Justice

Definitions

1. Justice is the virtue by which we give each person what they are due
2. Fairness and equity in our dealings with others
3. The firm and constant will to give their due to God and neighbor

What is Justice?

Justice in medicine means treating all patients fairly, advocating for equitable healthcare systems, and using resources responsibly. It requires us to see beyond individual encounters to systemic patterns of inequality and work toward their remedy.

Why should we practice the virtue of Justice?

• Equal treatment: All patients deserve excellent care regardless of their circumstances
• Resource stewardship: Fair allocation of limited medical resources
• Health equity: Addressing disparities in healthcare access and outcomes
• Professional duty: Medicine's social contract includes promoting justice
• Patient dignity: Justice affirms the equal worth of all persons

How do we foster Justice?

1. Examine biases: Reflect on how implicit biases may affect your care
2. Advocate for the vulnerable: Speak up for patients who lack power or voice
3. Use resources wisely: Consider cost-effectiveness and stewardship
4. Learn about disparities: Educate yourself about health inequities
5. Support systemic change: Work to reform unjust structures in healthcare

Clinical Case

You are an internal medicine resident working your outpatient service. Mrs. N is a 63-year-old female with well-controlled hypertension and hyperlipidemia who presents with a three-month history of increasing numbness in her right hand that has not responded to physical therapy. You review her previous cervical spine radiographs that showed multi-level degenerative changes. You think that an MRI of the cervical spine would help confirm your suspicion of neuroforaminal narrowing as the cause of the hand numbness. Your attending physician agrees and asks you to order a cervical spine MRI with contrast (intravenous gadolinium). You do not remember ordering this exam too often but wonder if the gadolinium is needed so you ask. Your attending says that occasionally we may find something with the gadolinium and besides the insurance company will pay for it.

Next week you are now rotating through radiology hoping to get your contrast questions answered. By good fortune, the radiology resident is reviewing spine imaging requests and sees your order for Mrs. N. You ask the radiology resident regarding the need for gadolinium in patients with cervical spine problems. The discussion revolves around whether the patient has any “red flag” indicators such as concern for infection, history of malignancy or prior neck surgery. You state that Mrs. N does not have any of those and you ordered the study to evaluate for degenerative neuroforaminal narrowing. The resident states that the study would best be done without the gadolinium per American College of Radiology Appropriateness Criteria. However, the radiology resident states that since the insurance approved it and it is difficult to get a hold of any requesting physician to change orders, that the imaging center just does the study- besides they get paid more for using contrast.