Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

From therapeutic jurisprudence...to jurisprudent therapy

For nearly a decade, "therapeutic jurisprudence" (TJ) has provided a theoretical framework within which legal rules, legal procedure, and legal roles are analyzed in terms of their therapeutic, neutral, or antitherapeutic effects. This article proposed "jurisprudent therapy" (JT), an extension of the TJ model, as a context for analyzing mental health science, mental health practice, and mental health roles in terms of their "jurisprudent," neutral, or "antijurisprudent" effects. The JT perspective neither supplants nor supersedes TJ; rather, it mirrors and augments an established process for interdisciplinary contrast, comparison, and integration. Just as an empathic and evolving legal system provides psychological benefits, so does a legally informed and juridically compatible progression of social science promote principles of justice and human freedom. Consideration of these two complementary models in tandem yields an array of brainstorming devices, to synergistic effect, with heuristic implications for teaching, research, and service delivery.     

The Space That Difference Makes: On Marginality,Social Justice and the Future of the Health Humanities

Feminist theorist and educator, bell hooks, asserts that to seek true liberation one must choose marginality. One must choose to occupy the space outside the binary between colonizer-colonized, hegemonic center-periphery, and us-them in order to create a location of possibility. This essay will reveal the practice of social justice as the navigation of the space that difference makes and argue that choosing marginality provides a framework for health humanities work towards social justice in health care. The space of the launderette that is depicted in Hanif Kureishi’s 1986 film, My Beautiful Laundrette, provides an example of choosing marginality and illustrates how difference structures both real and imagined spaces, which influences how individuals ultimately perceive one another. We will draw from the work of bell hooks; political geographer, Edward Soja; and Marxist philosopher, Henri Lefebvre, to demonstrate the importance of the health humanities’ position at the margin to traditional health care education.     

Ethical social justice: Do the ends justify the means?

This article offers an ethical decision‐making model, informed by community psychology values, as a means for guiding psychologists when engaging in social justice‐oriented work. The applicability of this model is demonstrated through a case analysis elucidating how America's psychologists individually and collectively arrived at the decision to endorse torture—ostensibly as a means for preventing terrorism. Critics have wondered how the American Psychological Association succumbed to these involvements, and how to prevent such ethical lapses in the future. Unfortunately, the American Psychological Association's ethical codes fail to provide explicit guidance for psychologists' involvement in social justice work that impacts communities and systems. To address this gap, we present a values‐driven, ethical decision‐making framework that may be used to guide psychologists' future practices. This framework infuses fundamental community psychology values (i.e., caring and compassion; health; self‐determination and participation, human diversity, social justice; and critical reflexivity) into a 9‐step model.     

Justice, health, and healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits of rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Justice,Health, and Healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Infusing Multicultural and Social Justice Competencies Within Counseling Practice: A Guide for Trainers

In light of rapidly changing demographics within the United States, counselors are challenged to provide culturally responsive services to facilitate optimal client functioning. This article highlights recommended training strategies within a developmental framework to promote multicultural and social justice competencies for trainers of mental health professionals.     

In the world but not of it: managing the conflict between Christian and institution.

Christian physicians, nurses and other health care workers must manage a daily conflict of conscience between their Christian faith and predominantly secular health care institutions. This essay examines various efforts for managing these conflicts: a turn towards social justice or a seeking of holiness. Seeking social justice, however, is theologically empty. Traditionally, the Christian requirement that we be "in this world but not of it" requires a journey along a narrow path to holiness. Christian medical morality must, therefore, be understood within this light. However, just as there cannot be generic health care, but rather health care for a particular person's needs and problems there cannot be generic holiness, but only a holiness grounded in worshiping God rightly. In so worshiping the Christian will be assisted in negotiating the inescapable and perilous vocation of being in the world but not of it.     

