From Hospital Beds to Fair Societies
Exploring the paradigm shift in bioethics from individual consent to social justice
When a patient arrives at a hospital, the question has traditionally been: "Do they consent to treatment?" But in an era of genetic engineering, AI in medicine, and widespread health disparities, bioethicists are raising a more profound question: Is this system just? The field of bioethics, once primarily concerned with individual autonomy and informed consent, is undergoing a radical transformation—shifting its gaze from the hospital bedside to the broader structures that determine who gets care and who doesn't.
Focus on individual autonomy, informed consent, and doctor-patient relationships
Focus on structural equity, collective well-being, and systemic justice
A groundbreaking survey published in 2025 reveals that an overwhelming majority of bioethicists now believe the field must directly address questions of justice 4 . This article explores why bioethics must turn toward justice—and how this shift is transforming both theory and practice in one of today's most critical fields.
The push for a justice-oriented bioethics represents both a return to roots and a revolutionary step forward. When theologian Paul Ramsey helped establish the modern bioethics movement, he emphasized the inherent dignity of every patient—a concept that implicitly contained seeds of justice concerns. However, in subsequent decades, the field increasingly narrowed its focus to individual autonomy, particularly through the lens of informed consent 8 .
| Traditional Bioethics Focus | Justice-Oriented Bioethics Focus |
|---|---|
| Individual autonomy and consent | Structural equity and collective well-being |
| Doctor-patient relationship | Healthcare systems and policy design |
| Immediate treatment decisions | Long-term health disparities |
| Informed consent forms | Resource allocation and access |
| Case-based analysis | Systemic reform and policy change |
As Professor Jenny Reardon argues in "Why and How Bioethics Must Turn toward Justice: A Modest Proposal," creating a genomics (and healthcare system) that "offers more gifts than weights" requires central attention to questions of justice. This necessitates expanding bioethical imaginations so they can respond to questions of structural inequity rather than merely individual choice 1 .
The most compelling evidence for this shift comes from a landmark survey published in July 2025 in the American Journal of Bioethics Empirical Research. Titled "A Survey of Attitudes Toward Social Justice Obligations in the Field of Bioethics," this study provides the first comprehensive data on how bioethicists view their field's relationship to justice issues 4 .
Researchers worked with leaders in bioethics to create a comprehensive survey through an iterative design process
The survey was distributed through professional bioethics listservs and individual emails to ensure broad representation
Ultimately, 355 bioethicists from the United States and Canada completed the survey, providing a substantial sample size for analysis
Researchers examined both quantitative responses and qualitative comments to capture nuanced perspectives 4
of bioethicists endorsed incorporating social justice concerns in their work
believed bioethics scholarship should advance social justice
agreed bioethics is too focused on autonomy and individual concerns
The survey also revealed generational differences, with early-career bioethicists more likely to support integrating social justice into bioethics, suggesting that this shift is likely to accelerate in coming years 4 .
This theoretical shift toward justice is having profound practical implications across healthcare and biotechnology. Two case studies illustrate how justice-oriented bioethics is tackling pressing contemporary issues.
In rural communities across the United States, Medicaid isn't just another program—it's the foundation of healthcare infrastructure. Justice-oriented bioethicists are applying ethical principles to analyze policy decisions that affect these vulnerable communities.
"In towns like the one I grew up in – a town like many others – removing Medicaid could mean the collapse of half the healthcare system" 3 .
In September 2025, federal policy changes stripped many immigrants of access to essential health services including community health centers, mental health services, and Head Start programs. Justice-oriented bioethicists identified this not merely as a policy change but as structural scapegoating 7 .
By blaming immigrants for healthcare system shortcomings and then cutting off their access to aid, policymakers create a cycle of exclusion and suffering that makes false accusations appear true. This engineered disadvantage represents a profound violation of justice 7 .
Monica Bennett, legal director of the ACLU of Kansas, explains this dynamic: immigrants are being used as "someone for people to point to and say, 'it's your fault that our health care system doesn't work properly'" 7 .
Implementing justice-oriented bioethics requires both theoretical frameworks and practical tools. The following resources represent essential components of the justice-oriented bioethicist's toolkit:
Evaluates operational needs of Research Ethics Committees globally to inform quality improvement
Example: Johns Hopkins University's RECAT helps ethics committees ensure equitable research review 5
Addresses ethical issues at organizational level—policies, business strategies, institutional decisions
Example: Harvard's Organizational Ethics Consortium focuses on justice in health system decisions
Bridges social sciences, natural sciences, arts, and engineering to create new training and thinking
Example: UC Santa Cruz's Science and Justice Research Center builds alliances across disciplines 1
Shifts evaluation from individual cases to systemic impact and equity outcomes
Example: Emerging frameworks that measure reductions in health disparities rather than just case resolution
Ensures marginalized voices inform ethical decision-making
Example: Participatory practice models that center affected communities
These tools enable bioethicists to move beyond theoretical critique to active intervention in systems and structures that perpetuate health inequities.
The turn toward justice in bioethics represents more than a theoretical shift—it's a fundamental reimagining of the field's purpose and promise. As the 2025 survey demonstrates, this is no longer a fringe position but an emerging consensus among scholars and practitioners 4 . The question is no longer whether bioethics should address justice, but how it can do so effectively.
As we move forward in an era of unprecedented scientific possibility, the turn toward justice in bioethics offers hope for a healthcare system that is not just technologically advanced but fundamentally fair. The revolution in bioethics isn't coming—it's already here, and it's centered on the age-old question that now demands new answers: Is this just?