Medical ethicsBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6962.1159 (Published 29 October 1994) Cite this as: BMJ 1994;309:1159
Justice has a wider scope
- P J Heath
EDITOR, - I am concerned that Raanan Gillon's article on the four principles of medical ethics may be in danger of oversimplifying a complex subject beyond reason - in particular in respect of the idea of justice.1 Whereas the first three principles may be thought of as relatively straightforward concepts affecting a clinician's personal moral behaviour in relation to the care of individual patients, justice is of much wider scope: it is capable of interpretation in formal, ethicopolitical, individual, and sociopolitical terms, each of which has its own range and scope of application and finds a specific role in relation to health care ethics.
The question of the social and political definitions is particularly fraught in these times of the ready identification of justice with economic values, and it is in this area that people look for a more sophisticated analysis of how they may approach allocative questions. In answering their questions I am concerned that we do not start by saying that justice was defined by Aristotle as the equal treatment of equals and the unequal treatment of unequals; in fact, in Heller's view he was saying, in criticising The Republic, just the opposite.2 He did not believe that people could be equal in any way, and his idea of distributive justice was that it …