Published online by Cambridge University Press: 09 March 2016
This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.
1. Barry, B. Why Social Justice Matters. Cambridge: Polity; 2005.Google Scholar
2. Callahan, D. Ethics and population. Hastings Center Report 2009;39:11–13.CrossRefGoogle Scholar
3. Whitehead, S, Shehzad, A. Health outcomes in economic evaluation: The QALY and utilities. British Medical Bulletin 2010;96:5–21.CrossRefGoogle ScholarPubMed
4. Stolk, P, Willemen, MJC, Leufkens, HGM. “Rare essentials”: Drugs for rare diseases as essential medicines. Bulletin of the World Health Organization 2006;84:745–51.CrossRefGoogle ScholarPubMed
5. Wellman-Labadie, O, Zhou, Y. The US Orphan Drug Act: Rare disease research stimulator or commercial opportunity? Health Policy 2010;95:216–28.CrossRefGoogle ScholarPubMed
6. Restrepo-Ochoa, DA. Health and the good life: Contributions by Amartya Sen’s capability approach to ethical reasoning in public health. Cadernos Saúde Pública 2013;29:2371–82.CrossRefGoogle ScholarPubMed
7. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. New York: Oxford University Press; 2009.Google ScholarPubMed
8. Daniels, N. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008.Google Scholar
9. Rawls, J. A Theory of Justice. Oxford: Oxford University Press; 1999.Google Scholar
10. Nussbaum, MC. Women and Human Development. Cambridge: Cambridge University Press; 2001.Google Scholar
11. Sen, A. Why health equity? Health Economics 2002;11:659–66.CrossRefGoogle Scholar
12. Williams, A. The “fair innings argument” deserves a fairer hearing! Comments by Alan Williams on Nord and Johannesson. Health Economics 2001;10:583–5.CrossRefGoogle Scholar
13. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. Plos Medicine 2006;3:e442.
14. Dávila Torres J, Rodríguez Díaz Ponce MA, Echavarría Zuno S. El IMSS en el sistema nacional de salud. México: Fondo de Cultura Económica-Alfil; 2012.
15. Sen, A. The Idea of Justice. London: Allen Lane; 2009.Google Scholar
16. Snelling, PC. What’s wrong with tombstoning and what does this tell us about responsibility for health? Public Health Ethics 2014;7:144–57.CrossRefGoogle Scholar
17. Basta, PC, Ponte de Souza, ML. Mortality by suicide: A focus on municipalities with a high proportion of self-reported indigenous people in the state of Amazonas, Brazil. Revista Brasileira de Epidemiologia 2013;16:658–69.Google Scholar
18. Cohen, GA. On the currency of egalitarian justice. In: Otsuka, M, ed. On the Currency of Egalitarian Justice, and Other Essays in Political Philosophy. Princeton, NJ: Princeton University Press; 2011:3–43.CrossRefGoogle Scholar
19. Anderson, ES. What is the point of equality? Ethics 1999;109:287–337.CrossRefGoogle Scholar
20. Segall, S. Health, Luck, and Justice. Princeton, NJ: Princeton University Press; 2009.CrossRefGoogle Scholar
21. See note 1, Barry 2005.
22. See note 20, Segall 2009.
23. Alwan, A, McLean, DR, Riley, LM, Tursan d’Espaignet, E, Douglas, C, Stevens, GA, et al. Monitoring and surveillance of chronic non-communicable diseases: Progress and capacity in high-burden countries. The Lancet 2010;376:1861–68.CrossRefGoogle ScholarPubMed
24. See note 20, Segall 2009, at 60.
25. See note 20, Segall 2009, at 47.
26. Voigt, K. Appeals to individual responsibility for health: Reconsidering the luck egalitarian perspective. Cambridge Quarterly of Healthcare Ethics 2013;22:146–58.CrossRefGoogle ScholarPubMed
27. Scanlon, T. Justice, responsibility and the demands of equality. In: Sypnowich, C, ed. The Egalitarian Conscience: Essays in Honour of GA Cohen. Oxford: Oxford University Press; 2006:70–87.CrossRefGoogle Scholar
28. Campinha-Bacote, J. The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing 2002;13:181–4.CrossRefGoogle ScholarPubMed
30. See note 20, Segall 2009.
31. De Hoyos, A, Nava-Diosdado, R, Mendez, J, Ricco, S, Serrano, A, Flores Cisneros, C, et al. Cardiovascular medicine at face value: A qualitative pilot study on clinical axiology. Philosophy, Ethics, and Humanities in Medicine 2013;8(3); available at http://www.peh-med.com/content/8/1/3 (last accessed 16 Jan 2016).CrossRefGoogle Scholar
32. Hanssen I, Lise-Merete A. Interpreters in intercultural health care settings: Health professionals’ and professional interpreters’ cultural knowledge, and their reciprocal perception and collaboration. Journal of Intercultural Communication 2010;23; available at http://www.immi.se/intercultural/nr23/hanssen.htm (last accessed 16 Jan 2016).
