Markkula Center of Applied Ethics

"J" Is for Justice


By Margaret R. McLean


"It's not fair!" From the first moment I realized that mom had given me the smaller half of the warm chocolate chip cookie, I've known about justice. This was not the justice meted out on "Perry Mason." This was youthful moral indignation--a sense that I was not getting what I deserved.

We have all felt the sting of unfair treatment--perhaps someone cut into the grocery line ahead of us, perhaps we've been victims of racism or sexism. No matter what the cause, questions of fairness are questions of justice.

The justice approach to ethical decisions asks us to consider how we distribute scarce resources to those who need them. When we cannot give all people what they need, how do we determine who gets what? According to the United Network for Organ Sharing, there were 92,722 people waiting for organ transplants in August 2006, but only 6,126 people had donated organs between January and May of 2006. How do we distribute 6,126 organs among 92,722 people? This is a question for justice.

Aristotle said that we should treat people the same unless there is some morally relevant difference between them. Candidates for transplant are not identical--some are sicker, some are poorer. Is health or income a morally relevant difference? Should those who are sicker go to the head of the transplant line? Should those who can pay out of pocket have an advantage?

There are a number of good reasons that lead us to treat someone differently--a person's effort or need or merit for example. Perhaps our effort is acknowledged with a pay increase. Perhaps we receive food stamps because we have no other way to put bread on the table. Perhaps we are given a plaque for saving a life. We are quite accustomed to being treated differently. That's fine with us as long as we are treated fairly too.

Fairness requires that we are consistent in how we treat each other. If kidneys are distributed according to medical need, then they must invariably be given to those who are closest to death. Or, if organs are given to those who can reap the most benefit, then they must unfailingly be given to those with the best chance of survival.

Justice asks us to question how it is that we distribute scarce medical resources such as flu vaccine and organs. Justice summons us to ponder if the current health care system is treating everyone fairly. If not, justice demands change.


Margaret R. McLean is the director of biotechnology and health care ethics at the Markkula Center for Applied Ethics.

Return to The ABC's of Medical Ethics.

Posted in August 2006


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