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# Justice: fair distribution and equal treatment

- Principle

Justice asks us to treat like cases alike and to share health resources by fair, public criteria.

Updated Nov 5, 2026

## Key points

- Formal justice: treat like cases alike; no discrimination by age, sex, ethnicity, religion or ability to pay.
- Distributive justice: share scarce resources by public, relevant criteria.
- Allocation criteria under debate: need, equality, expected benefit, first come first served, merit and the market.
- In research (Belmont): fair selection of participants; do not always use the most vulnerable.
- Justice is everyone's duty, not only the doctor's: it is set mostly by laws and institutions.

## What it is

In bioethics, justice has two faces. Formal justice asks that equals be treated equally and that no one be discriminated against. Distributive justice asks how to share scarce resources (beds, organs, time, money) among many people. Theories differ: utilitarianism seeks the greatest total benefit, egalitarianism gives priority to the worst off, libertarianism trusts the market and communitarianism the values of the community. The Belmont Report applied justice to research: the risks and benefits of studies should not always fall on the same groups.

## What it requires

- Discriminate against no patient for reasons unrelated to their clinical situation.
- Use clinical, explicit and public criteria to allocate scarce resources (triage, transplant lists).
- Avoid useless spending, because what is used without benefit is missing for another patient.
- In research, share burdens and benefits fairly.

## In clinical practice

- Emergency triage: the sickest patient is seen first, not the one who arrived first or pays more.
- Rationing decisions should be made by institutional rules, not case by case at the bedside.
- Colombia's Law 23 of 1981 requires giving the benefits of medicine to everyone who needs them (art. 3) without distinction of nationality, socio-economic status, race, politics or religion (art. 1, no. 1).
- The Declaration of Geneva asks that age, disease, disability, background or beliefs not come between doctor and patient.

## Limits and exceptions

- Limit: justice does not allow denying a patient what they need just to save money.
- Limit: when resources are plentiful, distributive justice does not conflict; the problem arises with scarcity.
- Allocation criteria should be explainable in public and open to review.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the difference between formal and distributive justice?

Formal justice asks that like cases be treated alike without discrimination; distributive justice asks how to share scarce resources fairly.

## What does justice require in research according to the Belmont Report?

Fair selection of participants: the risks and benefits of studies should not always fall on the same groups.

## Who is seen first in fair triage?

The sickest patient by clinical criteria, not the one who arrived first or can pay more.

## Which theory of justice gives priority to the worst off?

Egalitarianism (for example, the theory of John Rawls).

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## Connections

## Related 1

- [Allocating scarce resources and triage](https://durgical.com/en/medical-ethics/allocating-scarce-resources-and-triage/)

[← All of medical ethics](https://durgical.com/en/medical-ethics/)

Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research](https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html) (U.S. Department of Health and Human Services, Office for Human Research Protections, 1979); [WMA International Code of Medical Ethics](https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/) (World Medical Association, 2022); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=68760) (Función Pública, Gestor Normativo (Colombia), 1981).

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