Nursing Article 1

Nursing and justice as a basic human neednup_459 34..44

Megan-Jane Johnstone RN BA PhD FRCNASchool of Nursing and Midwifery, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Melbourne, Victoria, Australia

Abstract This paper explores the idea that justice is a basic human need akin tothose famously depicted in Maslow’s hierarchy of human needs and, assuch, warrants recognition as a core element in representative ideasabout nursing. Early nurse theorists positioned the principles and prac-tice of nursing as having their origins in ‘universal human needs’. Theprinciple of deriving nursing care from human needs was thought toprovide a guide not only for promoting health, but for preventing diseaseand illness. The nursing profession has had a longstanding commitmentto social justice as a core professional value and ideal, obligating nursesto address the social conditions that undermine people’s health.The ideaof justice as a universal human need per se and its possible relationshipto people’s health outcomes has, however, not been considered. Onereason for this is that justice in nursing discourse has more commonlybeen associated with law and ethics, and the legal and ethical responsi-bilities of nurses in relation to individualized patient care and, morerecently, changing systems of care to improve health and health out-comes. Although this association is not incorrect, it is incomplete. A keyaim of this paper is to redress this oversight and to encourage a broaderconceptualization of justice as necessary for human survival, health anddevelopment, not merely as a professional value, or legal or ethicalprinciple for guiding human conduct.

Keywords: justice, health, basic human needs, ethics, human rights, care,nursing.

Introduction

One of the most influential core elements in repre-sentative ideas of nursing to emerge over the pastthree decades has been that of the nursing profes-sion’s unique emphasis on care as ‘an essential humanneed for the full development, health maintenance

Correspondence: Dr Megan-Jane Johnstone, Professor of

Nursing, School of Nursing and Midwifery, Faculty of Health,

Medicine, Nursing and Behavioural Sciences, Deakin University,

221 Burwood Highway, Burwood, Melbourne, Vic. 3125, Austra-

lia. Tel.: + 61 3 9244 6120; fax: + 61 3 9244 6159; e-mail:

[email protected]

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34 © 2010 Blackwell Publishing Ltd Nursing Philosophy (2011), 12, pp. 34–44

and survival of human beings in all world cultures’(Leininger, 1984, p. 3) and its derivative activity ofcaring as the moral foundation and essence of nursing(Watson, 1985; Benner & Wrubel, 1989; Leininger,1990). The nursing profession’s pre-eminent focus oncare and caring has, however, resulted in anotherequally important human need being overlooked,notably justice.

Social justice (of which justice is a component) haslong been posited as a core professional value, ideal,and concept in nursing and even described as beingcritical to nursing’s professional identity (Bekemeier& Butterfield, 2005; Boutain, 2005, 2008; Giddings,2005; Kirkham & Browne, 2006; Schim et al., 2006;Fahrenwald et al., 2007; Bell & Hulbert, 2008).However, justice as a basic human need per se and itsfundamental importance to human survival, health,and development has not been comprehensively con-sidered. Moreover, although social justice has beeninterpreted as imposing on nurses an obligation toengage in social action and to ‘collaborate with others(including the people and populations most impactedby negative social conditions) to address failures inhealth and social systems that undermine the healthof people’ (Bekemeier & Butterfield, 2005, p. 154),consideration of the notion has stopped short of posi-tioning justice as a need, i.e. as something that is ‘vitalto the essentials of life and to the flowering of thehuman spirit’ (Taylor, 2006a, p. xi) and that requiresfulfilment like any other basic human need.

Justice, like care, has been identified as being essen-tial for the full development, health maintenance, andsurvival of human beings in all world cultures (Sluka,2006; Taylor, 2006b). As Tolman has observed:

While we can and do live with injustice, we cannot live

without justice altogether. It is in this sense that justice is

the absolutely necessary condition for the existence of

humanity. (Tolman, 2006, p. 23)

The oversight of justice as a basic human need innursing is therefore interesting, especially whenplaced in the context of the modern nursing profes-sion’s historical commitment to social justice con-cerns and the stance taken by early nurse reformersthat social justice together with collaborative leader-ship was ‘central to nursing and inseparable from

nursing work’ (Bekemeier & Butterfield, 2005,p. 153).

