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Healthcare Justice

Page history last edited by Mikaela Raymond 2 years, 2 months ago

Introduction:

 

The healthcare industry is responsible for saving the lives of millions of people every year, and thus has the responsibility to ensure justice for every patient that walks through the door of any medical facility throughout the country. Healthcare justice encompasses a wide scope of topics and involves several other spheres of justice including racial and gender justice. As a theory of justice, healthcare justice aims to bring a high level of care and consideration for every patient, regardless of finances, gender, race, sexual orientation, or social position. Additionally, healthcare justice advocates for the well being of healthcare providers working within the healthcare system by providing a supportive and inclusive environment. Through the efforts of advocacy groups like the Health Justice Commons, the healthcare industry has worked towards trying to provide the same quality of care for everyone. However, despite the standards that have been set, healthcare justice has fallen short of its goals. 

 

The standards for healthcare were created in order for every patient to receive a high level of quality care, regardless of the hospital or health center they go to. Regardless, there are many different ways in which these standards fail to provide people the care they deserve. Despite the standard that is promised, there is a large variability in the care that is provided across hospitals(Reich 2014). Many hospitals throughout the United States have struggled financially which has caused their ability to provide care to falter. In turn, this has caused hospitals in low income areas to have less resources and therefore left unable to provide the care that hospitals in higher income areas are able to. Additionally, minorities have not felt as supported and cared for as white men do in the healthcare industry. Many women and non-white individuals have expressed that they haven’t received the same level of care as their white and/or male peers and that their medical concerns are not taken into as much consideration. Overall, the standards for healthcare are still severely hindered, although there are many organizations that are fighting to fix them. 

 

Major Debates and Questions:

 

Economic Justice

 

Economic justice is one of the biggest issues of healthcare justice in modern day. The healthcare system, specifically health insurance companies, has twisted the purpose of healthcare into a money-driven operation rather than one that is committed to helping those in need(Reich 2014). Due to the increasing cost of procedures and medicines, patients require insurance that will cover the majority of their expenses. However, patients are in a constant battle with health insurance companies and healthcare advocates in order to get financial aid for lifesaving medical care. The major issue with health insurance companies that many patients have struggled with is that there are little to no regulations regarding who gets funding for certain medical procedures and how much they’re given. The choice is completely up to the insurance company. This has caused major conflict between hospitals and insurance companies since the insurance agents are often uneducated on the subject of medicine and often don’t realize the severity of certain conditions(Friedman 2011). Additionally, hospitals have struggled immensely with finances, especially in low income areas. Governmental funding that is given out to hospitals is very scarce and is most often distributed to high-end hospitals in high income areas, leaving many smaller hospitals in dire financial situations. Without funding, hospitals have to resort to purchasing less medical supplies and can’t afford to keep patients in long-term care for as long as more financially stable hospitals(Reich 2014). Without addressing the financial situation for both hospitals and patients, the healthcare industry will never be able to provide appropriate care in all areas of the United States. 

 

Gender Justice

 

In the sphere of healthcare, women are seen as the caretakers of chronically ill and/or long term care patients and often receive less comprehensive care than their male peers. Due to many hospitals’ inability to provide long-term care, the healthcare system has turned to women as a way to continue patient care outside of a healthcare facility. Without providing any additional assistance, women are often forced to take care of patients with complex medical conditions that require several medications and other forms of treatment. This causes many women to become severely overworked as they have to struggle to uphold their own jobs, personal lives, and the additional task of taking care of an ill person. As an added issue, women are given no financial compensation for their extra commitment which leads to financial problems related to the economic justice issue described above. In handing over care to women, healthcare professionals frequently provide only a rudimentary introduction on how to care for their loved one. Without providing any substantial instructions, women experience elevated stress levels as they try to give comprehensive care to the patient that they have swiftly been given responsibility for(Hooyman and Gonyea 1995). In their own experiences in healthcare, women also feel as if they aren’t listened to as much as men. As shown through several studies, women with the same severity of symptoms for the same conditions go undiagnosed or poorly treated as compared to men who receive advanced care much quicker. Conditions such as coronary artery disease, Parkinson’s disease, and tuberculosis have been diagnosed in a similar amount of men and women, yet the amount spent on clinical care for men greatly outweighs the amount spent on women(Hamberg 2008). Women must be treated with greater respect and equality in the healthcare system in order to achieve the same standard of care that has been promised nationwide. 

