1. © 2010 Jones and Bartlett Publishers, LLC A Practical Approach For Decision Makers SECOND EDITION EILEEN E. MORRISON

2. © 2010 Jones and Bartlett Publishers, LLC Class Four: Justice

3. © 2010 Jones and Bartlett Publishers, LLC Agenda Active beneficence and discussion Definitions Patient justice in health care Distributive justice definitions and theories What is just? Exercise Summary

4. © 2010 Jones and Bartlett Publishers, LLC Practicing Active Beneficence? Two examples from each community? What were the benefits? What if this were the way we all acted?

5. © 2010 Jones and Bartlett Publishers, LLC Justice “Injustice anywhere is a threat to justice everywhere”. Martin Luther King Jr. What does this quote mean? How does the public define justice? Justice is also balancing benefits and burdens or risks and benefits. Justice becomes more difficult when resources are required to make it happen and they are scarce.

6. © 2010 Jones and Bartlett Publishers, LLC Patient Justice in Health Care Patients believe that you will be just. Patients believe that you will do all that you can to heal them. The system cannot always live up to these expectations. Because health care is a business, the ability to pay makes a difference. The patient’s personality can make a difference.

7. © 2010 Jones and Bartlett Publishers, LLC What is Active Patient Justice? Practice positive consistency. Education of the staff is key. Watch compassion fatigue through scheduling. Role modeling is important.

8. © 2010 Jones and Bartlett Publishers, LLC Moral Duties for Justice? Respect everyone as a human being. Explain the reasons for giving or not giving treatments. Give options. Know and use a Patient Bill of Rights. What do you think patients rights should be? What would Kant ask you to do? What would Buber ask you to do?

9. © 2010 Jones and Bartlett Publishers, LLC Distributive Justice Based on society’s expectations. Market driven economy makes it difficult. Access to health care is linked to insurance coverage. What is the obligation to the non- insured?

10. © 2010 Jones and Bartlett Publishers, LLC Theories of Distributive Justice In America views differ on distributive justice, Think about the utilitarian position. Think about the free market approach. Think about Rawls and his definition. What is basic health care?

11. © 2010 Jones and Bartlett Publishers, LLC What is the Health Care Organization’s Role? What is your obligation for care? How can you balance money and mission? Check your marketing strategies. Balance Medicare/Medicaid and charity care? Limit service area? Community assessment and accurate information is key.

12. © 2010 Jones and Bartlett Publishers, LLC How does this all apply? Candy represents health care resources (money, people, technology, etc.) Remember your budget; you must run your business. Decide who gets how much of the resource within your community. Some people have special needs. Debrief. Conclusions????

13. © 2010 Jones and Bartlett Publishers, LLC Ways to Provide Staff Justice Know your power. Watch your practices and attitudes. Read, read, read. Ask the staff. Learn to be an effective writer. Check your timing. Become an active observer.

14. © 2010 Jones and Bartlett Publishers, LLC Case Comments Case of the Dipsomaniac Veteran  What does this case have to do with justice?  What should have been done to prevent this? The Case of the Just Downside  What ethics principles were used in this case?  How would you feel if Mr. Muggs were your boss?

15. © 2010 Jones and Bartlett Publishers, LLC In summary… What is your role in bringing justice to your health care organization? How can you help to better balance mission and money?