This essay claims that ‘access to justice’ has erroneously been assumed to be synonymous with invisible concepts instead of access to a lawyer’s language. The Paper outlines how a language concerns the relation between signifiers, better known as word-images, on the one hand, with signfieds, better known as concepts, on the other. The signifieds are universal, artificial and empty in content. Taking the Canadian Charter of Rights and Freedoms as an example, officials have assumed that Charter knowledge (...) has involved signifieds (such as rules, principles, doctrines and tests) as if the signifiers were transparent. But any one signifier differs from another signifier without the lawyer ever accessing the invisible signifieds. Ironically, although the lawyer, law professor or law student believes that s/he is studying legal ‘practice’ and although legal knowledge has been considered a matter of signified concepts, the knowledge has really concerned the differentiating relations of signifiers. As a consequence, the moment of accessing the concepts (signifieds) has been forever deferred. ‘Access to justice’ has become access to the special language of signifiers, a language which lawyers alone are privileged to enforce. Turning to the Charter, lawyers claiming to know the special Charter language became indispensable to social life. Even the meaning-constituting human subject became a signifier, better known as ‘the legal person’ defined by Charter rights. Charter language, however, has deferred an access to the invisible concepts such as ‘freedom’ or ‘democracy’, terms in Section of the text. Access to justice’ has become access to the language of the privileged class of lawyers. The lawyer’s language has become a theoretical language in the name of access to justice. And yet, because the theoretical language has been propagated as concerned with ‘practice’, it has been difficult to challenge the social-cultural content of the language of lawyers. (shrink)

The public interest in the administration of justice requires access to justice for all. But access to justice must be “meaningful” access. Meaningful access requires procedures, processes, and institutional structures that facilitate communication among participants and decision-makers and ensure that judges and other decision-makers have the resources they need to render fully informed and sound decisions. Working from that premise, which is based on a reconceptualization of the objectives and methods of the (...) class='Hi'>justice process, the author proposes numerous specific changes in decision-making processes and practices. These changes are required to achieve a standard of decision-making that is consistent with the public interest in the administration of justice within a constitutional framework under the social and political conditions of the early 21st century. The essay illustrates the application of the principles and methods of legitecture to analysis of problems of institutional design in law. (shrink)

The access-to-justice movement broadly concerns the extent to which people have the ability to resolve legally actionable problems. To the extent that individuals seek resolution through civil litigation, they can be disadvantaged by their unmet need for legal services, particularly in high-stakes cases and complicated areas of law. In part, this is because legal services and litigation are cost-prohibitive, especially for indigent plaintiffs. As a result, these individuals are priced out of litigation and, by extension, unable to use (...) law to seek justice. I propose an innovative legal intervention to this problem called “compensatory preliminary damages,” which builds from the work of Gideon Parchomovsky and Alex Stein. I argue that preliminary damages should function as compensatory awards for harm to a plaintiff’s ability to access justice, rather than a contingency loan that might make indigent plaintiffs worse off than before if they lose. As compensatory awards, preliminary damages address a defendant’s liability for a plaintiff’s prospective litigation costs that inequitably affect the plaintiff’s ability to access justice. In short, given a suitable connection between the underlying harms of the case and the plaintiff’s resources to meet their legal needs, the litigation costs that plaintiffs must face to litigate should, in some cases, be compensable. To seek such compensation, I propose that plaintiffs would have to plead, among other things, that their alleged injuries have resulted in various barriers to accessing justice, but that the hardship to the plaintiff and the balance of equities favor shifting the cost to access justice onto the defendant. By awarding such damages, courts make plaintiffs whole for harm to their access to justice that is not conditional on a decision after the merits or their final recovery for the injuries alleged. As such, the award would not need to be repaid. -/- . (shrink)

