Towards justice: Applying Rawlsian fairness to health professions education

Health professions education (HPE) continues to confront persistent inequities in access, opportunity and outcomes, even as diversity, equity and inclusion (DEI) initiatives have become increasingly contested within institutional and public discourse. Although DEI efforts draw upon a long intellectual tradition in the social sciences, DEI research within HPE remains undertheorized, in part because the field is often siloed from broader philosophical debates about justice and fairness. While these concepts are widely valued, they are interpreted and applied differently across cultural, political and institutional contexts, contributing to misunderstanding and resistance when DEI-oriented reforms lack explicit normative grounding. Revisiting the theories that underlie DEI work is therefore important for clarifying why inequities matter in HPE and how institutions justify efforts to address them.

We highlight prioritarian moral reasoning as a foundational, though often implicit, commitment underlying DEI work in HPE. Prioritarianism holds that improving the position of those who are worse off carries special moral importance, particularly when disadvantage arises from structural conditions rather than individual choice. Within this framework, John Rawls's theory of 'justice as fairness' offers a lens for examining DEI in HPE institutions. Rather than presenting Rawls as a comprehensive or universally accepted theory, this paper situates his work alongside broader intellectual traditions that inform DEI and emphasizes its relevance for examining how educational opportunities are organized and justified.

Drawing on Rawls's emphasis on fair opportunity and attention to those least advantaged, the paper highlights how justice as fairness can be used pragmatically in admissions, curriculum, assessment and resource allocation. In particular, it invites HPE to ask whether the changes being implemented are acceptable under conditions of fair opportunity and whether they would improve the position of the least advantaged. Used this way, Rawls's ideas support efforts to identify structural barriers and design policies that expand meaningful opportunity.