DNP 603 Module 2 Theoretical Foundations of Social Justice Paper Example

Owed at the Jail Door: Three Theories and One Nurse's Position on Justice After Release

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 603: Health Equity and Social Justice

Instructor Name

Month Day, Year

Owed at the Jail Door: Three Theories and One Nurse's Position on Justice After Release

Introduction

People released from prison and jail die at strikingly high rates in the weeks after release, most often from drug overdose (Binswanger et al., 2007). As an emergency nurse, I have treated many of them. This paper explores three theories that shape how I understand that pattern and synthesizes them into a position about what justice requires.

Rawls: Justice as Fairness

Rawls (1971) asked what principles people would choose for a society if they did not know their own place in it, a thought experiment he called the veil of ignorance. He argued they would choose equal basic liberties for all and would accept social and economic inequalities only if they benefit the least advantaged members of society, the difference principle, and are attached to positions open to all under fair equality of opportunity.

Applied to release from jail, the veil of ignorance is clarifying. Someone who did not know whether they would be the person leaving jail with no medication, no coverage and no housing would not choose a system that leaves that moment unsupported. The difference principle asks whether the arrangements around release benefit the least advantaged; abrupt loss of treatment and coverage plainly does not.

Rawls's theory has limits for health. It focuses on the distribution of primary goods, such as rights, opportunities and income, rather than health itself, and it treats people as rational choosers rather than embodied beings shaped by history.

Farmer: Structural Violence

Paul Farmer and colleagues described structural violence as the social arrangements that put individuals and populations in harm's way, harm that is structural because it is embedded in political and economic organization, and violent because it causes injury, usually to people who are not responsible for the arrangements (Farmer et al., 2006). They urged clinicians to recognize these forces in the patients they treat.

Structural violence explains what Rawls's theory abstracts away. The person overdosing nine days after release did not create the policies that stopped his addiction treatment at the jail door, the rules that suspend Medicaid during incarceration or the housing market that left him on a relative's couch. Those arrangements are the reason risk concentrates in the first two weeks, when overdose deaths ran 129-fold above the rate for other residents in one large study (Binswanger et al., 2007). Farmer's lens moves the analysis from individual choice to structures and insists that clinicians name them.

Its limit is that it describes harm more powerfully than it prescribes what to do or how to weigh competing claims.

Powers and Faden: Well-Being and Social Justice

Powers and Faden (2006) argued that social justice in public health is concerned with securing a sufficient level of well-being for everyone, across several essential dimensions: health, personal security, reasoning, respect, attachment and self-determination. They emphasized that disadvantages tend to cluster and reinforce one another, so the most urgent task of justice is to address systematic patterns of disadvantage that cut across dimensions.

People leaving jail often experience disadvantage in every dimension at once: health, through untreated addiction and chronic illness; personal security, through housing instability; respect, through stigma; attachment, through disrupted family ties; and self-determination, through limited employment options. This clustering explains why a single intervention, such as a clinic referral, often fails.

Synthesis: My Position

Together, these theories support a position I hold more firmly than when I began this course: the weeks after release from incarceration are a period of predictable, structurally produced danger, and a just health system must treat preventing death in that period as its own responsibility, not as an individual's burden.

Rawls provides the standard: arrangements must be justified to the least advantaged, and from behind the veil of ignorance no one would accept the current transition. Farmer provides the diagnosis: the danger is produced by structures, including treatment interruption and coverage gaps, not by personal failure. Powers and Faden provide the scope and the priority: because disadvantage clusters across dimensions, the response must address several at once, and because the pattern is systematic, it deserves urgent priority.

For nursing practice, this means continuing addiction treatment through release, ensuring naloxone and coverage at the jail door, and connecting people to clinics designed for their needs. Evidence suggests such efforts matter: a primary care program tailored for people recently released from prison, with a community health worker, reduced emergency department visits compared with expedited primary care alone (Wang et al., 2012).

Conclusion

Each theory alone is incomplete. Rawls gives a standard without structures, Farmer gives structures without a standard, and Powers and Faden give the dimensions and priorities that connect them. Combined, they tell me that what I see in the emergency department is an injustice with identifiable causes, and that nurses with advanced preparation have both the knowledge and the obligation to act on it.

References

Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison: A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157-165. https://doi.org/10.1056/NEJMsa064115

Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449. https://doi.org/10.1371/journal.pmed.0030449

Powers, M., & Faden, R. (2006). Social justice: The moral foundations of public health and health policy. Oxford University Press.

Rawls, J. (1971). A theory of justice. Harvard University Press.

Wang, E. A., Hong, C. S., Shavit, S., Sanders, R., Kessell, E., & Kushel, M. B. (2012). Engaging individuals recently released from prison into primary care: A randomized trial. American Journal of Public Health, 102(9), e22-e29. https://doi.org/10.2105/AJPH.2012.300894