Justice and Social Justice

The common way of assessing ethics in health care is to use principles, the common ones being autonomy, beneficence, non-maleficence and justice. In their paper, entitled “Feminist Intersectionality: Bringing Social Justice to Health Disparities Research,” Jamie Rogers and Ursula A Kelly consider how justice is poorly represented, more specifically social justice.

The Belmont Report describes justice as pertaining to the just distribution of the benefits and burdens of research based on individual need, individual effort, individual societal contribution and individual merit. [...] It is time to move beyond thinking about ‘doing no harm’ in health research to identifying and addressing adverse social influences on the health of underprivileged groups, and the implications of their consequent poor health.

Feminist Intersectionality

Rogers and Kelly turn to the concept of Feminist Intersectionality to shed light on research in health.

An intersectionality approach explains the multiple, complex dimensions of inequality and power structures that create roles of domination and subordination under the rubric of race, class, gender and sexuality.

They argue that inequities experienced in society can and do translate to health research, furthering these experienced inequities. Historically, they remind of us of who held the power over funding and funds for research. Researchers themselves have also been for a long time mostly white men, until more recently. And, even in selecting a more "diverse" crowd of participants, Rogers and Kelly highlight:

The incremental inclusion of populations based on unidimensional differences (e.g. ethnicity, gender, race, and class) does not equate with an inclusion of the interests, perspectives and experiences of populations that are considered diverse.

What is striking is when you consider the selection of what is researched and what is not. Health problems are ranked on a social scale of socially acceptable to socially inacceptable behaviours, removed from their greater context.

There is a great sense of blame, in selecting research studies in health, in that unhealthy behaviours that are deemed the person's biological or behavioural fault are placed low on the priority list.

We’re all complicit in this when we’re talking about "health promotion" and we neglect to consider contextual factors and focus in on the individual: when we tell our clients to change their diet to lose weight and when we neglect to give an alcoholic a liver transplant. The inherent judgment that behaviour A leads directly to health outcome B is not so simple and also neglects the factors that contribute to behaviour A in the first place. We cannot just say not to do something but need to understand why it happened in the first place, certainly only then we can ensure more lasting changes.

Furthermore, Rogers and Kelly say, "health problems that have been stigmatized and stereotyped as largely affecting marginalized populations (e.g. substance abuse and mental illness) typically receive less research funding until the problem is recognized as directly or indirectly affecting the dominant group."

‘Crack Babies’

Lately, there has been some talk after an article was written in the New York Times that placed judgement on cocaine addicted pregnant women, blaming them for the effects on their children and communities (see it here). As a reaction, Lynn Paltrow wrote an interesting commentary on the issue (full commentary here), she finishes with :

Perhaps then the real ethical quandary that should be addressed is why stories like these suggest that the greatest threat to children is their mothers – rather than the lack of universal health care, the economic policies undermining our communities, and the unethical doctors who turn away pregnant women seeking medical help.

Rogers and Kelly also emphasized that "In the 1980s, the influence of cocaine exposure on a fetus was widely exaggerated in reports of scientific evidence, mostly because confounding variables such as poverty, violence, and prejudices in prenatal care were not considered in initial research studies."

Thus, when we’re considering categorized ‘vulnerable populations’ it is important to consider that people fall under many categories in different ways and at different times in their lives. Within and between populations and individuals there is also an exponential number of intersections and differences and it is important to consider this when we define our research population. Research in health may not be able to correct inequities but it is quite essential for ethical practice and can make a larger effort not to further said disparities.


Feminist Intersectionality: Bringing Social Justice to Health Disparities Research (2011) by Jamie Rogers and Ursula A Kelly, Nursing Ethics, 18(3) 397–407