Case Study: Justice

Colleen Duckworth & Zekè Lue

Azusa Pacific University
July 2, 2018
Definitions
❖ Justice: Fairness, what is deserved, entitlement (Beauchamp & Childress, 2013)
❖ Distributive Justice: “Fair, equitable, and appropriate distribution of benefits and
burdens determined by norms that structure the terms of social cooperation”
(Beauchamp & Childress, 2013, p. 250).
➢ Criteria: “Achievement, education, merit, experience, contribution, need
deprivation, and effort” (Beauchamp & Childress, 2013, p. 249).
 Framework: Distributive Justice
Principles of distributive justice:
To each person:
1. According to rules and actions that maximize social utility
2. A maximum of liberty and property resulting from the exercise of liberty
rights and participation in fair free-market exchanges
3. According to principles of fair distribution derived from conceptions of the
good developed in moral communities
4. An equal measure of liberty and equal access to the goods in life that every
rational person values
5. The means necessary for the exercise of capabilities essential for a
flourishing life
6. The means necessary for the realization of core dimensions of well-being

(Beauchamp & Childress, 2013, p. 253)

 Case Study
Mario Luigi Balotelli is an Italian citizen, visiting New York,
whose travel visa has expired. He has had one month of
hemoptysis, night sweats, chest pain, fatigue, and
unintentional weight loss. His symptoms have prevented
him from being able to play his music at a local nightclub for
cash. He was afraid to seek medical care because of his visa
status and uncertainty about the access he would have to
healthcare. When he finally went to the doctor, he was
diagnosed with active tuberculosis (TB). His medical bills
totaled $29,000, and he is unable to pay them.

❖ Considering the framework of distributive justice, was justice was served by

giving medical care to Mario?
Team Members of the Bioethics Committee
Patient

Americans

Attending nurse

Attending doctor

Co-chairs: Zeke and Colleen

 Patient Progress Note
Mario was treated, and his TB is now latent. His treatment has prevented further spread
of his infection. He has a moral claim to healthcare from American resources based on
several factors (Nickel, 1986). He has a severe need. He can carry infectious diseases to
others around him. He contributes to society through his music and charming
personality, as well as through the sales taxes and rent that he pays, which all count as
social cooperation. Justified distribution of care for TB can be determined by norms that
structure the terms of social cooperation (Beauchamp & Childress, 2013). Some argue
that membership as a citizen is required to have a moral claim to services, and that
members should have more benefits than non-citizens, while others argue that lack of
citizenship is made up for by social contributions, and that American governments have
duties to protect noncitizens from harm (Nickel, 1986). The duty of American nurses,
doctors, and taxpayers to provide care is not just charity or prudence, it is a
humanitarian responsibility (Nickel, 1986). It is justified to provide care to Mario.
ANA Code of Ethics
● Provision 1: The nurse practices with compassion and respect for the
inherent dignity, worth, and unique attributes of every person.
○ Provision 1.3: The worth of a person is not affected by illness, ability, socioeconomic
status, functional status, or proximity to death. Respect is extended to all who require and
receive nursing care in the promotion of health, prevention of illness and injury, restoration
of health, alleviation of pain and suffering, or provision of supportive care
ANA Code of Ethics
● Provision 8: The nurse collaborates with other health professionals and the
public to protect human rights, promote health diplomacy, and reduce
health disparities.
○ Provision 8: The nursing profession holds that health is a universal human right. As the
World Health Organization states: “…the highest attainable standard of health is a
fundamental right of every human being.” This right has economic, political, social, and
cultural dimensions. It includes: access to health care, emergency care, and trauma care;
basic sanitation; education concerning the prevention, treatment, and control of prevailing
health problems; food security
Paice, J. A. & Coyne, P. (2017). Justice in America: Ethical
issues in cancer pain control. Journal Of Hospice &
Palliative Nursing, 19(6), 508-513.
● The opioid epidemic has made access to pain medication more difficult for
those who truly need it.
● In 2014 more than 28,000 thousand people died from opioid overdose.
● Pain management of patients with cancer may have helped with this
epidemic because patients with substance use disorder (SUD) have been
known to receive their drugs from cancer patients.
● Opioid distribution may also occur when cancer patients think they are
helping family members who are suffering from chronic pain by giving them
access to their opioids.
Paice, J. A. & Coyne, P. (2017). Justice in America: Ethical
issues in cancer pain control. Journal Of Hospice &
Palliative Nursing, 19(6), 508-513.
● In an effort to slow down the opioid crisis steps such as reducing the
number of tablets patients are able to receive regardless of efficacy of the
set number leading some patients to ration their meds further leading to
insufficient pain management and opioid withdrawal.
● Medicaid and medicare now only cover certain opioids leading those
without sufficient income without access to the accurate opioid required to
manage their pain.
Paice, J. A. & Coyne, P. (2017). Justice in America: Ethical
issues in cancer pain control. Journal Of Hospice &
Palliative Nursing, 19(6), 508-513.
● Ethical implications present themselves in the patients from lower
socioeconomic status (SES) background receiving subpar assessments, and
pain management. This can also include vulnerable populations; the elderly,
racial minorities, and patients with a history of substance abuse.
● Questions emerging from this epidemic related to justice appear in the form
of fair treatment of pain.
● Recommended solutions include standardized urine toxicology tests for all
patients in an attempt to reduce implicit bias, as well as partnerships with
pharmacies to maintain adequate stock of opioids.
MacKay, D. (2015). Standard of care, institutional
obligations, and distributive justice. Bioethics, 29(4), 262-
273.
● Clinical research poses questions of distributive justice because different
levels of treatment are provided to subjects in clinical trials.
● There are professional obligations as well as natural duties to providing
clinical trial care.
● Public research agencies and private-for-profit corporations have different
obligations to conduct research, related to funding and distribution of care.
MacKay, D. (2015). Standard of care, institutional
obligations, and distributive justice. Bioethics, 29(4), 262-
273.
● Public research agencies have an obligation to provide basic health care
and aid to people of lower income countries.
● Private-for-profit corporations have regulatory obligations of seeking profit.
● Private-for-profit corporations should be held accountable for ethical
obligations.
Review
The criteria for distributive justice are: select all that apply
A. Achievement
B. Education
C. Merit
D. Experience
E. Contribution
F. Desire
G. Effort

Vero o Falso: The ANA Code of Ethics states that health is a universal right.

What color and type of jacket was Mario wearing?

References
American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. ANA: Silver Springs, Maryland.

Beauchamp, T. L. & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford Press: NY.

MacKay, D. (2015). Standard of care, institutional obligations, and distributive justice. Bioethics, 29(4), 262-273. Doi:

http://dx.doi.org/10.1111/bioe.12060

Nickel, J. W. (1986) Should undocumented aliens be entitled to health care? The hastings center report, 16(6), 19-23. Retrieved from

https://sakai.apu.edu/access/content/group/5aa090ff-f427-4aa6-90c0-

e9c0d32bc30b/Justice/should%20undocumented%20aliens%20be%20entitled%20to%20healthcare.pdf

Paice, J. A., & Coyne, P. (2017). Justice in America: Ethical issues in cancer pain control. Journal Of Hospice & Palliative Nursing,

19(6), 508-515. doi:10.1097/NJH.0000000000000384

Summers, J. (n.d.). Principles of healthcare ethics. Retrieved from http://samples.jbpub.com/9781449665357/Chapter2.pdf