Justice, Decency, and the Humiliated PatientJustice, Decency, and the Humiliated Patient
Contemporary biomedicine operates within institutional structures that systematically fail both the demands of justice and the imperatives of basic human decency. This paper undertakes a sustained theoretical examination of two distinct but complementary philosophical frameworks: John Rawls’ theory of justice as developed in A Theory of Justice (1971) and its companion volume Justice as Fairness: A Restatement (2001), and Avishai Margalit’s moral and political philosophy as articulated primarily in The Decent Society (1996). These frameworks are differentiated at the macro-societal level: Rawls addresses the fair distribution of primary goods and opportunities within a just basic structure, while Margalit operates at what he terms the more urgent and immediately realizable register of decency, which demands above all that social institutions cease to humiliate the persons subject to them. The paper argues that the medical system fails on both counts simultaneously—it is neither just in the Rawlsian sense nor decent in the Margalitian sense—and that this dual failure carries profound implications for the therapeutic model. Drawing extensively on the author’s published clinical and theoretical work across neurology, pain management, hermeneutic medicine, and medical ethics, the paper develops a systematic critique of the healthcare system’s structural injustices alongside its quotidian practices of humiliation, and advances a positive therapeutic model grounded in recognition, respect, and the restoration of patient dignity. The paper concludes with proposals for institutional and interpersonal transformation consistent with both Rawlsian and Margalitian demands.