In 2009 the Roundtable on Sustainable Palm Oil established a conflict resolution mechanism to help rural communities address their grievances against palm oil companies that are RSPO members. This article presents the broadest ever comprehensive assessment of the use and effectiveness of the RSPO conflict resolution mechanism, providing both overviews and in-depth analysis. Our central question is: to what extent does the RSPO conflict resolution mechanism offer an accessible, fair and effective tool for communities in Indonesia to resolve conflicts with (...) companies? Our aim is not only to provide a ‘reality check’ of this mechanism but also to contribute to the wider debate on how communities can seek access to justice when engaged in intractable conflicts with palm oil companies. For data collection, we took three steps. First, we used our own database of 150 conflicts between communities and companies in Indonesia. We identified 64 conflicts that involved RSPO member companies, of which 17 prompted communities to convey their grievances to the RSPO’s conflict resolution mechanism. Second, we used the database of the RSPO, which handled 85 complaints against companies in Indonesia in the period 2009–2020. Third, we conducted fieldwork, in total, about 6 months of fieldwork and extensive interviews on three conflicts involving RSPO companies to identify mechanisms leading to both failed and successful instances of conflict resolution. For our assessment, we used three criteria to assess the conflict resolution mechanism of the RSPO: accessibility, procedural justice, and the outcomes of the process. We conclude that—on all counts—the conflict resolution mechanism is biased in favor of companies. The result of these biases is that the actual capacity of the RSPO’s mechanism to provide a meaningful remedy for rural communities’ grievances remains very limited. This unequal access to justice sustains conflicts between companies and communities over land. (shrink)

In 2017, the National Prosecution Bureau of Chile created the Special Unit for Human Rights, Gender-Based Violence, and Sex Crimes, becoming a milestone for criminal prosecution policies as the first time a state institution in Chile used the term ‘gender-based violence’ explicitly in its title. There was no law in the country that addressed and sanctioned this behaviour—recognising it as a social phenomenon—at the time of the Unit's creation. What does the creation of this new Unit mean for access (...) to justice from a gender perspective? To answer this question, we have critically analysed the creation of this Unit as a case study from a feminist institutionalist standpoint. We found that this institutional change might bring a broadening in access to justice for women, girls and LGBTQI+ persons by implementing a gender perspective. (shrink)

Recent years have seen the emergence of online courts and tribunals: digital platforms that enable self-represented litigants to complete electronically the entire court process, from filing through final disposition. This article proposes that the unique nature of online courts as digital interfaces enables them to implement a new strategy—diversity by design—to improve access to justice and procedural justice for a diverse population of SRLs. Reflecting a human-centered legal design approach, and building on research in human-computer interaction and (...) digital choice architecture, this strategy entails embedding diversity accommodating features in the technological design of court platforms. Specifically, building on the empirical relationship between users’ demographic attributes and their digital usability and aesthetics judgments, this article suggests that online courts can dynamically adapt their interfaces according to the attributes of a given user in ways that help diverse SRLs engage with online courts, support their effective participation in proceedings, and improve their procedural experiences. The potential impacts include enhancing SRLs’ confidence and trust in using online courts and ameliorating their ability to process information, deliberate, make informed decisions and communicate them. Finally, the article discusses concerns regarding the desirability and ethicality of dynamically adapting, that is—personalizing, court interfaces. (shrink)

Ratio Juris, Volume 34, Issue 2, Page 121-138, June 2021.

The 1995 Constitution of the Republic of Uganda in terms of article 31 (2) thereof, establishes rights under which widows and widowers can inherit property from their spouses and enjoy parental rights over their children. A duty is placed on the government to make appropriate laws to this end. More important though, the state has a duty to facilitate the administration of estates in general by making, through decentralization, the institutional and legal framework on succession more accessible to ordinary people. (...) An issue that deserves fresh consideration is whether this obligation to make the legal and institutional framework on succession accessible to ordinary people and especially widows, the years fater the Constitution was promulgated has been realized, and if so, whether it has advanced the property rights of these surviving female spouses in the estates of their deceased spouses. (shrink)

This article discusses the process of empirical research on access to justice, explaining the procedure from data collection to analysis. Research into access to justice finds ways to render civil justice to citizens equitably. Reliable, non-anecdotal data is a prerequisite for useful empirical research into access to justice. Three international initiatives illustrate the reflection of access to justice in research projects. They are, the World Bank's Justice for the Poor Program, (...) UNDP Commission on Legal Empowerment of the Poor, and the Tilburg Microjustice Initiative. The most comprehensive empirical projects on access to justice are those sponsored at the national or sub-national level. Non-governmental drivers of broad-based data collection are other legal actors. This article discusses examples of data collection and evaluation in countries where research has generated data on civil justice. Finally, this article discusses barriers to access to justice, which cause exclusion. (shrink)