The key aim of this paper is to explore the idea thatjustice is a basic human need and to encourage abroader conceptualization of justice as being not justa legal or ethical principle for systematically guidinghuman conduct, but as ‘fundamental to our beinghuman’ (Tolman, 2006, p. 13) and a ‘compelling com-ponent of human welfare’ (Taylor, 2003, p. 209). In thediscussion to follow, attention will be given to explor-ing the origins of the contemporary proposition thatjustice is a basic human need and as such warrantsrecognition alongside other basic human needs suchas those famously depicted in Maslow’s hierarchy ofhuman needs (Maslow, 1943, 1987). It will be sug-gested that, given the nursing profession’s longstand-ing commitment to the ethical ideals and goals ofsocial justice, the idea of justice as a basic (universal)human need warrants being formally recognized as anadditional basis from which the principles and prac-tice of nursing may be derived. It will also be sug-gested that justice as a basic human need warrantsbeing clearly delineated and explicated in the philo-sophic, theoretical, research, ethical, and practiceposture of nursing.

Nursing and its origins in ‘universalhuman needs’

Nurse theorists have long positioned the principlesand practice of nursing as having their origins in ‘uni-versal human needs’, i.e. needs that are culturally uni-versal and fundamentally necessary for humansurvival. An early influential exponent of this viewwas the late American nurse theorist, Virginia Hend-erson who, in her classic work Basic principles of

nursing care (first published in 1960 and subsequentlyrevised in 1969), explained that the principle of deriv-ing nursing care from human needs provided a guidenot only for promoting health, but for preventingdisease and illness as well (Henderson, 1991). Whileacknowledging that all welfare services have theirorigin in (biological and social) human needs, Hend-erson went on to stress that what distinguished thepre-eminence of nursing in this regard was its uniquefunction, ability, and ethical mandate to contribute to

Nursing and Justice as a Basic Human Need 35

© 2010 Blackwell Publishing Ltd Nursing Philosophy (2011), 12, pp. 34–44

‘what makes for “a healthy citizenry” ’ (Henderson,1977 edn, p. 3). Unlike physicians, who Hendersonregarded were unique on account of being ‘pre-eminent in diagnosis, prognosis, and therapy’, theuniqueness of nursing in this instance lay in the role ofthe nurse in assisting

the individual, sick or well, in the performance of those

activities contributing to health or its recovery (or to peace-

ful death) that he [sic] would perform unaided if he [sic] had

the necessary strength, will or knowledge. And to do this in

such a way as to help him [sic] gain independence as rapidly

as possible. (Henderson, 1977 edn, pp. 3–4)

Henderson was critical of what she saw as a misplacedemphasis on ‘the fundamental human need forshelter’ and the related activity of ‘protecting theperson from the elements’ (Henderson, 1991, p. 16).Reflecting on this narrow conceptualization of humanneed (and her own related personal observations ofthe environmental constraints imposed on individualsin healthcare settings, particularly hospitals), shewarned:

If for too long we deprive a person of what he [sic] values

most – love, approval, fruitful occupation – this condition of

deprivation is often worse than the disease we are attempt-

ing to cure. (Henderson, 1991, p. 17)

Although Henderson’s views pertained primarily tothe provision of individualized nursing care in institu-tional settings, for which she has been criticized (seeClark, 2006), she was nonetheless acutely aware of theneed for all healthcare personnel to ‘constantly evalu-ate their roles and be ready to modify them for thecommon good and modify the programmes thatprepare them for their work’ (Henderson, 1978, 2006edn, p. 21). She also strongly believed that in order fornurses to be successfully prepared for their work(which she accepted also involved the promotion ofthe universal human right to health care), their teach-ing and learning programs must include ‘whatevergives them the broadest possible understanding ofhumanity and the world in which they live’ (Hender-son, 1978, 2006 edn, p. 21).

