“Justice” is a term which has been used to portray a number of ideas, including fairness, equality, and lawfulness. In this class, the meaning of “justice” is one of the questions to be discussed. But, we are using it to describe the morally best resolution to situations involving conflicts of interests between individuals. So for example, “lawfulness” would be an unacceptable answer (on its own) to the question of what we mean by “justice” in this class. It would be begging the question since we would still have to question how the law should be made in order to be just.

David Hume argues that justice is only an issue in situations where benevolence, charity, and/or resources are limited (p. 547.). Most people would also add that more than one individual (person or not) is involved. So, questions of justice do not occur in every medical ethics dilemma. But they do occur in many. Which situations involve questions of justice depends on the interpretation of justice being used.

Some people divide justice into two types.

  1. Non-comparative justice is that part that is concerned with making sure people gets what they are entitled to.
  2. Comparative justice is concerned with the distribution of benefits and burdens in society. A form of this is distributive justice. Distributive justice explores the morally best means to distribute scarce or limited resources amongst individuals or groups.

The extent to which these two can be treated separately is an open question. But the distinction helps to identify important justice considerations.

Plato’s dialogue, The Republic, is largely a discussion of the meaning of justice. Some of the suggested interpretations of justice are….

Plato believed that the last was the true meaning of justice.

Aristotle came up with the suggestion that distributive justice consists of treating equals equally and unequals unequally (Bk. V, Chap. VI). So, for example, if you have two patients in the emergency room and each are equally in need of aid and they came in at the same time and equal in all other relevant aspects, according to Aristotle, you would have to either treat them both at the same time or devise a fair method of choosing who gets seen first (such as a random coin toss). This interpretation is sometimes referred to justice as impartiality. The problem with this interpretation is in determining which criteria are morally relevant to distinguish between those who are equal and those who are not. Are there situations where unequal treatment is never justified? For example, many people feel that all people should have equal access to a basic minimal level of health care, but higher-level care is the responsibility of the individual. What is a basic minimal level?

Another related interpretation of justice is what Aristotle calls “commutative justice” and what is more commonly known as the golden rule, “Do unto others what you would want done unto you in a relevantly similar situation.” (Many modern philosophers refer to this form of justice as moral reciprocity). This interpretation is also ambiguous. It may be that others do not want what you would have chosen. What is the criteria to determine which situations are relevantly similar?(e.g. free emergency treatment versus free cosmetic surgery).

A different interpretation of justice comes from Taoism, Stoicism, and a host of religious traditions. This is, basically, that justice is that which is in accordance with nature (or the will of a higher power). The difficulty here is in determining what is true nature and what is actually a warped portrayal of nature. Also, inherent in this interpretation is the assumption that there is a true nature that one can look to as a guide instead of simply a popular interpretation of “true nature” which will change as the culture changes.

Utilitarians and other consequentialists, respond to this by saying that society’s conception of justices does change. So, they feel that a better guide for justice is the actual consequences of an action on the individuals involved. As you know from previous lectures, utilitarians judge these consequences according to the amount and quality of pain and pleasure (or unhappiness and happiness) they produce. This can be problematic though. This guide could result in calling traditional cases of injustice just, such as killing someone for a crime he/ she did not commit. Also, how do you measure happiness and unhappiness?

Consider the criteria listed below. Which do you believe are justified in cases where the treatment is life-saving, improves impaired functioning/appearance, or enhances normal functioning/appearance.

Criteria used for the distribution of limited medical resources are:


Aristotle, Nicomachean Ethics. translated by Weldon, J.E.C. Prometheus Books (Buffalo, NY:1987).

Hume, D. A Treatise of Human Nature. Penguin Books (London, UK: 1987).

Plato, Republic. translated by Shorey, P. in Hamilton, E. & Cairns, H. eds. Plato: The Collected Dialogues.Princeton University Press (Princeton, NJ: 1961).