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Social justice: a pillar of medical ethics that is often neglected

Given that there is a direct link between socioeconomic inequalities and health inequalities, it is the healthcare professional’s role to combat these inequalities too.

Doing good, doing no harm, and respecting the patient’s autonomy – as well as that of the healthcare professional – have been core principles of medical ethics since Hippocrates.

In 2009, representatives of American faculties of medicine pointed out that social justice was a fourth pillar of medical ethics. They criticise the health system for not seeking actively enough to improve the health of the poorest section of society. Some factors even militate against it, especially the culture of individualism and the tendency of many doctors to chase after the highest possible income. As long as healthcare professionals fail to campaign for policies to reduce inequalities, including when this goes against their own financial interests, medical ethics are not being fully applied.

This need to address social injustices applies to all countries. There is increasing evidence – notably from the World Health Organization – of a link between health inequalities and economic and social inequalities. So unless they are committed to improving social justice, healthcare professionals are failing to truly comply with medical ethics.

©Prescrire 1 September 2011

"Medical ethics and social justice" Prescrire Int 2011; 20 (119): 220. (pdf, free)

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