1. Drevdahl, Denise RN, PhD
  2. Kneipp, Shawn M. ARNP, PhD
  3. Canales, Mary K. RN, PhD
  4. Dorcy, Kathleen Shannon RN, MN

Article Content

Authors' response:

Engagement in dialogue is an essential element in gaining understanding about such issues as social justice and social capital, so we welcome this opportunity to do so. The primary focus of our article was to examine how the ethical principle of justice is actualized in today's society. In the article we attempted to provide some background in ethics as grounding for a discussion of health disparities and social capital, rather than as an argument for social justice from one particular ethicist's point of view (eg, Aristotle). We are not claiming that Aristotle's ethical perspective is the perspective from which nurses should operate. Related to this point, what "the good" represents is not a universal given-what constitutes a "good" is defined within each situation or context. It might be simply pleasure and nothing else (hedonism), or it might be ensuring basic necessities for all of society. It is not, however, a given, according to Rawls.1


We distinguished between two different conceptions of justice-market justice and social justice. Rawls very loosely defines "social justice" as whatever scheme of justice a society adopts. This is very different from that put forth by Beauchamp,2 who discusses specifics of what social justice means in public health terms and clearly aligns it in opposition to market justice.


Rawls' conception of justice uses the "veil of ignorance" scenario, where what is just or acceptable for the distribution of "goods" is dependent on no one knowing what his or her social situation may be when a system of justice is adopted. Rawls also acknowledges "the various conceptions of justice are the outgrowth of different notions of society against the background of opposing views of the natural necessities and opportunities of human life."1(p9) Thus, the ability of a society to devise a system of justice based on the veil of ignorance can never actually be implemented-rather, Rawls puts it forth as a theoretical exercise or ideal. The question left then is: How do societies develop a system of justice when the use of a veil of ignorance can never be achieved?


Contemporary philosophical theories of justice are largely ones of distributive justice (including Rawls'). Although distributive problems are necessary for a reasonable theory of justice, social justice should not be diluted solely to distributive principles. In the distributive paradigm, matters of social justice center on partitioning material goods, such as wealth and resources. This narrow vision of social justice thus excludes the social, political, and institutional structures and contexts that create unjust distribution patterns-the exact patterns that the theory wishes to ameliorate.


Distributive justice theorists have, indeed, extended the scope of the concept of justice to nonmaterial goods. For Rawls, justice is the "way in which the major social institutions distribute fundamental rights and duties."1(p7) This approach, however, understands elements of social life as things rather than as systems of rules and relations. Evaluating a theory of social justice must include analyzing those social structures (institutions, rules, laws, etc) that enable or constrain individuals, communities, and populations. The individualist ontology of social capital (eg, the reliance on individual beliefs and values to promote civic engagement) thus sidesteps examining economic and political inequalities.3 Critically evaluating the theoretical underpinnings of social capital is an important step in determining the usefulness of social capital, as well as market justice, as frameworks for use in nursing practice.


There is no question that throughout the world there are vast inequalities in the allocation of material goods-the millions living in poverty and suffering from starvation are populations in desperate need of the distribution of goods. Focusing on distribution is a limited version of justice, however, as it leaves the mechanisms for how society and institutions operate unexamined. Widening the scope of social justice for nursing practice such that the "concepts of domination and oppression, rather than the concept of distribution [horizontal ellipsis] [are] the starting point[s] for a conception of social justice"4(p16) is critical to the work of all public health nurses.


-Denise Drevdahl, RN, PhD


Assistant Professor


Nursing Program


University of Washington Tacoma


Tacoma, Washington


-Shawn M. Kneipp, ARNP, PhD


Assistant Professor


College of Nursing


University of Florida


Gainesville, Florida


-Mary K. Canales, RN, PhD


Assistant Professor


School of Nursing


University of Vermont


Burlington, Vermont


-Kathleen Shannon Dorcy, RN, MN


Senior Lecturer


Nursing Program


University of Washington Tacoma


Tacoma, Washington




1. Rawls J. A Theory of Justice. Rev ed. Cambridge, MA: BelKnap Press of Harvard University Press; 1999. [Context Link]


2. Beauchamp D. Public health as social justice. In: Beauchamp D, Steinbock B, eds. New Ethics for the Public's Health. New York: Oxford University Press; 1999:101-110. [Context Link]


3. Muntaner C, Lynch J. Social capital, class, gender and race conflict, and population health: an essay review of Bowling Alone's implications for social epidemiology. Int J Epidemiol. 2002;31:261-267. [Context Link]


4. Young IM. Justice and the Politics of Difference. Princeton, NJ: Princeton University Press; 1990. [Context Link]