50+ Lifestyles

Your Advocacy Connection

We Solve Long-Term Care Problems

In the Healthcare Context, Is “Distributive Justice” Really Justice at All?

By Jamie Long
GolderCare Solutions
The Passionate Patient Advocate

“We must be just in allocating limited resources.”

“We want to treat all patients equally.”

“We have to think about what’s fair to everyone.”

These are the kinds of statements family caregivers hear every day – sometimes from hospital case managers, sometimes from insurance gatekeepers, and often from institutions trying to explain why something can’t be done.

They sound noble. Ethical. Principled. But what if they’re not?

What if, in the real world of healthcare and long-term care, the concept of distributive justice – the supposed bedrock of medical fairness – isn’t delivering justice at all?

The Ideal vs. the Reality

In academic ethics, distributive justice refers to the fair allocation of resources among individuals. It’s a principle with roots in philosophy, public health, and policy design. On paper, it makes sense: when resources are limited, we must use them wisely. Everyone deserves equal consideration.

But that ideal unravels in practice.

Because in the real world, “equal treatment” too often means universal neglect. It doesn’t elevate care standards – it simply justifies lowering them across the board. It turns scarcity into policy and labels that as fairness.

Justice as a Mask for Systemic Failure

Distributive justice is often invoked by institutions that are overwhelmed, under-resourced, or constrained by perverse incentives. It becomes a rhetorical shield – used to:

• Deny care that patients clearly need
• Push families out of the system before they’re ready
• Deflect responsibility from broken processes
• Silence advocates by suggesting they’re asking for “too much”

The word “justice” gives moral cover to what is, in many cases, bureaucratic convenience.

A caregiver asking for an extra day of rehab? Denied – because “it wouldn’t be fair to others waiting for a bed.”

A patient requesting a second opinion? Discouraged – because “everyone deserves equal access, and we don’t do that here.”

What’s really happening isn’t justice. It’s triage, rationing, and often abandonment – packaged in the language of ethics.

The Burden Shifts to the Caregiver

What’s especially insidious is how this version of justice turns the tables on those trying to help.

Advocates – usually family members who have stepped in where the system has stepped out – are treated as if their assertiveness is selfishness. As if fighting for your loved one is somehow a threat to the common good.

“We have to think about all our patients.”

Translated: Your loved one isn’t special.

Subtext: And maybe you should stop trying to make them so.

This is moral inversion. A system that can’t meet basic standards of coordinated, compassionate care uses the language of equality to dismiss the people trying to fill its gaps.

What Would Justice Actually Look Like?

If we’re serious about justice in healthcare, it won’t come from flattening everyone’s care experience into the same thin layer of services.

It would mean:

• Supporting caregivers as extensions of the care team, not as nuisances or adversaries
• Designing systems around real-life complexity, not administrative simplicity
• Equity of outcome, not just equality of access
• Care decisions based on context, not quotas

It would also mean recognizing that some patients need more – and that real fairness doesn’t mean everyone gets the same, but that everyone gets what they actually need.

Justice, or Just a Convenient Excuse?

In the abstract, distributive justice may sound ethical. But when it becomes a weapon of delay, a justification for denial, or a pretense for institutional indifference, it loses all moral authority.

If justice only works in theory – but fails in practice – then maybe it isn’t justice at all.

Maybe it’s just triage with a moral mask.

Let’s stop pretending that the system’s failings are ethical decisions. And let’s start creating models that serve real people, not just abstract principles.

This article was contributed by Jamie Long, Chief Patient Advocate, with GolderCare Solutions Unlimited, an organization dedicated to helping families find smart, integrated solutions to long-term care challenges.