Justice and health care in the rheumatic diseases.

Coping with a chronic disease is a formidable challenge. Owing to the disabling consequences of their underlying conditions, individuals who suffer with a chronic rheumatic disease have especially daunting lives with their existence often dominated by their health-related needs. Due to the high prevalence, the demographic distribution, indeed the very nature of the rheumatic diseases, too many sufferers of these conditions in our society remain disenfranchised with respect to their access to health care. Those who come from already disadvantaged socioeconomic circumstances face particularly difficult challenges. Rheumatologists and their allied health professionals, therefore, have a moral obligation to ensure greater fairness to their patients--those already compromised by the natural lottery that gave them their disease. To enhance the appreciation of this problem and to motivate the rheumatic disease community, we attempt to identify those variables that create the need for and imperil access to medical care for the rheumatic diseases. The implications of these observations are then explored from the ethical perspective of justice. We conclude with suggestions as to how to change the health care system to address these problems.