In the context of principle-based ethics, justice refers to “the moral obligation to act on the basis of fair adjudication between competing claims”
(Gillon 1994, 3). As proposed by Gillon, fair adjudication in health care settings implies distributive justice (i.e., fairly distribute scarce resources); rights-based justice (i.e., the respect for people’s rights); and legal justice (i.e., respecting laws that are morally acceptable). Such an approach to justice overcomes the common pitfall of equating justice with equality, which ignores the fact that people can still be treated unjustly even when treated equally (McKeon 1941). In the context of health care, justice is the source of heated political debates, and when applied to rehabilitation robotics, it raises important concerns.
Given the high cost of robotic technologies and the recent emergence of several of its applications in the field of rehabilitation, it is reasonable to expect that access to several of the devices discussed in this book is limited to developed countries (and health care systems that can afford such innovations). Even within such systems, it is reasonable to expect that some users may be able to benefit from the implementation of these technologies, while others may have to wait, sometimes for a certain period of time (if the robot is in the process of development and access was given only to research participants) or perhaps indefinitely (if social insurance systems do not cover such interventions as part of the standard of care). The dynamics created by this distribution of resources challenges practitioners and developers to design low-cost options that can ensure broader access (e.g., the Compact Rehabilitation Robot [CR2]; Khor et al. 2014). Lego robots (described in Chapter 7) for children with disabilities represent an alternative to more expensive robots, and while still unaffordable in some regions and for some populations, they provide one possible avenue in thinking broadly about justice in the context of rehabilitation robotics.