Preview Response

Justice / Medicine

Lydia Dugdale

Professor of Medicine and Director, Columbia Center for Clinical Medical Ethics

Associate Director of Clinical Ethics, NewYork-Presbyterian Hospital/Columbia University Vagelos College of Physicians and Surgeons

I am struck that the modern practice of medicine often challenges Wolterstorff’s treatment of justice (“rendering to each what is his or her right, or due”) in two key ways. First, the regnant principle in medicine is respect for autonomy, which means that treatment for patients often becomes mere wish fulfillment (which may in fact be unjust). And second, inherent to the practice of medicine is a sort of mercy that overlooks culpability on the patient’s part. The smoker thus receives treatment for his lung cancer, and the intravenous drug user treatment for her hepatitis C, despite their own complicity in becoming sick—again, a matter of mercy, not justice.