Thursday, April 07, 2005

What has Justice got to do with it? Recent paper suggests little if any in clinical decisions

A recent Archive of Internal Medicine article ( " Physician's Responses to Resource Constraints , Hurst, SA et al. Arch Intern Med 2005;165:639-644) reports results of a survey inquiring about "resource constraints" in practice. In regard to what they describe as "resource allocation", reasoning about "justice" appears to play only a small role.( Only about 10% of responding physicians indicating it played a role in an allocation situation) This finding appeared to be a cause for concern to the authors as they describe this situation as a "gap" that could be bridged in fostering allocation of resources in difficult cases. I found the survey replies encouraging as typically in a resource allocation issue the answers revealed a strong concern for the patient's' welfare. Physicians in the real world,thank goodness, still seem to be more concerned with what it right for the individual patient,to whom they owe a fiduciary duty, than to some nebulous, poorly defined distributive justice, which seems to be mainly the concern of some academic bioethics departments. The constraints on resources typically is from HMO and other managed care entities' efforts to control costs. In that setting, pontificating about distributive justice, seems to be just a smokescreen.In this setting the unmodified term "justice" as typically discussed by certain bioethicists means "distributive justice" which by no means is the dominant secular view of what justice is-at least in this country.Medical Metamusings has a blog entry that I believe is worth reading and broaches the issue of "justice" as a medical ethical imperative.I would be very interested in a historical account of the origins of that concept's position in medical ethics becasue I can remember a time when it was not talked about.

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