As a result of Henderson’s (1978) ongoing attemptsto ‘identify the common elements, if they exist, inrepresentative ideas about nursing’ (p. 22), new direc-

tions in nursing practice and education were identi-fied and ultimately progressed, and in some casesaccelerated (Styles, 2006).

The concept of justice

For the purposes of this discussion, some clarificationof what is meant by the notions of justice and social

justice is warranted and is presented below.Justice (from the Latin justus meaning ‘righteous’)

is a complex and contested notion, which defiesprecise definition. Significantly, questions concerningwhat justice is and what its origins are have occupiedthe minds of philosophers for nearly 3000 years, andto this day remain the subject of philosophical debate.Significantly, the end result of this philosophicaldebate ‘has not been the development of a singularand refined universal theory of justice, but the devel-opment of a range of rival theories of justice’(Johnstone, 2009a, p. 43).

Among the different conceptions of justice to haveemerged through the ages of ongoing philosophicaldebate are: justice as revenge (retributive justice);justice as mercy; justice as harmony in the soul and

harmony in the state; justice as equity (impartiality andfairness); justice as equality (‘equals must be treatedequally, and unequals unequally’); justice as an equal

distribution of benefits and burdens (distributivejustice and redistributive justice); justice as what is

deserved (‘each according to one’s merit or worth’);justice as love; and justice as reconciliation and repa-

ration (restorative justice) (Johnstone, 2009a, pp.43–44).

In nursing discourse, justice is commonly used intwo related senses: distributive justice and justice as

fairness (Johnstone, 2009a). Distributive justice per-tains to the theorized stance that the material burdensand benefits of a society (including privileges andopportunities) must be distributed equally among itsmembers. The only exception to this is where anunequal distribution is necessary so as to ensure thatthat least well off are enabled to have access to aminimally decent level of society’s material benefits(Beauchamp & Childress, 2009).

Justice as fairness, in turn, pertains to a largelyintuitive sense of justice, which involves subjective

Megan-Jane Johnstone36


perceptions and judgements about whether the pro-cedures followed (i.e. how a distribution decision ismade) and the outcomes resulting from a given act oromission are positive (beneficial) or negative(harmful) and ‘fair’ (Beauchamp & Childress, 2009).According to Leventhal (1980), in order for a proce-dure (distribution decision) to be perceived as beingfair, the following six criteria must be met; namely, theprocedures must:

1 Be followed consistently2 Lack self-interest3 Be based on accurate information4 Allow for opportunities to correct decisions5 Represent the important interests of all concerned6 Comply with ethical standards.

A seventh criterion, enabling stakeholders ‘to havea voice’ in decision-making processes, has also beenidentified as influencing people’s perceptions of fair-ness (Lind & Tyler, 1988).

Social justice, of which justice is an element, is alsoa complex and contested notion. Defined by Levy &Sidel (2006) as ‘an ethical concept grounded in prin-ciples of distributive justice’ (p. 9), social justice pre-scribes ‘equity in the distribution of resources’ as isnecessary to sustain and/or improve health (Fahren-wald et al., 2007, p. 193).

In nursing, social justice discourse has historicallyemphasized the responsibility and obligation ofnurses to improve the health of ‘underserved, margin-alized, or vulnerable members of society’ (Boutain,2005, p. 405) and to ‘address the social conditionsthat underlie health problems’ in these populations,including the delivery of health services (Bekemeier& Butterfield, 2005, p. 153).