Gender and mental health: An examination of procedural justice in a specialized court context

The procedural justice framework has been applied in the criminal justice contexts of policing, corrections, and courts. According to this perspective, fair treatment, respectful dialogue and being given a proper voice will contribute to citizens' positive views of authority figures. While this literature has grown immensely, several questions remain unanswered. Do males and females perceive similar levels of procedural justice? Does mental health status influence perceptions of fair treatment? Whether procedural justice is a general perspective that can be applied across social groupings has important implications for correctional treatment in that programs that truly “work” for all are more cost‐effective. Toward that end, the current study investigates the relationships among procedural justice perceptions, gender, and mental health status in specialized drug courts, a context that has received little empirical attention. We do so using secondary data originally collected between 2003 and 2009 for Rossman, Roman, Zweig, Rempel and Lindquist's Multisite Adult Drug Court Evaluation (MADCE). Results from a full‐sample analysis reveal that women report higher levels of procedural justice; that drug court participation significantly influences procedural justice perceptions; and that depressive symptomology is a significant predictor of procedural justice perceptions. In male‐ and female‐specific subsamples, drug court participation exerts similar effects for males and females, as does depressive symptomology. Implications for theory, research, and practice are discussed.     

Measured fairness, situated justice: feminist reflections on health care rationing

Bioethical discussion of justice in health care has been much enlivened in recent years by new developments in the theory of rationing and by the emergence of a strong communitarian voice. Unfortunately, these developments have not enjoyed much in the way of close engagement with feminist-inspired reflections on power, privilege, and justice. I hope here to promote interchange between "mainstream" treatments of justice in health care and feminist thought.     

The moderating effect of perceived organizational support on the relationships between organizational justice and objective measures of cardiovascular health

This paper builds on a recent meta-analytic review on the relationships between organizational justice and health. Specifically, we examine the moderating role of perceived organizational support (POS) on the relationships between organizational justice and three objective cardiovascular health measures, namely, heart rate, systolic blood pressure, and diastolic blood pressure, among a population of 290 public construction workers. The interaction between justice and POS was statistically significant using procedural justice, demonstrating that procedural justice is associated with improvements in the three health outcomes only when POS is relatively high. In other words, higher levels of both procedural justice and POS were needed for reduced heart rate and reduced systolic and diastolic blood pressure. However, the interaction between distributive justice and POS did not significantly relate to the health outcomes. This study makes a contribution to the field by focusing the effects of psychosocial workplace variables on measures of cardiovascular health, and demonstrating an important boundary condition of the relationships between procedural justice and cardiovascular risk factors.     

Psychology and self-help groups. Predictions on a partnership

Continued growth and increased legitimacy are anticipated for the American self-help group (SHG) phenomenon. Currently estimated at six and a quarter million participants annually, self-help groups will assume a central role in the nation's mental health delivery system over the next two decades. The first part of this article illuminates the self-help group phenomenon itself. Its scope, characteristics, supporting social climate, and associated research issues are reviewed. The second part is a futuristic examination of its interface with the newly industrializing world of health care. Massive increases in mental health services are predicted, especially via the SHG format. Theory development, research sophistication, changing SHG formats, a place in public policy, and acceptance into graduate curricula are also expected, as are collaborative relationships with a variety of professional disciplines. Psychologists are urged to enhance the relevance of the profession by taking an early leadership role in these developments.     

Justice and Game Advantage in Sporting Games

This paper is a case study of what Jon Elster calls "local justice"; particular schemes of justice which, on a relatively autonomous basis, are designed and implemented by institutions and practices to meet particular preferences and goals. The paper suggests an interpretation of the role of justice in sporting games. First, a framework for examinations of schemes of local justice is suggested. Second, norms are suggested that express the requirements that have to be met in order to consider a sporting game as just. The discussion shows that sports are characterized by a particular blend of meritocratic justice in which goods and burdens are distributed according to performance, and a non-meritocratic distribution through which goods and burdens arise as matters of chance. The essay concludes by arguing that the optimal blend of meritocratic justice and chance results in the realization of not merely fair sporting games, but of exciting and good games as well.     

United States and Canadian approaches to justice in health care: A comparative analysis of health care systems and values

The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.     

