At a recent meeting of the Wayne County Medical Society Editorial Board it was mentioned that today’s Wayne State University medical students have a greater interest in the idea of “social justice.” I initially assumed this was a positive change for the profession. But later I became unsure why this might be the case. Without a clear definition of “social justice” it is impossible to conclude whether this should be understood as something new, something positive or even possibly negative. This then raises the questions of how this unclear and undefined concept might apply to healthcare and its present and future physicians. Further, if “social justice” has not existed the question is why. Are we left then to conclude that “social injustice” is what has been culturally dominant?

The concept of justice has been credibly debated for eons by philosophers and thinkers such as Aristotle, Plato, Thomas Aquinas, and David Hume as it might relate to politics, economics and religion. To conclude in a general sense, a biblical sense and specifically as it relates to our Constitutional Republic, justice is equal treatment for all individuals by law. Clearly, “social justice” is not the same as “justice.” If this was the case, the term “social” would be superfluous.

Googling “social justice” brings forth this definition: “Justice in terms of the distribution of wealth, opportunity and privileges within a society.” I think this clarifies the difference between “justice” and “social justice.” Justice applies to individuals. “Social justice” applies to the collective.

What are the principles of “social justice” in general and more specifically as they relate to healthcare? If there is an improper balance in wealth, privileges and healthcare, what needs to be corrected and how?

If the state treats all people equally, then “social justice” is achieved? The problem though, and physicians should be most aware of this, is since people are unequal then you must treat them unequally to make them equal.

Education provides a clear example. There are bright, average and slower learners. If they are all treated equally, some do benefit, but some are also punished. Harvard University’s treatment of Asian Americans is an obvious example of “social justice” producing social injustice.

Please do not simply label this a game of semantics. It is deadly serious. Since it is the struggle du jour within the unique American culture: Should we treat people equally or treat them differently based on immutable characteristics such as race and gender or individual inequalities such as talent, motivation, work ethic and social circumstance in order to correct imbalances in wealth, opportunities and privileges within our society? There is the absolute reality that people are unequal in aptitude, talent, skills, and motivation. This must result in disparities of wealth, recognition and so on. Is it the role of the state to redistribute our property or coerce individuals into a circumstance of economic equality? Please be aware of the historically disastrous results when pondering an answer to this question.

Do vague notions of “social justice” produce abundance, including that of healthcare? Said another way, can medical care be matched to consumers, patients, desires and needs by the burning desire for “social justice?” One of the miracles of our country has been the creation of the abundance of goods and services when all of these are limited in supply. This did not happen through some magical utopian cornucopia; consider the reasons.

If physicians are selectively made to function via altruism, the supply and quality is guaranteed to diminish. The same can be said for all those people, humans, individuals who create the healthcare system. It is not an amorphous entity produced and functioning in some mystical miasma. It is simplistic to believe that there is such bias by providers that applying some notion of “social justice” will resolve healthcare and health disparities.

Two concluding points: Throughout my career in medicine I have been lucky to work and become friends with some really smart people. Many of them have written some truly brilliant columns that do what all good editorial writing should do: make you think.

C. S. Lewis wrote the “Screwtape Letters” as a series of messages from senior devil Screwtape to his protégé Wormwood. In 1963 he wrote an addendum “Screwtape Proposes a Toast.” Here Screwtape says, “It is our function to encourage the behavior, the manners, the whole attitude of mind, which democracies naturally like to enjoy, because these are the very things which, if unchecked, will destroy democracy.” “A democracy does not want great men. ∙∙∙ Allow no preeminence among your subjects. Let no man live who is wiser or better…than the mass. Cut them all down to a level …All equals. …’democracy’ can do the same work without any tyranny other than her own.” I strongly encourage a reading of the entire addendum, a fascinating 30 minutes.