Justice as a principle of bioethics
Already in this course you have talked about various models of justice, including Rawlsian ideas of justice as fairness. In bioethics, the kind of justice we are most commonly considering is distributive justice: how should we allocate the various benefits and burdens of healthcare. Unfortunately, injustices at the societal level—including differences in income, education levels, and so forth—often are reflected in health outcomes and access to health services. In fact, one of the best ways of predicting a person’s risk of having a stroke is by asking what postcode they live in. People living in the most deprived areas have a 70% higher stroke rate as persons living in the least deprived areas. Addressing the multifaceted reasons for this difference is one of the key challenges facing Australia’s health system in the coming years.
Distributive justice goes in two directions: on the one hand it requires persons to have fair access to necessary health services. On the other hand, it requires fairness in protecting persons from harms associated with healthcare. Participation in research is a really good example of this. Up until quite recently, research was considered quite a risky endeavour and so enrolment in research was generally characterised as risky and undesirable. And so when discussions initially arose about fair subject selection for research the main idea was preventing exploitation of vulnerable populations.
Those of you who have seen the 2015 movie The Stanford Prison Experiment will have some idea of what I’m talking about here. For those of you who haven’t seen it, the film recreates one of the most famous experiments in the history of social psychology. U.S. college students were put in a simulated prison environment, divided into those assigned the role of ‘guard’ and those assigned the role of ‘prisoner’. Many of the students surrendered their personalities, to greater and lesser degrees, becoming progressively more sadistic guards and submissive prisoners. As you can imagine, participation in an experiment like this can have long-lasting emotional repercussions both for the prisoners and the guards.
There have also been some notorious examples...