Human Justice Can Never Be

¶ … Human Justice Can Never be Achieved

Modern post-enlightenment culture believes it is struggling to achieve human justice in all aspects of society. However, a severe lack of human justice can be found throughout society, from inconsistent prosecution and sentencing of criminals based on factors such as race, to the unequal pay wages given to workers based on factors such as gender. Human justice can only exist in a society where all people are treated equally and fairly. According to Dr. Martin Luther King, Jr., "Of all the forms of inequality, injustice in health is the most shocking and inhumane" (King in Freeman 1991). A quick survey of the current state of health care in the developed countries of the world shows that there are many inequalities and examples of injustice. Inadequate health care causes pain and suffering for those patients who receive less than optimal care due to inequality throughout the system. Patients may have a culturally-influenced distrust for the medical system because of their race or income level, or they may experience problems having access to insurance or transportation. Individual clinical workers may hold prejudices that affect their ability to provide equal care to all patients (Henley 2004). Human justice can never be achieved in a health care system that gives patients less quality of care based on the patient's race or ethnicity, socio-economic class, gender, or personal morality.

Racial inequality is a major contributing factor that creates obstacles to human justice throughout society, and this is true within the health care system as well. A poll taken in 2003 found that African-Americans and Hispanic-Americans are three times more likely than non-minorities to believe that minorities receive lower quality of care when visiting health care professionals; only one in five White Americans believe that a member of a minority group will receive poorer health care, while forty-one percent of Hispanics hold this opinion ('Minorities believe...' 2003). According to this survey, which was sponsored by several academic and public health organizations, reasons for unequal health treatment of ethnic and racial minorities included both barriers caused by cultural/language differences and discrimination by health workers. Additionally, this survey showed that many Americans would like to see serious penalties for health care providers and insurance companies that have discriminated against racial and ethnic minorities. This survey was done as a followup to the Institute of Medicine (IOM) study, from 2002, that showed there are indeed inequalities in the health care system based on racial issues, including prejudice and stereotyping from doctors and health care workers that contribute to other complex factors ('Minorities believe...' 2003). According to the president of the Medical Association of Georgia, "The patient-doctor relationship is the chief principle in our code of ethics... Physicians who break this trust with their patients should not be practicing.... Whether unequal medical treatment is caused by differences in income and education or social and cultural factors, [it is] unjustifiable and will not be tolerated" (Fowler in Rutlegde 2003). In 1993, a study published by the Journal of the American Medical Association showed that race, not the financial ability to pay for treatment, may actually be the most influential factor affecting the type of treatment offered to patients (Rutlegde 2003). Minority patients have described hospital and emergency room caregivers as "indifferent, uncaring, unresponsive, and uncommunicative" and report that they "just don't hear me" (Rutlegde 2003). While most health care workers probably do treat minority patients well, negative experiences with individual workers that cannot get past cultural barriers or personal prejudices may cause distrust among minority groups. For example, African-Americans still have a particular distrust for the American health care system because of the negative experiences of research subjects in the Tuskegee Syphilis Study -- where thousands of Black people were infected with syphilis and not given treatment -- and the Los Angeles measles studies (Henley 2004). Whether or not some of this distrust is unnecessary today, the fact remains that "the average Black person in the United States lives six years fewer than his or her white counterpart, and African-American babies die twice as often as white infants" (Freeman 1991).

Another factor that influences the quality of health care received is socio-economic status. Without universal health care, which does not exist in most developed countries, it is inevitable that people with less money will have less access to quality health care because they cannot pay for expensive medical treatment. Other economic factors also contribute to a lack of quality health care for people in lower socio-economic groups. For example, a study from 1999 showed that "the extent of income inequality in society determines its average health status: the greater the gap between the incomes of the rich and poor, the worse the health status of citizens," drawing on research showing that there is a strong correlation between life expectancy and income inequality (Kawachi 1999). This may be a particular issue for the United States health care system, because the income inequality in America is the most severe among all countries in the industrialized world, where income inequality and poverty may account for twenty-five percent of the rates in mortality (Kawachi 1999).

Several reasons why income inequality may account for such a disparity of health care, have been proposed, including the finding that states within America with the largest gaps between the rich and the poor spent the least amount of government money on health care (Kawachi 1999).

Gender is also a factor which leads to unequal treatment of patients within the health care system. Gender is recognized widely as a factor which leads to injustice throughout society, for example the fact that women receive lower wages than men when doing equivalent work, and it is equally true that women receive less quality health care. Female patients of every ethnic or racial group have been shown in many studies to receive care that is not equal to the treatment of men in that same group. In recent decades, more women have entered the health care field, and this has increased the quality of care for female patients overall. However, women still face particular challenges to receiving adequate health care. "Statistics show that they continue to get inferior care for a range of problems, including heart disease, diabetes, osteoporosis, Alzheimer's disease, breast cancer, and domestic violence" (Rutledge 2003). Women have been shown to be more likely than men, in some situations, to seek medical treatment for certain conditions, however they are far less likely to have discussed specific treatment options with their doctors. This particular study concluded that it is likely women are less likely to be referred to specialists or surgeons than men, or are likely to be referred later than men with the same condition (Rutledge 2003). Like with health care discrimination against other minority groups, the cause of unequal treatment of women has been linked to factors including communication barriers, or "insufficient communication between the patients and the caregiver," and personal prejudices held by health care workers, such as doctors believing that female patients are less suitable candidates for some surgeries without clinical evidence to support this belief. (Rutledge 2003). The World Health Organization did an in-depth analysis of the inequalities in health care based on gender in 1998. It was found that gender inequality exists in the medical industry from the initial medical research that is conducted, to the availably and access to health care, to the quality of care received (WHO 1998). In the realm of medical research, evidence points to gender discrimination influencing what topics are chosen for study and what methods are used during research, and that the major health concerns of women are not given equal weight in research to those of men, unless those health concerns are central to the women's ability to reproduce (WHO 1998). The American Medical Association reported in 1991 that researchers tend to ignore possible differences between male and female patients in diagnosis and treatments, and diseases that are shared by both men and women will often be treated as an exclusively male disease (WHO 1998). In accessing quality health care, women have expressed concerns about the way the medical community treats female patients. For example, women suffering from depression are more likely to be given medication as treatment without addressing the underlying causes of the depression. The World Health Organization also reported that receiving medical treatment is often a demeaning experience for women who are treated with less respect than male patients.