Although social justice is not a new concept innursing, it is nonetheless poorly articulated andpoorly understood in nursing education, research, andpractice. A review of the nursing literature for theyears 1990–2006, for example, found that nursing con-ceptualizations of social justice were superficial,ambiguous, incomplete, and inconsistent, making itdifficult for the concept to be taught let alone appliedin practice (Bekemeier & Butterfield, 2005; Boutain,2005, 2008). Without a consensus definition of socialjustice, the capacity of nurses to undertake robust

comparative research has also been undermined.These deficits have led for calls for more critical atten-tion to be given to both the notion and practice ofsocial justice by the nursing profession. As Boutain(2008) explains,

Without a more complex and nuanced view of social justice,

nurses [will be] less able to fully utilize this concept as a

framework to redress unjust conditions in healthcare deliv-

ery and health attainment. (p. 47)

Nurses will likewise be less able to contribute tounderstandings of how an ‘interdisciplinary conceptof social justice is useful in promoting just health andsocial relationships in society’ (Boutain, 2008, p. 47).The consideration of justice as a basic human need, asproposed in this paper, provides a timely opportunityfor a more complex and nuanced view of social justiceto be considered and developed.

Justice as a basic human need

The notion of justice as a basic human need can betraced back to the original and innovative work ofAnthony Taylor, a New Zealand-based Emeritus Pro-fessor of Psychology, who was prompted to undertakea ‘psychological reappraisal of justice’ after being onassignment in Fiji following the May 2000 attemptedcoup by a group of armed insurgents (Taylor, 2003).Upon directly encountering the ‘bewilderment, disap-pointment, and shock’ of a group of Parliamentariansand their families who had been held hostage duringthe coup attempt, Taylor observed that some of psy-chological reactions that were being manifest by thevictims fell outside of the familiar categories of stress/trauma reactions (Taylor, 2003, 2006c). This raised forhim unfamiliar questions ‘about the nature of justiceand of inviolable human rights’ and how attacks onthese alone might manifest as a stressor needingtherapeutic intervention (Taylor, 2003, p. 210).

What particularly stood out for Taylor were theshock, horror, disillusionment, and disbelief the hos-tages felt, which they attributed to ‘the shattering oftheir legitimate expectations from being members ofa community’ (Taylor, 2003, p. 210). This led him toreflect on the psychological nature of justice andhow violations of it might compound the emotional,



physical, and other losses that a person can experi-ence when their need of justice is violated, frustrated,or unfulfilled (Taylor, 2003, 2006a, 2009a, 2009b). Hisreflections ultimately informed the development ofthe following argument:

Justice is not simply an idealistic concept with implications

for the development of individuals and their communities

towards the highest goals of human endeavour. Nor is it just

the interpretation and application of common law and

statute law that applies in every jurisdiction. Rather, it is an

inherent human need, the violation of which compounds the

emotional, physical, and property loss that victims of crime

[and other injustices] suffer. (Taylor, 2009a, p. 3)

In his emerging works Taylor came to the conclusionthat psychologists and others working with victims ofinjustice need to pay closer attention to building ‘amore realistic picture of the complex frameworkwithin which people live’ and to pay attention to

the effect of the deprivation of justice as well as to its fulfil-

ment, and join forces with other scientists and scholars to

validate the concept, consider the remedies for injustice, and

help to bring about a more just society for the greater good

of all its members. (Taylor, 2003, p. 217)

Taylor further concluded that, taking these consider-ations into account, justice needs to be recognized asbeing much more than merely a ‘utilitarian procedurefor resolving conflict’ (Taylor, 2006a, p. xi).

In a landmark anthology addressing the subject,Taylor and colleagues assert on philosophical, theo-retical, and research grounds that justice is just as vitalto the essentials of life as are other more convention-ally recognized ‘basic human needs’, such as food,warmth, water, and other bodily needs (Taylor,2006b). Emphasizing the necessity of justice for safetyand belonging (both of which are generally acceptedas being essential for human development), Taylorand his colleagues argue that it is time for justice to begiven its ‘proper place in the classical hierarchy ofbasic human needs’ as originally proposed by Maslow(1943) and be given full recognition as a psychologicalmotivating force (Taylor, 2006a). These ideas havebeen developed further in more recent works (Taylor,2009a, 2009b), in which Taylor more clearly definesthe origins and function of justice notably as:

(a) a major motivating factor essential for individual, social,

and community development, (b) an essential precondition

for approximating the good life, (c) the reciprocal quality of

relationship that obtains between people for their mutual

well-being. (Taylor, 2009a, p. 2)

Taylor’s thesis on the psychology and motivationalfunction of justice finds further support in the work ofFischer & Skitka (2006) who suggest that ‘peoplehave an inherent need to believe in a just world – i.e.to believe that good things happen to good peopleand bad things happen only to bad people’ (Fischer &Skitka, 2006, p. 86). These authors go on to explainthat the reason people need to believe in a just worldis, in part, ‘because the belief provides a sense ofpredictability and meaning in life as well as givingsome assurance that behaviour and characteristicswill be appropriately rewarded or punished in thelong run’ (Fischer & Skitka, 2006, p. 87). Recognizingjustice as a basic human need serves other importanthuman interests as well, including people’s:

• Long-term self-interest (in order to survive andthrive, people need to be able to engage in sociallycooperative behaviour with those who behave fairly)• Social identity (when people are treated fairly, thiscommunicates the degree to which they are valuedand respected as a member of the group; as Rosen-field’s (1997) research exemplifies, in instances wheredisadvantage and inequality are linked, this can poseserious threats to a person’s self-worth (esteem) andself-efficiency (identity), the accumulative effect ofwhich over time can translate into anger and a desirefor restitution• Need to express or defend themselves as morally

authentic beings (also a constituent of social identity,listed above) (after Fischer & Skitka, 2006, p. 88).

When people experience an injustice, it is univer-sally experienced as oppression, which if not remediedmay inevitably lead to resistance and conflict (Sluka,2006). This, in turn, can leave those most affectedfeeling shocked, hurt, bewildered, disillusioned, dehu-manized, anxious, depressed, frustrated, and in a stateof disbelief that their expectations as members of amoral community have been so gravely betrayed(Taylor, 2003, 2006a). These and similar feelings



evoked by an injustice are such that, in addition to themore material consequences of a specific violation(e.g. being taken hostage, being physically injured byan unprovoked assault, having ones’ culture and iden-tity assaulted, being robbed of one’s precious posses-sions, having one’s children stolen and/or abused,being denied education and employment opportuni-ties because of the colour of one’s skin or the capacityto speak English as a second language), the incompre-hensibility of the injustice at issue is such that it maybe sufficient in and of itself to serve as a stressor thatis detrimental to the health and well-being of thepeople affected (Summerfield, 2000; Taylor, 2006a).Indeed, the hurt of an injustice can be so profoundthat those affected may stand in need of ‘therapeuticintervention’ (Taylor, 2003, p. 210).

People who, in the face of an injustice, can find nomeaningful answer to the existential question ‘Why?’,and whose traditional methods of handling crises areoverwhelmed and rendered incapable of helping, areparticularly vulnerable in this regard and may stand inparticular need of ‘therapeutic justice’ as an interven-tion (Summerfield, 2000; Taylor, 2003).

Healthcare justice and thenursing profession

The modern nursing profession has a rich and distinc-tive history of promoting healthcare justice for theindividuals, groups, and communities it serves. One ofthe foremost proponents of a justice perspective innursing was the noted reformer of hospital, district,and workhouse nursing, Florence Nightingale (1820–1910) (Barritt, 1973). Nightingale’s model of nursingand hospital reform was profoundly influenced by theworks of the ancient Greek philosopher Plato (circa427–347 BC), especially his classic treatise on theideal state The Republic (Plato, 1955edn). The Repub-

lic’s emphasis on science of the soul, which includedmoral science (ethics), resonated deeply with Night-ingale (LeVasseur, 1998). Of particular influence,however, was The Republic’s emphasis on the ‘righteducation’ for the state’s guardians who, according toPlato must be ‘completely devoted to what they judgeto be the interests of the community, and never beprepared to act against them’, the prevalence of

justice, the importance of good character, and theprocesses for ensuring a just and harmonious societybetween all classes (Plato, 1955edn, p. 157).

