title: A broader view of justice.
abstract: In this paper I argue that a narrow view of justice dominates the bioethics literature. I urge a broader view. As bioethicists, we often conceive of justice using a medical model. This model focuses attention at a particular point in time, namely, when someone who is already sick seeks access to scarce or expensive services. A medical model asks how we can fairly distribute those services. The broader view I endorse requires looking upstream, and asking how disease and suffering came about. In contrast to a medical model, a social model of justice considers how social determinants affect the health of a population. For example, social factors such as access to clean drinking water, education, safe workplaces, and police protection, profoundly affect risk for disease and early death. I examine one important social determinant of health, health care coverage, to show the limits of a medical model and the merits of a broader view.
authors.affiliation: University of Washington School of Medicine, Department of Bioethics and Humanities, Seattle, WA 98195-7120, USA. nsjecker@u.washington.edu
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Jecker
mesh_terms: D004522:Educational Status; D028663:Ethical Theory; D015276:Health Care Rationing / Q000941:ethics*; D006291:Health Policy; D006297:Health Services Accessibility / Q000941:ethics; D006304:Health Status; D054625:Healthcare Disparities / Q000941:ethics; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011203:Poverty; D011322:Primary Prevention / Q000941:ethics*; D012935:Social Justice / Q000941:ethics; D012959:Socioeconomic Factors; D014481:United States; D035862:Vulnerable Populations