33. Dworkin, RM. Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2002.Google Scholar
34. Scanlon, TM. Preference and urgency. The Journal of Philosophy 1975;72:655–69.CrossRefGoogle Scholar
35. Callahan, D. Principlism and communitarianism. Journal of Medical Ethics 2003;29:287–91.CrossRefGoogle ScholarPubMed
36. Reyes, G, Nuche, J, Sarraj, A, Cobiella, J, Orts, M, Martín, G, et al. Bloodless cardiac surgery in Jehovah’s Witnesses: Outcomes compared with a control group. Revista Española de Cardiología 2007;60:727–31.CrossRefGoogle ScholarPubMed
37. Post, S, Fleck, L. Case study: My conscience, your money. The Hastings Center Report 1995;25:28–9.CrossRefGoogle Scholar
38. Altamirano-Bustamante, M, Altamirano-Bustamante, N, Lifshitz, A, Mora-Magaña, I, De Hoyos, A, Ávila-Osorio, MT, et al. Promoting networks between evidence-based medicine and values-based medicine in continuing medical education. BMC Medicine 2013;11(39); available at http://www.biomedcentral.com/1741-7015/11/39 (last accessed 16 Jan 2016).CrossRefGoogle Scholar
39. Romero, MN. Investigación, Cuidados enfermeros y Diversidad cultural. Index de Enfermería 2009;18:100–5.CrossRefGoogle Scholar
40. See note 38, Altamirano-Bustamante et al. 2013.
41. See note 34, Scanlon 1975.
42. A large part of the population in developing countries uses medicinal plants to meet their primary health needs. Even though indigenous peoples in Latin America and their medical traditions can be very different at times, in general indigenous practices offer medical benefits. Several universities in Bolivia (Potosí and La Paz) have graduate courses on intercultural health in which the pharmacopeia of indigenous medicine is studied, validating through clinical trials some of the popular uses of these plants, in order to increase our knowledge of these plants and their benefits. In Mexico, several years ago the Institute for Social Security (IMSS) implemented a nationwide study on the use of medicinal plants. For example, guava leaves (Psidium guajava l.) were prescribed with great therapeutic success and at a very low cost to treat common diarrhea and other gastric diseases; such use and its results have recently been confirmed. The results of many of these trials have been positive and have attracted the attention of ethnobiologists and the pharmaceutical industry. See Aguilar A. El estudio etnobotánico de las plantas medicinales en México. In: Ríos M, Borgtoff H, eds. Las plantas y el hombre. Quito: Abya-Yala; 1991; and a more recent study in Costa Brandelli, CL, Brandt Giordani, R, Attilio De Carli, G, Tasca, T. Indigenous traditional medicine: In vitro anti-giardial activity of plants used in the treatment of diarrhea. Parasitology Research 2009;104(6):1345–49.CrossRefGoogle Scholar
43. The structure of intercultural hospitals allows combined access to traditional healers and biomedical physicians. A patient who comes to an intercultural hospital may choose to see a traditional healer or a biomedical physician, and what is important in these cases are good reference mechanisms between the healers and physicians, that also allow further reference to second and third levels of attention. Intercultural hospitals seek to join the efforts of these different forms of medicine to help the patient. Of course, there are parts of the traditional indigenous medicine that have no clear clinical impact, such as the ritual part of this medicine, but it is still important in maintaining patient-centered care. The joint work of traditional healers and biomedical physicians ensures that these practices are not harmful to the patient and, at the same time, that they are welcoming to indigenous minorities. See Duarte-Gómez, B, Branchet-Márquez, V, Campos-Navarro, R, Nigenda, G. Políticas nacionales de salud y decisiones locales en México: el caso del hospital Mixto de Cuetzalan, Puebla. Salud Pública de México 2004;46(5):388–398CrossRefGoogle Scholar; Mathez-Stiefel, SL, Vandebroek, I, Rist, S. Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia. Journal of Ethnobiology and Ethnomedicine 2012;8(26). Available at http://www.ethnobiomed.com/content/8/1/26 (last accessed 16 Jan 2016).CrossRefGoogle ScholarPubMed
44. See note 28, Campinha-Bacote 2002.