

adhered to in informed consent

ThemeWagon. (n.d.). Ethical Professional Practice Guidelines AMM 2016. Academy of Medicine of Malaysia (AMM) - ethical professional practice guidelines AMM 2016.
https://www.acadmed.org.my/index.cfm?menuid=131
Importance in
Healthcare
The importance of resource allocation (4 perspectives- ethical issue, law and ethics, policies and ethics, empirical
studies).

• Rising public and professional expectations

• An expanding pool of treatable patients and costly

new technology balanced against tightly monitored

health care budgets (Cancer, HIV, renal/liver

transplant etc.)
• Competing government priorities and provincial

deficits.
• Ethics, law, policy and empirical studies provide

insights that can help clinicians as they try to

distribute health care resources fairly.

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
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Importance in
Healthcare
Ethics

• If healthcare resources are scarce, how should they be distributed?

• Distribution choices will benefit some and not others.
• How should choices be made?
• What values should guide these choices?
• The power imbalance that exists between physician and patient to promote the patient's best
interest
• The extent of this ethical duty, which is fundamental to the physician's role in resource
allocation, is a matter of controversy.

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
Importance in
Healthcare
Ethics

• Levinsky argued that "physicians are required to do everything that they believe may benefit

each patient without regard to costs or other societal considerations."

• In contrast, Morreim argued that "the physician's obligations to the patient can no longer be

a single-minded, unequivocal commitment but rather must reflect a balancing. Patients'

interests must be weighed against the legitimate competing claims of other patients, of
payers, of society as a whole, and sometimes even of the physician himself.

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
Importance in
Healthcare
Law

• Human rights codes prohibit discrimination on the basis of ethnicity, place of origin,

religion, age, sex, sexual orientation and physical or mental disability.

• If resources were allocated purely on such grounds it could lead to an inquiry and legal

proceedings by a provincial human rights commission.

• Remarks by a British judge "Difficult and agonizing judgments have to be made as to how

a limited budget is best allocated to the maximum advantage of the maximum number of

patients. That is not a judgment which the court can make.”

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
Importance in
Healthcare
Policy

• Clear, fair and widely accepted institutional or professional policies can

provide guidance for physicians who are faced with difficult resource allocation
decisions.
• Policies developed for the allocation of organs have reduced conflict between
teams and helped prioritize recipients within organ transplantation programs,
using generally accepted and publicly reviewed principles and guidelines.

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
Empirical studies
(In context of dialysis, transplantation, rural medicine, and critical care).

1. Critical care physicians considered

• quality of life as viewed by the patient,
• probability of survival,
• the reversibility of the acute disorder
• the nature of any chronic disorder as important factors in deciding which
patients to admit to the intensive care unit (ICU).

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
Empirical studies
(In context of dialysis, transplantation, rural medicine, and critical care).

2. Age & Resources - Do people consider age as a relevant variable in health care resource allocation?
• Most people accept the withholding of life-prolonging medical care from some critically ill older patients,
• but few would categorically withhold such care on the basis of age alone.

3. Efficacy & Equity - How do decision-makers balance concerns of efficiency and equity?
• in medical decision-making to explore the trade-off between cost-effectiveness and equity in the setting

of budget constraints.
• Many respondents said they would choose a less cost-effective test for the entire population over a more

cost-effective test for half the population.

• Equity was valued above cost-effectiveness.

Martin F. McKneally, MD, PhD; Bernard M. Dickens, PhD, LLD; Eric M. Meslin, PhD; Peter A. Singer MD, MPH
(http://www.nlc-bnc.ca/eppp[1]archive/100/201/300/cdn_medical_association/cmaj/series/bio -palm/bioethics13.htm)
Albert R. Jonsen, PhD (https://depts.washington.edu/bioethx/topics/resalld1.html)
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YOU