Despite more than half a century of reform efforts, access to civil justice is still understood to be in a state of crisis. Part of the reason for this is because there is no consensus among the legal community on the meaning of justice in this context. This paper seeks to provide a much-needed theoretical underpinning to the access-to-civil-justice movement. It advances ‘justice as fairness,’ as articulated by the American philosopher John Rawls, in conjunction (...) with Lesley Jacobs’ model of equal opportunities, as a suitable theory in which to frame the access-to-civil-justice movement. I explain why this framework is appropriate for pluralistic democracies like Canada and how it can be used to define measures of justice. This exercise is thus not simply a theoretical discussion, but rather is intended to be used as a practical framework to assess current and proposed policy initiatives. (shrink)

This article surveys five approaches to justice in contemporary Anglo-American legal thought: pure proceduralism, the sources thesis, the semiotic model, the social convention model, and the ‘law and...’ model. Each approach has associated justice with the foundation of the legal structure of rules, principles and the like. The foundation for pure proceduralism has rested in the conditions (such as majority will, freedom of expression, and political equality), external to the pure process. For the sources thesis, the foundation has (...) been the state institutions, such as courts and legislatures and ultimately to the state external to the legal structure. With the semiotic model, the structure of signifying concepts (rules, principles, doctrines and other intelligible objects) takes the foundation as a non-signified concept (such as Hans Kelsen’s Grundnorm) external to the signifying relations inside the structure. For the social convention model, the key has been the observation by a jurist of the regularity of a multiplicity of experienced events and the regularity, in turn, is a concept which abstracts from and unifies the multiplicity into a concept. The final approach, the law and…approach, has assumed that the foundation lies in the external and independent disciplinary discourse, thereby reinforcing the observed legal structure as given. -/- The foundation, in each context, has been considered external to the units and analytical reasoning of the legal structure. The foundation, that is, has been considered neither legal nor illegal. The consequence has been that jurists, working within the structure founded by an externality, cannot access justice. The clue to justice, I suggest, is concealed inside the structure itself: namely in the multiplicity of experienced events which the concepts and signifying relations have enclosed and forgotten. The Paper briefly fleshes out the latter sense of access to justice. (shrink)

The global health crisis in non-communicable diseases (NCDs) reveals a deep global health inequity that lies at the heart of global justice concerns. Mirroring the HIV/AIDS epidemic, NCDs bring into stark relief once more the human consequences of trade policies that reinforce global inequities in treatment access. Recognising distributive justice issues in access to medicines for their populations, World Trade Organisation (WTO) members confirmed the primacy of access to medicines for all in trade and public (...) health in the landmark Doha Declaration on the TRIPS Agreement and Public Health of 2001. (shrink)

Land is a constitutional issue in Ethiopia. Article 40 of the FDRE constitution enshrines governing provisions about rural and urban land. Legislation power is given to the federal government (Article 51(5) of the constitution) although this power can be delegated to regions (Article 50(9) of the same constitution). In contrast, administration power is allocated to regions (Article 52 (2(d)) of the constitution). The federal government has enacted the Rural Land Administration and Use Proclamation 456/2005. Both federal and regional land laws (...) have Alternative Dispute Resolution clauses. However, the opportunities and challenges of these clauses from the access to justice perspective are not studied very well. The main objective of this paper is to assess the legal framework and practice of ADR mechanisms in the rural land administration system from the access to justice perspective and come up with a policy option. Doctrinal type of legal research is applied where it involves theory testing which deals with studying existing laws (both federal and regional laws). In addition, both primary and secondary sources have been used. Primary qualitative data was collected through semi-structured interviews. The study found that there are legal constraints. One significant legal constraint is the requirement for mandatory mediation in certain regional states before seeking recourse in a court of law. Mediation is not clearly and uniformly applied per the law and in practice (often the practice and legal framework confuse mediation with arbitration, inappropriately giving decision-making powers to mediators, and turning them into arbiters). Women and Vulnerable Groups are generally more negatively affected by the overreaching of mediators into decision-making, because the mediators are more easily influenced by the party opposing women and Vulnerable Groups, and/or the mediators are culturally biased. This study recommends that mediation should be made optional, where mediators are chosen by the parties and the legal framework is clear that the role of the mediators does not involve imposing decisions. For Oromia and SNNPR, the legal regime of mediation should be clarified to avoid confusion with the arbitration. It is necessary to train community-level mediators in the law and the protection of land rights of Vulnerable Groups against gender discrimination. (shrink)

