Expanding the Justice Discourse: A Call to Use a Health Justice Framework in Bioethics

Abstract: Distributive justice, as it has been deployed in bioethics, is a thin and insufficient concept to advance equity. By supposing that our individuated interests are most relevant, it constrains the bioethicists’ purview to resolving inequalities in healthcare delivery and allocation. While these are important and necessary concerns, health inequality has been shown to be predominantly influenced by structural forces like poverty, racism, and misogyny, filtered through the social and cultural relationships among people, and mediated by purposeful, systemically driven imbalances in power. Resolving inequality requires a concept of justice that forcefully names structural drivers and frames solutions as matters of solidarity and community survival.

Health justice (HJ), a concept arising from health law scholarship, deserves serious consideration for its ability to engender a thicker conception of justice in bioethics, one with more potency to combat modern existential threats to equity. It is a framework that focuses attention on oppression as the root cause of inequity while centering the empowerment and healing of those who have been targeted by forms of structural and epistemic violence.

This panel will offer lessons learned from a bioethics collaborative that underwent a process to realign its mission under a HJ framework. Panelists will (1) familiarize participants with the concept of HJ, (2) describe theoretical and practical ways the HJ framework is used to transform approaches to institutional relationships, community-engaged research and medical education and (3) engage the audience in participatory exercises on ways to consider HJ in their work and institutions.

Keywords: health justice, health equity, organizational ethics