This paper asks the question of how much should society spend on diagnosis as opposed to medical treatments and compensation when implementing its goals of distributive justice in health policy through publicly-funded medical entitlement programs in a world of limited information? A model is presented in which social planners seek to maximize expected social welfare by allocating medical goods, including diagnostic tests among medically dissimilar individuals when there is imperfect information about the medical condition of an individual, subject to the resource constraints of a medical entitlement fund. The goals of distributive justice underlying the social welfare function is governed by a parameter representing society's aversion to inequality. It is argued that society, given its aversion to inequality, need not always entitle the medically more fortunate individual to less treatment and compensation. Moreover, in most cases, it is socially desirable to spend a finite and equal amount on diagnostic tests for each individual, even though there is some probability of misdiagnosis. In some unusual cases, zero expenditures on diagnostic tests will be socially optimal.
Authors examining the developing dispute resolution alternatives to the adversarial system have identified nine converging "vectors" or alternatives in what has been termed the Comprehensive Law Movement. These authors have sought to understand how the developing vectors can remain separate and vibrant movements while sharing common ground. Some analyze these developments as being within law and legal practice, others see them as alternative approaches to law, and still others take a combined approach. It will be impossible to understand how these vectors have meaningful differences from law and legal practice if the search is limited to looking within law and legal practice. It will be impossible to understand how these vectors have meaningful commonalities with law and legal practice if the search is limited to looking external to law and legal practice. Instead of comparing the vectors with the adversarial system, higher order criteria are required. What is needed is a comprehensive and internally consistent super-system of norms; one that can be used to evaluate the adversarial system and the evolving vectors on an equal footing. An Aristotelian natural law virtue theory of justice can: (a) provide a functional guiding definition of justice; (b) serve as a comprehensive and internally consistent super-system of norms; and (c) provide the theoretical and evaluative foundation required to clarify the relationships among the adversarial system and the developing vectors. Finally, it will become clear why the Comprehensive Law Movement might be more appropriately conceptualized as the Comprehensive Justice Movement.
The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.
The right to health care is a social achievement of democratic states based on law. In order for this to become effective in a just way, it is necessary for many elements to come together. This article analyses these elements in their different moments: the state as a guarantor of this right and to limit assistance; the health institutions, direct managers of care, which must combine efficiency and equity; and, finally, the health professionals, who are in the final instance the real distributors of resources. Traditionally medicine always omitted evaluation of the socio-economic factors from its sphere. It even came to consider that these questions were opposed to good medical practice. Today such an assertion is unsustainable. For a health professional the path to efficiency passes by way of assuring clinical effectiveness, in this way guaranteeing both the patient's interest and the suitable distribution of resources.
Summary.-Employees in three call centers were surveyed about their perceptions of organizational justice. Four factors were measured: distributive justice, procedural justice, interpersonal justice, and informational justice. Structural equation modeling was employed to test whether a two-, three-, or four-factor model best fit the call center data. A three-factor model of distributive, procedural, and informational justice provided the best fit to these data. The three-factor model that showed the best fit does not conform to any of the more traditional models identified in the organizational justice literature. This implies that the context in which organizational justice is measured may play a role in identifying which justice factors are relevant to employees. Findings add to the empirical evidence on the dimensionality of organizational justice and imply that dimensionality of organizational justice is more context-dependent than previously thought.
Charitable assistance is a common response to food insecurity in many affluent countries. The coalition featured in this case study is explicitly concerned with social justice, mitigating the potential for charitable assistance to mask the extent of food insecurity, its root causes and its long-term consequences. The coalition structure has assisted community workers in transcending day-to-day routines, so as to reflect on the politics of food insecurity and institutionalised responses to this problem. Coalition members have defined food security as an objective whose achievement will entail comprehensive reform. One noteworthy outcome has been to recommend that member groups not redistribute a number of foodstuffs commonly donated by individuals and corporations. In grappling with a tension between responding to immediate needs for food and addressing the root causes of these needs, community workers have paid attention to public health.
Controversy has arisen surrounding findings of not criminally responsible (NCR) or not guilty by reason of insanity (NGRI) in recent years. In some countries, the debate has been driven by the concerns of victims, who are seeking greater information on discharge, accountability on the part of the offender, and involvement in the disposition of NCR or NGRI perpetrators. Their demands raise questions about proportionality between the seriousness of the index offense and the disposition imposed, the place of retribution in the NCR regimen, and the ethics-related challenges that emerge from this tension. We conducted a literature review focused on the relationship of victims to NCR and NGRI processes. The literature is limited. However, theoretical reasoning suggests that interventions based on restorative justice principles reduce persistently negative feelings and increase a sense of justice for victims of criminally responsible defendants. Opportunities and problems with extending such processes into the area of mentally abnormal offenders are discussed.
Indigenous American communities face disproportionate health burdens and environmental health risks compared with the average North American population. These health impacts are issues of both environmental and reproductive justice.
In this commentary, we review five indigenous communities in various stages of environmental health research and discuss the intersection of environmental health and reproductive justice issues in these communities as well as the limitations of legal recourse.
The health disparities impacting life expectancy and reproductive capabilities in indigenous communities are due to a combination of social, economic, and environmental factors. The system of federal environmental and Indian law is insufficient to protect indigenous communities from environmental contamination. Many communities are interested in developing appropriate research partnerships in order to discern the full impact of environmental contamination and prevent further damage.
Continued research involving collaborative partnerships among scientific researchers, community members, and health care providers is needed to determine the impacts of this contamination and to develop approaches for remediation and policy interventions.
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This ethnographic study describes the results of a collaborative journaling process that occurred between a student and his instructor of a second-year social work communications course. Many questions from the student's and the instructor's perspectives are raised regarding accommodating the student with a severe speech impairment in a course that specifically focuses on communication skills. Preliminary recommendations are made for social work students and professionals with communication limitations, and for social work educators.
Emerging technologies like Tandem Mass Spectrometry (TMS) enable multiple tests on a single blood sample and allow the expansion of Newborn Screening (NBS) to include various metabolic diseases. Introducing TMS for NBS raises important social and ethical questions: what are the criteria for adding disorders to screening panels? What evidence justifies expansion of screening? How can equity in NBS access and standards be ensured? How can policy standards be set, given the multiplicity of stakeholders? To address emerging issues, policy-makers, patient advocates, clinicians and researchers had a workshop during the 2005 Garrod Symposium. The participants received a summary of the discussion and understood the workshop's goal was to provide a basis for further discussion. This article contributes to this ongoing discussion. Several proposed recommendations assert the centrality of including social and ethical issues in the assessment of whether or not to introduce TMS. The article outlines five key recommendations for advancing the NBS agenda: national public health leadership; transparency; increased national consistency in NBS strategy, including minimum standards; collaboration between the federal and provincial/territorial governments and diverse stakeholders; and supporting research and/or programs based on effectiveness, which integrate ethical and social issues into assessment.