 

Racial Justice

 

Men and women from the non-white community are vastly underserved in healthcare. As healthcare in the United States began, it was built around a racist framework since slavery was still extremely common. As the United States progressed and fixed most of its racist policies and mindsets, medicine continued to be racially biased. Although there are strides that have been made, there still hasn’t been enough research on some of the more subtle differences between the bodies of white people and people of other races. Since there are some differences in the presentation of certain conditions, non-white people are already disadvantaged when it comes to medical care since the variability of presentations are not widely taught in medical schools(Byrd, Clayton, and Blendon 2000). In addition, non-white people, specifically those of the black and Hispanic communities, are severely under-treated for pain. In the hospitals near mainly black and/or Hispanic dominated communities, there is an unusually low stock of opioid drugs. Opioids are common painkillers for patients with severe pain, yet they’re extremely addictive and are given out only if absolutely necessary. In these hospitals, there is racial bias that assumes that black or Hispanic people will try to get a prescription for these medications despite not being in severe pain. This has caused these groups to be underserved and undertreated. The black community specifically has a higher incidence of cancer and a higher rate of cancer-related deaths than any other racial group. Despite having the highest reported number of patients, cancer patients from the black community are often inadequately treated for pain related to their condition. Additionally, black patients have a lower survival rate of early stage lung cancer due mostly because they are provided potentially curative surgery at a much lower rate. Although people may try to contribute that statistic to external reasons, the rate of curative surgery was not connected to any of the patients’ socioeconomic status, insurance coverage, or their access to care. As an added disadvantage, black patients are less likely to be referred for transplants at transplant centers. Specifically, only 50.4% of black women were referred as compared to 70.5% of white women, and only 53.9% of black men were referred for a transplant as compared to 76.2% of white men who went to transplant centers(Freeman and Payne 2000). These few ways that non-white people have been underserved illuminate the racial bias that still survives within healthcare. In order to achieve the promised standard of care, the deep-rooted racial biases in healthcare must be addressed and mended. 

 

Justice for Healthcare Workers

 

The healthcare industry is unfortunately a commonplace for high-stress, low-support work environments that has limited the amount of staff willing to work in these establishments. Specifically, nurses experience an extremely high level of stress in the workplace due to the incredible amount of responsibilities placed upon a quickly diminishing amount of workers. Not only is the job required by nurses already taxing and demanding, the interactions between nurses and doctors often make their stress even more unbearable(Reich 2014). Nurses often feel as if their work and efforts are not valued by the doctors they work for as they are constantly met with dissatisfied physicians that not only disvalue the work they have completed, but add to their stress by adding extra work that is completely unnecessary for nurses. Many nurses have reported feeling mistreated by physicians as they are constantly tasked with completing work that the physicians simply do not feel like completing themselves. Due to the conditions that nurses face, there has been a drastic decrease in the number of nurses applying to work and a heavy increase in the number of nurses quitting their jobs due to the effect that their stress has had on them. Stress is commonly known to lead to worsening health and severe health problems which is not only taxing on a person, but further affects the staffing issue since nurses need to take sick days to take care of the problems that their own job has caused them(Shirey et al. 2010). Nurses require justice in order to not only make healthcare more efficient, but make the healthcare work environment a more inviting and supportive place that doesn’t overwork and stress its employees. Without addressing the work environment within the healthcare industry, the staffing issue will continue to hinder healthcare and lead to patients not being physically able to receive care. 

 

Advocacy Group:

 

Among many other groups fighting for healthcare justice, the Health Justice Commons (HJC)  fights for a myriad of justice spheres including racial justice, gender justice, and disability justice. The Health Justice Commons has realized the inequalities in healthcare and is committed to reworking the entire healthcare system in order to make healthcare accessible to everyone regardless of financial status, race, gender, or sexual orientation. The Health Justice Commons is specifically concerned with the issue of economic justice as it affects health insurance and the inequality and biases against non-white, non-cisgender, and non-male persons. Their organization is founded on five core principles: “justice is the best medicine”, “health is wealth”, “no one is disposable”, “to harm one is to harm all”, and “universal access”. Under these core principles, the Health Justice Commons will transform healthcare into an institution centered around justice in order to serve everyone according to true, nationwide healthcare standards. In an effort to accomplish their goals, the HJC offers classes to the public to educate them on their rights and the failures within the healthcare system. In educating the public, the HJC plans to bring awareness to the issues within healthcare and encourage more people to advocate for their own rights and the rights of others(Health Justice Commons 2018). By adhering to the core principles of the HJC and gathering attention surrounding their goals, the healthcare industry will become a more just institution that is able to provide care to every patient in an equal manner.