When the cost-effectiveness of newly approved cancer treatments is insufficient or unclear, they may not (immediately) be eligible for reimbursement through basic health insurance in publicly funded healthcare systems. Patients may seek access to non-reimbursed treatment through other channels, including individual funding requests made to hospitals, health insurers, or pharmaceutical companies. Alternatively, they may try to pay out of pocket for non-reimbursed treatments. While currently little is known of these practices, they run counter to a deeply held egalitarian ethos (...) that is prevalent in many publicly funded healthcare systems. In this article, we investigate to what extent this ethos can be grounded in theories of justice, notably egalitarianism and prioritarianism. We argue that allowing out-of-pocket payments by patients themselves, in principle, is not unjust from the perspective of either of these theories, provided that it does not raise in-practice justice-based concerns, for instance by displacing more cost-effective care, to the detriment of other patients, or by failing to treat patients equally. In contrast, we conclude that the practice of making exceptions for individual patients by health insurers or healthcare providers does run counter to the justice-based requirements of equal treatment. (shrink)

Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent (...) and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. (shrink)

This article is currently available as a free download on ingentaconnect.

This article is currently available as a free download on ingentaconnect.

Many societies, and nearly all wealthy, developed countries, provide universal access to a broad range of public health and personal medical services. Is such access to health care a requirement of social justice, or is it simply a matter of social policy that some countries adopt and others do not? If it is a requirement of social justice, we should be clear about what kinds of care we owe people and how we determine what care is (...) owed if we cannot possibly meet every health need, as arguably no society can. We should be clear about what constitutes appropriate access to that care, given that there are diverse barriers to access. We must also be able to say why we owe these things as a matter of justice, and, of course, different accounts of social justice will bake and serve this cake in different ways. (shrink)

This paper develops the traditional Jewish understanding of justice (tzedakah) and support for the needy, especially as related to the provision of medical care. After an examination of justice in the Hebrew Bible, the values and institutions of tzedakah in Rabbinic Judaism are explored, with a focus on legal codes and enforceable obligations. A standard of societal responsibility to provide for the basic needs of all, with a special obligation to save lives, emerges. A Jewish view of (...) class='Hi'>justice in access to health care is developed on the basis of this general standard, as well as explicit discussion in legal sources. Society is responsible for the securing of access to all health care needed by any individual. Elucidation of this standard of need and corresponding societal obligations, and the significance of the Jewish model for the contemporary United States, are considered. (shrink)

A theory of justice for the basic structure of society may constrain though not directly govern colleges. The principle of "equal opportunity" commonly applied to jobs either does or does not apply to varsity opportunities. If it applies, it interdicts sex discrimination but, one fallacious argument notwithstanding, it states no obligation to expend resources on new teams. If it does not apply, an analogue of Rawls's difference principle may appropriately constrain inequalities between the sexes. In either case the preferences (...) of a majority of the sex affected by any inequality are pivotal in fashioning any tenable distributive policy. Those preferences are neglected by a government policy that assimilates equal opportunity to equality of (i) the ratio of male:female varsity athletes and (ii) the ratio of male:female students. It is argued that such policy rests on affirming the consequent. Its effects include misallocations of resources and overvaluation of athletics. It is argued that what should approximately be equal is competitive access, the ratio of available positions to aspirants, for each sex. Two versions of a principle of equal competitive access are proposed, the recommended one of which pertains to teams whose net consumption of resources is positive. (shrink)

G. A. Cohen was one of the world's leading political theorists. He was noted, in particular, for his contributions to the literature of egalitarian justice. Cohen's classic writings offer one of the most influential responses to the currency of the egalitarian justice question - the question, that is, of whether egalitarians should seek to equalize welfare, resources, opportunity, or some other indicator of well-being. Underlying Cohen's argument is the intuition that the purpose of egalitarianism is to eliminate disadvantage (...) for which it is inappropriate to hold the person responsible. His argument therefore focuses on the appropriate role of considerations regarding responsibility in egalitarian judgment. This volume comprises chapters by major scholars addressing and responding both to Cohen's account of the currency of egalitarian justice and its practical implications and to Cohen's arguments regarding the appropriate form of justificatory arguments about justice. (shrink)

