Current theories of justice describe the arrangement of institutions for a just society; ones that seek to demonstrate equal concern and respect for all. In these conditions it is anticipated that humans will have an opportunity to flourish and live well. However, the link between theories of justice that guide decision-making arrangements for institutions and justice for individuals is not clear; this is particularly evident in regard to healthcare.
The provision of healthcare is the primary societal institution charged with diagnosing and treating illness, disease or injury in order to restoring health. For those who are aging, health is to be understood in its normative sense and healthcare as comprehensive integrated systems of care that supports diverse health and functioning. In this way healthcare also contributes to the many elements that are integral for human flourishing.
At the same time, people who are aging and in need of healthcare represent some of society’s most vulnerable. This suggests that the healthcare system is a societal institution that is a particular concern of justice. Traditionally, theories of justice have sought promote the equitable distribution of a particular ‘bundle’ of goods such as resources, welfare or capabilities as the primary aim of justice. However, this does not necessarily ensure that aging people who interact with a healthcare service are treated justly.
Assessing justice in healthcare as something more than an appropriate distribution of resources suggests that there are at least ‘two different senses’ in which the term ‘justice’ is used. In the first sense, justice deals with the structural conditions for an ordered and just society but it is also concerned with the integral role that achieving and maintaining social relationships has in human flourishing.
Resulting from our embodiment, human flourishing, and the potential to flourish, will be very different for those who are very young and at the beginning of life compared with those who are toward the end. The constant feature however is the importance that sustaining vital social relationships is to human flourishing. Understanding and fostering the enabling conditions for these relationships therefore is an under-recognised yet imperative concern of justice.
This paper will argue that current theories of justice that focus on the equitable (or sufficient) distribution of goods, welfare or capabilities provide little guidance toward just decision-making for clinicians and the aging people they care for. It offers the notion of ‘human flourishing’ as a nexus between just institutions and just outcomes to bridge this gap.
Jayne Hewitt, RN, BN, LLB, LLM
PhD Candidate, Griffith Law School
After working for many years in the healthcare industry, and seeing firsthand how the law impacts upon the practice of health professionals and patient safety, Jayne undertook a Bachelor of Laws and a Master of Health Laws at the Queensland University of Technology in Australia. Recognizing the challenges that advances in biotechnology continue to have on healthcare, Jayne is a current PhD candidate with the Griffith Law School in Queensland, Australia, where she is researching understandings of justice in healthcare, and the integration of new technologies. Jayne teaches health law and ethics to interdiscipliinary cohorts of undergraduate health students as well as courses on medication safety.