Plato argued that a just society is one in whichpeople do what they are best suited to doing. Observ-ing that ‘we care most for what we love’, he reasonedthat if people loved what they did (e.g. being guard-ians of the state) they would make the right choices,i.e. choices that were in the best interests of the com-munity they were serving (Plato, 1955edn, p. 157).

Nightingale’s reforms and model of nursingstrongly emphasized ‘the right education’, whichincluded ‘character training’ and the acquisition of‘moral qualifications’ (Johnstone, 1994, p. 54), the pos-session of justice as a character trait that was good inits own right, a strong sense of responsibility to society(which included the ‘moral government of theworld’), and a passion for reform (see Nightingale,1915 edn). In regard to the latter, as LeVasseur (1998)explains in her insightful essay on ‘Plato, Nightingale,and contemporary nursing’, for Nightingale it was notenough merely to have knowledge of the good, but ‘itwas imperative to put that knowledge into action as aguardian of the people’ (p. 282).

As can be discerned from her writings and works,Nightingale was a passionate advocate of ‘love andjustice’ and ‘freedom and progress’ and of the role ofnurses in advancing these values in society (Nightin-gale, 1852, 1979edn, 1915edn). Doubting the capacityand commitment of the political rulers and lawmakers of her day to promote justice, freedom, andprogress, and to achieve the social reforms necessaryfor the good of the community, Nightingale (1915edn)was acutely aware that if nurses were to successfullyfulfil their role as ‘guardians of the community’sinterests’, they needed to: guard themselves againstbecoming ‘stagnant women’ (p. 5), engage in constantself-directed learning and work to improve their ‘ownmind and character every day’ (p. 50), develop profi-ciency and always striving to ‘know the reason why’(p. 70), and resist becoming enamoured with ‘the goodopinion which men have of you’ else fall prey ‘toneglecting themselves’ and become conceited andarrogant (p. 58). Mindful that ‘no one can trampleupon others, and govern them’, Nightingale was alsoat pains to remind her Sisters and Head Nurses of



their responsibility always to be ‘just’ when exercisingtheir authority over and leading others (Nightingale,1915edn, p. 16). In a talk given in May 1872, sheadvised those present:

We must not give an order, much less a reproof, without

being fully acquainted with both sides of the case [. . .] The

person in charge every one must see to be just and candid,

looking at both sides, not moved by entreaties or, by likes

and dislikes, but only by justice; and always reasonable,

remembering and not forgetting the wants of those of whom

she is in charge. (Nightingale, 1915edn, p. 14)

Human rights, justice and health

Any examination of the question of justice as a basichuman need would be less than complete withoutsome attention also being given to human rights andthe injustice of human rights violations.There are tworeasons for this: first, as Levinson (2004), the UnitedNations Commissioner for Human Rights, points out‘human rights are above all a question of justice’(quoted in Taylor, 2006c, p. 5); second, like justice,human rights have been profoundly linked to humanhealth and well-being and, in several respects, like-wise stand as a basic human need (see Mann et al.,1999).

The contemporary relationship between humanrights, justice, and health can be traced back to 1994,when Jonathan Mann and colleagues published alandmark article on the then rarely considered, yetbasic link between health and human rights (Mannet al., 1994; Gostin, 2001). Recognizing the need toreorientate people’s thinking about major globalhealth challenges, the authors proposed a provisionalframework for structuring discussions about explor-ing the potential for health and human rights collabo-ration in public health research, education, andpractice. Two years later Mann (1996) pointedlycalled for the health and human rights agenda to bebroadened so as to ensure the ‘engagement of heathprofessionals in human rights related work’ (p. 1).

As a result of Mann’s and others’ work (see Mannet al., 1999; Gostin, 2001), there has been increasinginternational recognition that ‘health and humanrights are both powerful, modern approaches to

defining and advancing human well-being’ (Mannet al., 1994, p. 8). This idea has also been whollyendorsed by the World Health Organisation, asreflected in its ground-breaking Health and Human

Rights Publication Series (WHO, 2001, 2002, 2003,2005), which sets a global agenda for social and politi-cal reform aimed at improving health for all.