This book begins the discourse on post-trial access to drugs in developing countries. Underlying ethical issues in global health inequalities and global health research serve as the context of the debate. Due to rampant allegations of violations of rights of research participants, especially in developing countries, it discusses the regulatory infrastructure and ethical oversight of international clinical research, thus emphasizing the priority of safeguarding the rights of research participants and host populations as desiderata in conducting clinical trials in developing (...) countries. This is the first book that analyzes the major obstacles of affordable access to drugs in developing countries - patent and non-patent factors and how they can be overcome through a middle ground approach and a new paradigm to establish global health justice which includes national and global health responsibilities. The book also deals extensively with all complex aspects of the discourse on affordable access to drugs in developing countries, including intellectual property law, international regulations, political and cultural systems, international trade agreements. Furthermore it contains a robust ethical debate and in-depth analysis. The book crafts a paradigm of global health justice involving a sliding scale of national and global responsibilities for the realization of the right to health in general and access to drugs in particular. (shrink)

One less obvious impact of legal bilingualism in a postcolonial jurisdiction like Hong Kong is an increasing trend of unrepresented litigants. Since their lack of legal knowledge often places them at a disadvantage and poses numerous problems in court, the government has established the resource centre for unrepresented litigants to offer them information about legal procedure. This paper evaluates the usefulness of the Chinese official reference materials at the centre in equipping laymen for civil litigation. As a first point of (...) contact between unrepresented litigants and the law, these leaflets have a direct impact on the users’ understanding of litigation procedures and their courtroom performance. This paper argues that the leaflets suffer from two major problems: incomprehensibility of language and lack of structure. Problems involved in include inconsistency in terminology, problematic translation, and language complexity arising from the use of odd collocation, unusual words, difficult legal terminology and confusing parts of speech; whereas in , information is found to be scattered and disorganised. To improve readability, the paper suggests using plain language, and providing checklists of documents, and a legal glossary. Cross-jurisdiction practices will be examined to show how unrepresented litigants’ access to justice may be facilitated. (shrink)

Fairness of access to assistive technology is important for its allocation on an equitable basis and for broader social justice and rights issues. Although the use of Daniels’s notion of “justice as fair opportunity” is helpful to the context of assistive technology, other aspects of Daniels’s broader conceptualisation of “just health” are not appropriate in this context. It is argued that fairness of access to assistive technology is crucial for the equitable attainment of the sustainable development (...) goals; however, such access will be achieved only by the sector developing a much stronger systems thinking and market shaping perspective. (shrink)

Discussion on financial ethics increasingly includes the problem of exclusion of the poorer segments of society from the financial system and access to credit. This paper explores the ethical dimensions surrounding the concept of a human right to credit. If access to credit is directly instrumental to economic development, poverty reduction and the improved welfare of all citizens, then one can proclaim, as Nobel Prize Laureate M. Yunus has done, that it is a moral necessity to establish credit (...) as a right. Arguments both supporting and opposing the concept of a right to credit are presented. While there may be general agreement that access to financial services may provide a pathway out of poverty, granting a universal right could induce perverse effects such as overindebtedness. Bearing in mind the ultimate goal of proponents of this right as well as the potential harmful consequences, this paper offers a new perspective on the question of access to credit based on a goal-right system. (shrink)

A societal goal to which more and more people in the United States appear to be committed--at least officially--is the assurance of comprehensive health services for every person irrespective of income or geographic location. This paper offers one possible moral justification of the goal. It does so by attempting to apply various standard conceptions of social justice to considerations about health care and to reflect about the reasons why some of the conceptions seem more relevant than others. Several institutional (...) implications are also identified. (shrink)

Distributive Justice and Access to Advantage is the most recent anthology devoted to the work of the great and, sadly, late political philosopher G.A. Cohen. Wh.

