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Leadership for Justice in Health Care Leading the Way CHA Conference Perth 21 August 2012 Governance and Mission Stream Fr Frank Brennan SJ SVHA Board Director Professor of Law Director of Strategic Research Projects (Social Justice and Ethics) Australian Catholic University Slide 2 Greetings from Therese Vassarotti Slide 3 Susan Sullivans Commission (She who must be obeyed) to highlight our preferential option for people who are poor and model a response broader than the current Community Benefit strategy. to provide the theoretical underpinnings to kick off the session with practitioners committed to justice in health care Slide 4 So what is justice? John Rawls Imagine yourself behind a veil of ignorance The Original Position What distribution of goods and opportunities would you think fair or just? Slide 5 1. Everyone would be entitled to the same list of basic liberties. 2. The key offices in society would be open to everyone without discrimination. 3. The unequal distribution of goods and opportunities would be justified in so far as it assisted the worst off in society to be better off than they would have been if no unequal distribution were permitted. Slide 6 Amatya Sen Slide 7 Bob is very poor Carla made it Anne is the only one who can play it Slide 8 Economic egalitarian Give it to Bob Libertarian Let Carla Keep it Utilitarian Hedonist Let Anne play it Slide 9 Slide 10 Compassionate healthcare for the poorest? Integrated healthcare for those who would most profit by it? Excellent healthcare for those who can afford it? Slide 11 Slide 12 Commutative justice calls for fundamental fairness in all agreements and exchanges between individuals or private social groups Distributive justice requires that the allocation of income, wealth, and power in society be evaluated in light of its effects on persons whose basic material needs are unmet. Social justice implies that persons have an obligation to be active and productive participants in the life of society and that society has a duty to enable them to participate in this way. Slide 13 Indigenous Australians and their Just Entitlements a key social indicator Commutative Justice Land rights Distributive Justice Aboriginal Secondary Grants Scheme Social Justice Government funding for Aboriginal Arts Slide 14 There may come a time when Aborigines are no longer poor, disadvantaged and dispossessed. What are the special provisions to which Aborigines would be entitled because they are Indigenous Australians? (not because they are poor, disadvantaged and dispossessed) Slide 15 Imagine What would you think? Slide 16 What is a Just Way to Treat Asylum Seekers? Slide 17 There is a quota There are more refugees than places We dont like queue jumpers But is there a queue? Those who come by boat should not get any advantage over those who wait. Nauru, Malaysia, Indonesia, Onshore processing Slide 18 Slide 19 The Distinctively Catholic Challenge Bishop Anthony Fisher Catholic Bioethics for a New Millennium Three preferential options: preferential option for the poor and marginalised; the preferential option for the sick and the disabled; and the preferential option for the suffering and dying. Slide 20 Bishop Fishers 6 Tasks 1.consider seriously the materially and morally available options, neither engaging in a simple maintenance operation nor abandoning the trust received from our predecessors and the Church today. 2.there must be a critical mass of strategically located personnel practising their Catholic faith and being dedicated to the mission and values of our institutions. 3. there must be greater co-operation within the Catholic health-care sector. 4. we need to respond effectively to the political and financial pressures of the contemporary health-care ecosystem while still promoting our mission and ethics. 5. in the practical application of our ethics, studied ambiguity or evasion must be honestly addressed and corrected. 6. local bishops must vigorously oversee, coordinate and plan in this area. Slide 21 Taking Seriously the Social Determinants of Health There are five key influences on our health: 1.Genetics 2.Social Circumstances 3.Lifestyle 4.Accidents (and violence) 5. Access to health care. Slide 22 If you are from a poor, dysfunctional family with little education and low job prospects, your health outcomes most probably will be much worse than those of the person from a well off functional family with good education and fine job prospects. Slide 23 National Human Rights Consultation Im going to read out some groups now. For each, do you feel their human rights need to be given more, less or the same amount of protection as they are currently getting in Australia? Slide 24 Slide 25 David Hollenbachs Claims in Conflict Three strategic moral priorities (1)The needs of the poor take priority over the wants of the rich. (2) The freedom of the dominated takes priority over the liberty of the powerful. (3). The participation of marginalised groups takes priority over the preservation of an order which excludes them. Slide 26 The Challenge to the Practitioners How we can better attend to: the needs of the poor, the freedom of the dominated, and the participation of marginalised groups, while in justice and with prudence, still being duly attentive to the wants of the rich and the liberty of the powerful without whose support we would be much diminished, and while maintaining our Catholic identity without being rendered impotent in our purity?