Social Justice On Edge

Rosemary Flanigan
April 16, 2009

John Carney sent to several of us here at the Center a recent article in the Journal of the American Medical Association April 8), “The Ethical Foundation of American Medicine.”

The co-authors, one of whom is a physician, contend that the mantra of the BIG FOUR (beneficence, nonmaleficence, respect for autonomy and justice) have become unbalanced: “In a market-driven environment, fiscal independence seems to have become as important as autonomous decision making in practice, and concomitantly, attention to social justice may be decreased.”

Yes, yes, that’s been said before and if Kathleen Sibelius ever gets confirmed, she is going to have to do something about reimbursement patterns for Medicare and Medicaid, for instance.But the point that jarred me was this one: “. . .the percentage of Americans who agree that the higher the income, the more the individual should expect to pay in taxes to cover the cost of care for individuals who are less well off decreased from 66% in 1991 to 51% in 2003 and to 39% in 2006.”

Can you imagine even thinking about healthcare reform within this troubling trend—a trend that does not appear to be as pronounced in other westernized countries.The whole social justice issue stands tottering in the worlds of providers and receivers of healthcare. Maybe our former next-door-state-governor ought to hope she doesn’t get confirmed!

What a challenge.