As assisted reproductive technologies become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or (...) child protection order, are given a “presumption against treatment.” This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a “presumption against treatment” is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

The development of new effective but expensive medical treatments leads to discussions about whether and how such treatments should be funded in solidarity-based healthcare systems. Solidarity is often seen as an elusive concept; it appears to be used to refer to different sets of concerns, and its interrelations with the concept of justice are not well understood. This paper provides a conceptual analysis of the concept of solidarity as it is used in discussions on the allocation of healthcare resources (...) and the funding of expensive treatments. It contributes to the clarification of the concept of solidarity by identifying in the literature and discussing four uses of the concept: (1) assisting patients in need, (2) upholding the solidarity-based healthcare system, (3) willingness to contribute and (4) promoting equality. It distinguishes normative and descriptive uses of the concept and outlines the overlap and differences between solidarity and justice. Our analysis shows that the various uses of the concept of solidarity point to different, even conflicting, ethical stances on whether and how access to effective, expensive treatments should be provided. We conclude that the concept of solidarity has a role to play in discussions on the accessibility and funding of newly approved medical treatments. It requires, for instance, that healthcare policies promote and maintain both societal willingness to contribute to the care of others and the value of providing care to vulnerable patients through public funding. (shrink)

The development of new effective but expensive medical treatments leads to discussions about whether and how such treatments should be funded in solidarity-based healthcare systems. Solidarity is often seen as an elusive concept; it appears to be used to refer to different sets of concerns, and its interrelations with the concept of justice are not well understood. This paper provides a conceptual analysis of the concept of solidarity as it is used in discussions on the allocation of healthcare resources (...) and the funding of expensive treatments. It contributes to the clarification of the concept of solidarity by identifying in the literature and discussing four uses of the concept: (1) assisting patients in need, (2) upholding the solidarity-based healthcare system, (3) willingness to contribute and (4) promoting equality. It distinguishes normative and descriptive uses of the concept and outlines the overlap and differences between solidarity and justice. Our analysis shows that the various uses of the concept of solidarity point to different, even conflicting, ethical stances on whether and how access to effective, expensive treatments should be provided. We conclude that the concept of solidarity has a role to play in discussions on the accessibility and funding of newly approved medical treatments. It requires, for instance, that healthcare policies promote and maintain both societal willingness to contribute to the care of others and the value of providing care to vulnerable patients through public funding. (shrink)

Social Justice, Health Inequities, and Access to New Age-Related Interventions Content Type Journal Article Category Original Paper Pages 281-295 DOI 10.1007/s12376-009-0027-3 Authors Hans-Jörg Ehni, University of Tuebingen, Tuebingen, Baden-Württemberg Germany Georg Marckmann, University of Tuebingen, Tuebingen, Baden-Württemberg Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 3.

The objective of the paper is to explore the issue that despite the absence of adequate formal and systematic ways for the poor and disadvantaged people to get access to health benefit like in a rich liberal society, there are active social customs, feelings and individual and collective responsibilities among the people that help the disadvantaged and poor people to have access to the minimum health care facility in both liberal and non-liberal poor countries. In order to explain (...) the importance and functional contribution of the social norms in this respect, some examples will be illustrated from Bangladesh which is a poor liberal country. There will be two sections of the paper. In the first section, it will be exhibited how the naturally and socially disadvantaged people in a liberal society get benefit following Rawls‟ theory of distributive justice. In the second section, it will be showed that in a poor country where there are less resources of the government to provide enough services to the poor and disadvantaged people, the communal feelings and the informal social institutions play a vital role that helps the disadvantaged and poor people to get access to the health benefit. The traditional social norms impose indirect sanction on its people to come forward to help the worse off people of the country. It is depicted that Rawlsian theory of distribution does not work properly in these countries, rather the communitarian feelings is more welcomed for the benefit of the overall welfare of the society and this will be shown in the conclusion of the paper. (shrink)

In the Netherlands, access to healthcare has been guaranteed by social health insurance legislation. But since the introduction of the Health Insurance Act in the 1960s, the health insurance system has been in a state of flux. Numerous reforms have changed the system gradually, of which the latest is the introduction of a competitive health insurance scheme for the entire population.Cutting across the various reforms has, however, been the goal of access to healthcare services as defined by international (...) treaty law, including European Union law. In particular the leverage of Community law in strengthening the patient’s right to healthcare is remarkable. Since the European Court of Justice has accepted that healthcare should be considered as a service in terms of the EC Treaty, rights to healthcare have become inextricably linked with the free movement principles and are no longer restricted to the jurisdiction of the country of origin. (shrink)

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range (...) of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle. (shrink)

