1. David, Beverly Ann PhD, ARNP

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To the editor:

I read with interest the recent article "Reinvesting in Social Justice: A Capital Idea for Public Health Nursing?" (ANS 24:2, December 2001). The authors raise crucial questions of nursing practice, specifically in the public health sector. Their discussion of options to evidence nurses' commitment to eliminate health differentials is intriguing. However, I struggled with the underdevelopment of key concepts, a lack of integration, and an overabundance in the concepts presented.


Justice, as the authors suggest, is an admirable concept to guide nurses' actions. Justice is the uncompromising first virtue of all social institutions, just as truth is to systems of thought.1 Aristotle's traditional notion of refraining from pleonexia,2 gaining advantage for oneself by seizing what belongs to or denying what is due another, is the basis from which most familiar formulations of justice derive. Presuppositions of Aristotle's ethical theory include: (1) persons have a steady and effective desire to act justly and (2) an entitlement exists of what properly belongs to a person and what is due him.2 The good is defined independently from the right, and the right is defined as that which maximizes the good.3


Given these presuppositions, one can formulate a number of conflicts with the authors' application of Aristotle's theory in their argument. Specifically, the statement that humans are "basically good"4(p22) and seek to maximize that goodness with assistance from their reasoning and intellectual abilities. There is no reason, in this author's opinion, to assume just individuals or institutions, for that matter, would maximize the good in any situation. Of course, it is not inconceivable or impossible that the most good could be produced, but that would be pure coincidence.


Drevdahl et al4 ignore the critical priority of the concept of right over the concept of good in nontelelogical ethical theories. Deontological theories define the good as not being independent from the right, the right does not maximize the good, and goodness cannot be judged without referring to what is right.1 The loss of freedom for some cannot be made right by a greater good shared by others. The authors' statement that "the greatest absolute burden of poor health is borne at the bottom of the social hierarchy"4(p28) exemplifies how woefully inadequate a doctrine of final causes could be.


I would like to suggest to nurses that our practice conception of justice be more inclusive of and embedded in the first principles of ethical theory. These principles include, but are not limited to, fairness, fidelity, equality, mutual respect, efficiency, righteousness, beneficence, courage, and mercy. Rawls'1 theory of justice is one such theory whose primary subject is the basic structure of society and has as its moral ideal rightness as fairness.


The intent of this letter is not to provide a thorough discussion of ethical theory or social capital, for that matter. The authors' cautionary advice in regard to the uncritical acceptance of social capital in the public health discourse is well heeded. The determinants of public health are both contextual and individual. As such, health differentials within a population are more than the arithmetic sum of the health of individuals in those populations.5


Social capital as a theory and as a construct has great potential as we move beyond individualistic theories to cohesive, connected, contextual approaches to public health. It is my contention, and that of others,6 that social capital provides a wonderful opportunity to integrate economics and sociology into the field of social inequalities in health care. However, as nurses, we do a tremendous injustice to ourselves and those we serve if we do not critically examine the theoretical underpinnings that inform our action plan. I applaud the authors for raising critical issues and questions of nursing theory and practice. I look forward to further participation in the scholarly discourse.


-Beverly Ann David, PhD, ARNP


Christine E. Lynn College of Nursing


Florida Atlantic University


Boca Raton, Florida




1. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971. [Context Link]


2. Hardie W. Aristotle's Ethical Theory. Oxford: Clarendon Press; 1968. [Context Link]


3. Frankena W. Ethics. Englewood Cliffs, NJ: Prentice Hall; 1963. [Context Link]


4. Drevdahl D, Kneipp S, Canales M, Dorcy K. Reinvesting in social justice: a capital idea for public health nursing? Adv Nurs Sci. 2001;24(2):19-31. [Context Link]


5. Muntaner C, Lynch J, Smith G. Social capital and the third way in public health. Crit Public Health. 2000;10(2):107-124. [Context Link]


6. Wright E. Class Counts: Comparative Studies in Class Analysis. New York: Cambridge University Press; 1997. [Context Link]