Systemic training for healthcare professionals: the Chicago Center For Family Health approach

There has been increasing interest in family-centered, collaborative, biopsychosocial models of care by health and mental health professionals and consumers. This trend has led to growing demand and development of specialized training in family systems approaches to health care. This article describes the Families, Illness, and Collaborative Healthcare programs developed at the University of Chicago affiliate, the Chicago Center for Family Health. The program philosophy is guided by the following principles: a systems orientation focused on the family, a Family Systems Illness Model, a family resilience framework, a family-centered collaborative model of health care, and a social justice and advocacy orientation. Specific training components that implement these principles are described, including intensive certificate and fellowships; workshops, conferences, and institutes; and consultation and training services for community-based organizations. Discussion includes professional networking opportunities, funding challenges, and policy recommendations.     

Can Norman Daniels Help You Get a Wheelchair? A Commentary on Durocher et al.

Durocher and colleagues (2019) argue that Norman Daniels’s notion of just health could provide a useful framework for decreasing inequities in access to assistive technology. I argue that it would provide limited help for two reasons. First, Daniels’s reliance on normal species functioning as the goal of health care and his assumptions regarding the impact of normal species functioning on reasonable life projects create substantial difficulties for application to assistive technology. Second, although Daniels’s requirements for distributive justice provide a critical starting point for any discussion of health equity, these requirements appear already met within current assistive technology funding schemes.     

Roots and correlates of perceived injustice in the division of family work

Abstract This study provides a comprehensive test of the distributive justice framework to explain justice evaluations of the division of family work. Using data of 632 dual‐earner couples with young children from 3 European countries, the analyses provided good support for the distributive justice framework. The frequency with which spouses compared each other's amounts of family work, the outcome of the comparison of the husband's family work with the family work performed by other men, and the extent to which the partner appreciated one's family work proved to be most predictive of justice evaluations. Notably, the evidence supports the model equally for women and men and for justice evaluations of the divisions of domestic work and child care.     

The Global Scope of Justice

In this paper, I examine the question of the scope of justice, in a not unusual distributive, egalitarian, and universalistic framework. Part I outlines some central features of the egalitarian theory of justice I am proposing. According to such a conception, justice is – at least prima facie – immediately universal, and therefore global. It does not morally recognize any judicial boundaries or limits. Part II examines whether, even from a universalistic perspective, there are moral or pragmatic grounds for rejecting or limiting the global scope of justice. In particular, I scrutinize five universalistic objections: (1) the principle of "moral division of labor"; (2) the connection between cooperation and distributive justice; (3) the primacy of democracy; (4) the dangers of a world state; and (5) political-pragmatic reasons. I intend to show that these objections cannot undermine the strong normative claims of global justice. At the most, political-pragmatic reasons speak in favor of initially striving for somewhat less, in order to receive more general backing.     

Exploratory Health Disparities Research: The Need to Provide a Tangible Benefit to Vulnerable Respondents

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term "service" is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this "service" could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research.     

A Research Framework for Understanding the Practical Impact of Family Involvement in the Juvenile Justice System: The Juvenile Justice Family Involvement Model

Family involvement is recognized as a critical element of service planning for children’s mental health, welfare and education. For the juvenile justice system, however, parents’ roles in this system are complex due to youths’ legal rights, public safety, a process which can legally position parents as plaintiffs, and a historical legacy of blaming parents for youth indiscretions. Three recent national surveys of juvenile justice‐involved parents reveal that the current paradigm elicits feelings of stress, shame and distrust among parents and is likely leading to worse outcomes for youth, families and communities. While research on the impact of family involvement in the justice system is starting to emerge, the field currently has no organizing framework to guide a research agenda, interpret outcomes or translate findings for practitioners. We propose a research framework for family involvement that is informed by a comprehensive review and content analysis of current, published arguments for family involvement in juvenile justice along with a synthesis of family involvement efforts in other child‐serving systems. In this model, family involvement is presented as an ascending, ordinal concept beginning with (1) exclusion, and moving toward climates characterized by (2) information‐giving, (3) information‐eliciting and (4) full, decision‐making partnerships. Specific examples of how courts and facilities might align with these levels are described. Further, the model makes predictions for how involvement will impact outcomes at multiple levels with applications for other child‐serving systems.