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published in March of 1983 its Report, Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services . Concluding that there are "ethical obligations" on behalf of society which are balanced by individual obligations, the Report provides an ethical framework for ensuring "ultimate responsibility" of the Federal government to arrange for equitable access to health and to (...) a fair share of cost. In doing so the Report neither makes justice nor beneficence the prime moral principle in public health care, it rather calls for a common sense approach in "approximating adequacy". But how to define equality without creating uniformity in a society rich in its diversity, including attitudes towards health? Keywords: justice, beneficence, right to health care, equality, distribution CiteULike Connotea Del.icio.us What's this? (shrink)

The treaty of Lisbon makes European Union (EU) accession to the European Convention on Human Rights (ECHR) an obligation of result. The issue has been intensely discussed for more than thirty years, arguing that such accession is necessary in view of the need to ensure the ECHR standard of fundamental rights protection in Europe. This question again gains prominence as the EU member states and the institutions seek to agree on the negotiation directives of EU accession to the ECHR. The (...) process brings up the difficulties involved in creating a mechanism which would both facilitate the autonomy of the EU legal order and enable individuals to bring claims against the EU to the European Court of Human Rights (ECtHR). This involves the questions how it would be possible to ensure quick access to justice, and whether the ECtHR would continue to apply the doctrine of equivalent protection in relation to EU even after the latter becomes bound by the ECHR. The article argues that EU accession to the Convention is a prominent political step ensuring coherence of human rights protection mechanism in Europe. (shrink)

More than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them.One of the important determinants of access to drugs is the working of the patent system. (...) This paper first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO‐TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so‐called ‘Doha Declaration on the TRIPs Agreement and Public Health’, which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors. (shrink)

Both the USA and Europe limit access to care by undocumented immigrants. In the debate over what level of access to confer to IMs, there are various public policy rationales operating either explicitly, or below the surface, ranging from minimalist humanitarianism to full cosmopolitan equality, with several intermediate positions between these two poles. This article informs the international debate by providing a conceptual mapping of these underlying policy rationales. Each position is based on different lines of reasoning or (...) bodies of evidence, and each leads to somewhat different conclusions about the extent to which IMs should have access to different types of health care. It is unlikely that broad consensus will be achieved in this ongoing debate. However, by articulating the ethical, legal, pragmatic and conceptual reasons to support or oppose various positions, we hope to help determine where in the landscape of reasoned argument various positions lie, and how each position might be best supported or refuted. In particular, we see in this debate an illustration of Michael Walzer’s classic analysis of competing spheres of justice. Various positions depend to a considerable extent on whether their advocates approach this issue from the health policy sphere rather than the sphere of immigration policy, or whether they attempt to blend the two spheres. (shrink)

In the debates surrounding the ethical dimensions of interventions in the human genome, much attention is paid to determining whether—and if so, how—market access to these technologies ought to be managed in order to maximize social benefit. There are those who advocate a “laissez-faire” free-market approach to the development and use of genetic and genomic interventions. We are sympathetic to this view insofar as we understand the workings of the market stimulus effect. We use the term “market stimulus effect” (...) to refer to the outcome of a set of mechanisms whereby early adoption of a new technology by wealthy consumers promotes the development of versions of this product that are cheaper to produce, or are simply .. (shrink)

Background: With the number of young people with medical complexity increasing, an increasing number must navigate the transition to adulthood. This transition, in part, involves a situational transition in which young people and their families must access new services in the adult system. Objectives: To explore how societal ideologies, communities, and organizations represent the foundation of barriers to access to services. Research Design: The discussion in this paper, framed within a social justice perspective, outlines barriers to (...) class='Hi'>access to services at the societal and community levels including societal ideologies, differences in philosophies of care in pediatric and adult care, physical environments, and availability of services. Ethical Considerations: Since this is an exploratory discussion paper, no ethical approval was required. Findings and Conclusion: Based on analysis of the literature from a social justice perspective, it is suggested that the adult health care and social service systems do not provide the supports and services necessary to empower young people and their families to achieve their goals and maintain their health and quality of life. It is, thus, an ethical issue that the transfer from pediatric to adult services is occurring in the absence of appropriate services. Recommendations at the individual, community and policy levels highlight how nurses can address this ethical issue to promote more equitable access to services. (shrink)