 

Connection to broader theories of justice:

 

Justice in healthcare functions partly through distributive justice as described by John Rawls. Although Rawls did not include health in his theory and described it as a natural good, it can and should be attributed to distributive justice. Rather than distribute healthcare through its material goods, health itself should be the main focus of distribution. In creating laws and regulations regarding healthcare, Rawls’ veil of ignorance should be implemented. Unlike healthcare today, perceiving healthcare through the veil of ignorance would allow all people from every community to have access to the healthcare they deserve. As healthcare has developed, it has become biased and unjust, a quality that would be diminished or wholly eliminated if it were created without the knowledge of any single person’s socioeconomic status or individual experiences. If created through that lens, healthcare would, ultimately, be universal. Although that concept is widely debated, especially in the United States, it would allow all people to have access to lifesaving care that they would not otherwise be able to receive. Rawls’ distinction of health as a natural good undermines the effects that illnesses, diseases, etc have on the lives of patients that have been diagnosed with these conditions. Assuming that health cannot be distributed by the government or other agencies in a fashion to where the nation is able to support everyone in need is dismissive at a minimum. Unfortunately, this is the stance that has been taken in the United States today, and it must be fixed in order for every citizen to feel as if their physical, mental, and emotional health is cared for by their own government(Kneiss 2019). If the United States continued to adopt segments of distributive justice to implement into their healthcare system, it would be a step in the right direction and give the citizens that feel unsupported the sense that they are truly important in the nation they reside in. 

 

Conclusion:

 

Healthcare justice as a whole is a progressive, continually evolving scope of justice that fights for the equal representation of all people regarding their medical care. Despite the challenges that are still being fought through today, advocacy groups have recognized the pitfalls of the institution and are adamantly advocating for the necessary changes to be made. Without healthcare justice, no single citizen would be able to receive the healthcare that they deserve and it is therefore a crucial component of the world that we live in. 

 

Bibliography:

 

Byrd, Michael W, Linda A Clayton, and Robert Blendon. 2000. An American Health Dilemma: A Medical History of African Americans and the Problem of Race: Beginnings to 1900. New York: Routledge. https://doi.org/10.4324/9780203904107.

 

Freeman, Harold P and Richard Payne. 2000. “Racial Injustice in Health Care.” The New England Journal of Medicine 342 (14): 1045-1046. https://www.nejm.org/doi/pdf/10.1056/NEJM200004063421411.

 

Friedman, Kathleen M. 2011. “Health Care: A Human Rights and Economic Justice Issue: Journal of Participatory Medicine.” Journal of Participatory Medicine | Transforming the Culture of Patient Care. https://participatorymedicine.org/journal/opinion/commentary/2011/03/07/health-care-a-human-rights-and-economic-justice-issue/

 

Hamberg, Katarina. 2008. “Gender Bias in Medicine.” Women’s Health 4 (3): 237-243. https://doi.org/10.2217/17455057.4.3.237.

 

Health Justice Commons. 2018. HJC. https://www.healthjusticecommons.org/ (December 13, 2021). 

 

Hooyman, Nancy R and Judith Gonyea. 1995. Feminist Perspectives on Family Care Policies for Gender Justice. Thousand Oaks, California; London: SAGE. https://suny-pla.primo.exlibrisgroup.com/permalink/01SUNY_PLA/n9hfss/alma995001555604852.

 

Kneiss, Johannes. 2019. “Justice in the Social Distribution of Health.” Social Theory and Practice 45 (3): 397-425. https://www.jstor.org/stable/45237364.

 

Reich, Adam D. 2014. Selling our Souls: the Commodification of Hospital Care in the United States. Princeton, New Jersey; Oxfordshire, England: Princeton University Press. https://doi.org/10.1515/9781400850372.

 

Shirey, Maria R, Anna M McDaniel, Patricia R Ebright, Mary L Fisher and Bradley N Doebbeling. 2010. “Understanding Nurse Manager Stress and Work Complexity.” The Journal of Nursing Administration 40 (2): 82-91. http://www.jstor.org/stable/26819767.

 

 

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