I’m not going to write any prizewinning essays on the topic right now, but I can give you a rough summary, if that helps? Distributive justice means that resources should be shared fairly. In the context of medicine, it is really about access to healthcare, particularly for vulnerable patients. It means that we as a society need to be careful to make sure that vulnerable and disenfranchised (especially poor) patients are not denied access to essential treatments, and can engage fully with their own healthcare. Unfortunately, this is not always the case. But it should be. Justice is one of the four underpinning tenets of modern medical ethics. In reality, it is also usually about the rationing of resources. Where funds for healthcare (whether those of the state or those of individual patients ) are finite resource, the system must have some rationale for what funds are spent on what treatments. And it’s up to us to ensure that the ways in which we allocate resources is fair and non-discriminatory. This means that it should not disadvantage people based on gender, race, sexuality, age or disability, or their social class or poverty. It also means that the system should be transparent, with accountability; we need to know how resources are divided up, to know that people aren’t being unfairly treated. Someone (in the UK, that’s a body called NICE) ends up determining what treatments are cost-effective and are worth funding for the NHS. Not only that, but for particularly expensive treatments (like chemo, certain biologics, immunotherapies etc) the decision as to whether they are worth prescribing for individual patients goes to a panel, to make sure that they are prescribed to people who actually need them and are reasonably likely to benefit. Many medications are incredibly expensive; many of those are not covered by many insurance programs somewhere like the US. Some of the problems are due to the way patenting and licensing works; many medicines are practically inaccessible in middle and low income countries because they are sold at prices that are unaffordable to local patients, and Western companies are trying to use intellectual properly law to squeze out local competitors which are bootlegging medications keeping millions of people around the world alive. It’s an incredibly complex and important issue. For an interesting essay on the US, you could start with this. On an international level, I’d like to introduce you to the WHO’s essential medicines list. These are treatments that are, by definition, essential and should be available to everyone. But many (probably most) people in the world lack access to basic or essential medications. This is at least in part due to current pharmaceutical practices. On behalf of people I know who are involved in UAEM, I want to take this opportunity to recommend them as a non-profit organization, all over the world, in which students are aiming to, in their words:
(1) promote access to medicines and medical innovations in low- and middle-income countries by changing norms and practices around academic patenting and licensing, supported by our own independent research,
