The Gap Between the Norm and Patient Care: Challenges to the Bioethical Principle of Justice in Ecuador

Abstract

Introduction: The allocation of critical healthcare resources represents one of the most complex dilemmas in contemporary bioethics, particularly in contexts marked by structural limitations such as Ecuador. The bioethical principle of justice plays a central role in guiding clinical decisions related to the equitable distribution of scarce resources, including intensive care unit (ICU) beds, from ethical, legal, and deontological perspectives. Objective: To analyze the application of the bioethical principle of justice in the allocation of critical healthcare resources through the examination of a clinical case, integrating a hermeneutic, ethical, and legal approach within the Ecuadorian context. Materials and Methods: An argumentative hermeneutic essay was developed using a qualitative and reflective approach, structured according to the hermeneutic cycle in three phases: (1) pre-understanding, focused on the ethical dilemma “Ethical decision-making in ICU allocation for critically ill patients”; (2) micro-hermeneutic analysis of the case components; and (3) macro-hermeneutic argumentation aimed at achieving a comprehensive understanding of the phenomenon and its ethical and legal foundations. Results: The analysis demonstrated that the application of the principle of justice requires distribution criteria grounded in equity, proportionality, and non-discrimination, moving beyond purely utilitarian or administrative approaches. It also highlighted the need to integrate deontological principles and national regulatory frameworks to strengthen clinical decision-making in situations of resource scarcity. Conclusions: The bioethical principle of justice constitutes a fundamental ethical pillar that compels healthcare systems to ensure equitable resource distribution, guaranteeing access to care with respect, equality, and human dignity, regardless of age, gender, or clinical condition. Its proper application requires solid ethical training and clear normative criteria to guide responsible decision-making in critical contexts.