Nursing and upholding justice as abasic need

The notion of justice as primarily used in nursing andrelated discourse is more commonly associated withlaw and ethics. Only rarely have other perspectives(e.g. restorative justice) been considered (Johnstone,2009a). In the case of law (whereby justice is said tobe achieved when law is upheld) attention has prima-rily been focussed on the legal responsibilities of thenurse and on the processes required for maintainingsystems of justice rather than the underlying motiva-tions and reasons for doing so. Ethics likewise hastended to emphasize the maintenance of systems(whereby justice is said to have been achieved whenuniversal moral principles have been upheld),although in doing so it has also placed strong empha-ses on the underlying reasons for the maintenance ofsuch systems. A key underpinning philosophicassumption here is that people need to have a meansof self-regulating their behaviour towards oneanother and to achieve peaceable bonds amongpersons without brute force so as to be able toachieve and live cooperatively in a peaceable com-munity (Engelhardt, 1986; Beauchamp & Childress,2009).

The idea of justice being a basic human need thusstands as a significant challenge to the way justice hasbeen conventionally conceptualized and applied innursing. Moreover, it raises important questionsabout how justice is really understood and applied innursing contexts and how a psychological theory ofjustice (such as that posed by Taylor, 2003, 2006a,2009a, 2009b) might reorientate the attention andbehaviour of nurses in regard to both individualnurse–patient encounters as well as their encountersand relationships with the broader communities andsocieties they serve. Equally important, it raises the



question that if the conceptualization of justice as abasic human need is to be adopted and treated as acore element in representative ideas of nursing, howis this idea to be operationalized in nursing domainsand used effectively to focus individual and collectivenursing attention and social actions aimed at satisfy-ing the human need for justice of the constituents thatthe profession serves?

To operationalize the idea of justice as a basichuman need and to use it effectively to focus nursinginterventions aimed at meeting this need, at leastthree processes can be employed. Drawing on thework of Boutain (2008), these minimally include:awareness, amelioration, and transformation.

In the case of awareness, nurses need to ask criticalquestions about the justice needs of people and howpeople feel when they have been treated unfairly.Thisentails conducting self-reflection and getting others toreflect on what it feels like to experience an injusticeand/or to not have a justice need met. It also entailsidentifying what happened (what was the incident),why the incident occurred, what were the contributingfactors, what were the underlying social or systemfactors that possibly contributed it, and what can bedone to prevent it from happening again. It may alsoinvolve ‘saying sorry’ and employing the devices ofrestorative justice to ‘heal breaches’ and repair andrestore broken relationships (Johnstone, 2009a, pp.46–47).

Amelioration, in turn, entails ‘addressing the imme-diate results/consequences or antecedents to unjustconditions’ (Boutain, 2008, p. 46). Addressing theantecedents could range from engaging in socialactivism to a more localized activity such as educatingnurses about the principles and practice of socialjustice and its counterpart restorative justice. It mightalso include giving personal acknowledgement tothose at the sharp end of an injustice in a way thatenables them to feel valued, included, and ‘approvedof’ as members of the community. Transformation,meanwhile, involves ‘critically deliberating’ about therelationship between justice and health, with the aimof identifying and redressing the conditions thatignore this relationship, and which can lead to justiceas a basic human need being frustrated, denied, andultimately left unfulfilled.

An example of how conceptualizing justice as abasic human need might reorientate nurses attitudes,perceptions, and behaviours can be found in thewidely publicized 2008 case of Mr Ward, a 47-year-oldfather of four and respected Aboriginal Elder fromWestern Australia, who was literally cooked to deathin the back of an unventilated prison van while beingtransported to a court at a location 360 km away. MrWard was locked in the pod of the prison transportvan for almost 4 h non-stop, during which time theinternal air temperature of the pod rose to around47°C, with the surface metal temperature rising toaround 56°C. Unable to summon help, Mr Ward liter-ally ‘cooked to death’ over a 3-h period (Johnstone,2009b, p. 29).

