Since 1986, universal access to the National Health Service (NHS) is considered a human right in Spain. Informed by the principle of distributive justice (Boutain 2012), the objective of the NHS is to ensure equal access to health care resources for all citizens and residents. The NHS is one of the most important elements of the Spanish welfare state; however, this model has limitations in protecting the most vulnerable of the population due to structural factors of social inequality (gender, social class, and ethnicity, among others) (Mackenbach 2012) and the organization of the health system (e.g., people with a history of alcoholism have difficulty accessing a liver transplant). The current Spanish government has adopted a powerful neoliberal discourse of austerity with respect to public services as the unique solution to the current economic crisis. This policy has increased the difficulty in accessing the NHS at all levels of the population, with the greatest impact on the most disadvantaged sectors of society (elderly, unemployed, poor, illegal immigrants, etc.) (Bover et al. 2011). The aforementioned rapid and mandated changes are producing enormous moral tensions among Spanish health care professionals. A case such as Mr. Jones as presented by Nivens and Buelow (2013) was inconceivable in Spain a few months ago. The Spanish health system is undergoing a sudden transition from an imperfect model of distributive justice to a model of market justice in which health is considered an economic good regulated by market rules (Boutain 2012). Since then, health professionals have reacted to this new moral problem with diverse, but usual attitudes (Davis, Tschudin, and de Raeve 2006; Guerra 2008). Some of them show moral blindness since they do not recognize the problem; others show moral complacency explained by their inability to change the situation. Finally, some professionals show moral distress when they perceive a clash between their professional values and the values of the institutional/political system. LikeMr. Jones’ nurse, Spanish nurses have had limited success when trying to cope with these unjust situations. Even the most committed and sensitive professionals barely attain an ethical minimum when working within this new reality. The deterioration of Mr. Jones’ health is not only unjust Bioethical Inquiry (2013) 10:421–422 DOI 10.1007/s11673-013-9459-2
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