Just before he died, Mr Ward was taken to a hospi-tal after security guards, stopping to make a check,found him collapsed in the pod. Upon arrival at thehospital, staff described the air from the van as being‘. . . like a blast from a furnace’ (Johnstone, 2009b, p.29). On his admission into the emergency department,Mr Ward had a core body temperature above 41°C.He was found to also have a large full thickness burnon his abdomen, consistent with his having been incontact with the hot surface metal of the van. Despitehospital staff’s desperate efforts to cool him, Mr Warddied of irreversible heat stroke (Johnstone, 2009b).

A coronial inquest into Mr Ward’s death clearlyidentified who and what contributed to his avoidableand unnecessary death. A subsequent inquiry by theWest Australian Department of Public Prosecution,however, determined that no charges would be laid,because ‘a prima facie case did not exist for a criminalprosecution’ and ‘there was no reasonable prospectfor conviction’ (Department of Public Prosecutions,2010). Bewildered by this decision, Marc Newhouse,from the Deaths in Custody Watch Committee,reportedly responded ‘there is something seriously,seriously wrong with our criminal justice system’, con-cluding ‘justice has not been served’ (Newhouse –cited in ABC News, 2010). Criticizing the decision, theWest Australian State Government opposition leaderreportedly stated:

My view is the DDP should have proceeded (with charges)

because not to do so is to let down Aboriginal people in a set



of circumstances where they’ve been let down at every level

with regard to this case and in a context where they have

many, many historical grievances’. (Ripper – cited in

Parker, 2010)

The nursing profession’s response to this case wasmute. There is room to speculate that if the nursingprofession had a better understanding of justice asbasic human need it might have viewed the case asbeing considerably more than ‘yet another instance ofthe failure of the legal system’ (Johnstone, 2009b, p.29). It might also have behaved more responsively tothis case, such as by collectively speaking out againstthe injustice and calling for a deeper inquiry into howthe injustice at issue was being felt by Mr Ward’sfamily and community, its impact on their health andwell-being, its compounding of past wrongs and asso-ciated hurts, and the enormous collective effort thatwould be required across the State and nation to healthe broken relationships and make reparations forwhat had occurred.

Cases of injustices like the one exemplified byMr Ward’s wrongful death and lack of remedyhighlight that recognizing justice as a basic humanneed will require nurses and other health profession-als to ‘go beyond the “binding of wounds” ’ and ‘thetradition of remaining morally and politicallyneutral’ (Summerfield, 2000, p. 234). Nurses, likeother health professionals, need also to activatefor social reform as well as public recognition andreparation of the harmful health consequences ofinjustices that many people in our society bearsilently, alone, and without recompense. As Summer-field (2000) reminds us, the ill effects of witnessingand experiencing the destruction of one’s sociocul-tural world, embodying one’s history, identity, andliving values, ‘is not a private experience’ to betreated by an individualized care plan (p. 233).The distress of the tortured, the deprived, and thealienated individual is part of a greater collectivesuffering that requires acknowledgement and reso-lution in a social context. It is in this sense, asasserted by Summerfield (2000), that social reformand public recognition of justice stands as the ulti-mate therapy, for which we all share responsibility inproviding.

Conclusion

This paper has explored the idea that justice is a basichuman need and as such warrants a broader concep-tualization in nursing discourse that goes beyond itsconventional conceptualization as a legal or ethicalrule and principle of conduct. It was suggested that,given the nursing profession’s historical commitmentto social justice, the idea of justice as a basic (univer-sal) human need be formally recognized as an addi-tional basis from which the principles and practice ofnursing may be derived. To this end, justice as a basichuman need needs to be clearly delineated and expli-cated in the philosophic, theoretical, research, ethical,and practice posture of nursing. Further research andscholarship on this issue is warranted and it is hopedthat the discussion presented here will provide abeginning point for new work to be undertaken in thisarea.

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