| Course | PAC 415 Healthcare Ethics |
|---|---|
| Module | Module 4 |
| Paper type | Justice analysis |
| Length | About 1,006 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | September 2026 |
Free sample paper for PAC 415 Module 4
Who Gets Treatment? Justice and Access to Medications for Opioid Use Disorder in a Rural County
Student Name
Psychology and Addiction Studies Program, Aspen University
PAC 415: Healthcare Ethics
Instructor Name
Month Day, Year
Who Gets Treatment? Justice and Access to Medications for Opioid Use Disorder in a Rural County
Cedar Hollow Health's rural satellite clinic serves a county of 22,000 residents where one clinician prescribes buprenorphine for opioid use disorder. The clinic has a waiting list of 31 people, the nearest methadone program is 70 miles away, and the county's overdose death rate has risen for three years. The clinic's staff must decide how to allocate scarce treatment slots, and its leaders must decide what to ask of the health system and the state. This paper examines these decisions through the principle of justice, drawing on evidence about who receives treatment and who does not.
What Justice Asks
Justice in health care asks how benefits and burdens are shared out, and whether the sharing is fair. Beauchamp and Childress (2019) describe several theories that shape how fairness is understood: utilitarian theories that aim to maximize overall benefit, egalitarian theories that emphasize equal access, and theories that give priority to the worst off. Each suggests different answers to allocation questions, and practical wisdom must weigh them in the circumstances at hand. At a minimum, justice requires that access not depend on characteristics irrelevant to need, such as race or the ability to pay.
Evidence of Disparities
Access to buprenorphine has not been evenly distributed. Lagisetty et al. (2019) documented a divide in buprenorphine treatment by race and ethnicity and by payment, with treatment concentrated among white patients and those paying privately or out of pocket, while racial and ethnic minority patients and people with lower incomes were less likely to receive it. Geography adds another barrier: Andrilla et al. (2019) found that although the number of clinicians eligible to prescribe buprenorphine had grown, rural counties were still more likely than urban ones to have no such prescriber. Congress removed the federal waiver requirement in 2023, but in many rural areas prescribers remain scarce.
Barriers and Fair Responses
The table lists barriers in the county and responses that would make access fairer.
| Barrier | Who is most affected | Fairer response |
|---|---|---|
| One prescriber, long waiting list | Everyone, especially people without transportation | Train more prescribers; telehealth starts |
| 70 miles to methadone | People who need methadone | Advocate for a medication unit or mobile program |
| Cash-only practices nearby | Uninsured and low-income people | Accept Medicaid; sliding-scale fees |
| Stigma in the community | People who fear being seen at the clinic | Integrate treatment into primary care visits |
| Pharmacy stocking limits | People whose prescriptions go unfilled | Work with local pharmacies on supply |
Allocating Scarce Slots
Until capacity grows, the clinic must decide who comes off the waiting list first. A first-come, first-served list is simple and seems fair, but it ignores differences in risk. The clinic's staff agreed to prioritize people at highest risk of death, such as those recently treated for an overdose, pregnant people and people leaving jail or residential treatment, whose overdose risk is especially high, while offering everyone on the list naloxone, a bridge appointment by telehealth and regular contact. The criteria are written, applied consistently and reviewed monthly, so that allocation is transparent and not influenced by who calls most often or who is known to staff.
Guarding Against Bias
Allocation criteria can reproduce the disparities they are meant to reduce if they are applied unevenly. The clinic will review who is admitted from the waiting list by race, ethnicity, insurance and distance from the clinic every quarter, and will adjust outreach if some groups are consistently waiting longer. It will also track who drops off the list without being reached, since people with unstable phones or housing are easily lost.
What the Clinic Can Do
Beyond allocation, the clinic can expand capacity. Primary care clinicians can be trained to start and maintain buprenorphine, especially now that no special federal waiver is required. Telehealth can start treatment for people far from the clinic within federal and state rules. Partnerships with the jail and the regional hospital can start treatment at the points where overdose risk peaks. Each step reduces the need to ration.
What a Counselor Can Do
Counselors do not prescribe, but they shape access. They can make sure clients understand their options, help them complete paperwork and insurance applications, connect them to transportation, advocate within the clinic for fair allocation and speak up when they see patterns of unequal treatment. Justice also shapes how counselors treat each client: with the same respect and effort regardless of background.
Advocacy
Some barriers can only be removed by policy: Medicaid coverage and payment rates, the rules for methadone programs, funding for rural treatment and transportation. Clinicians and counselors have credibility when they describe what their patients face. The clinic will share its waiting list data, without identifying anyone, with county and state officials as evidence for expanding treatment.
Justice for People Leaving Jail
The weeks after release from jail carry an especially high risk of fatal overdose, because tolerance falls during incarceration. Starting or continuing medication before release and arranging the first community appointment in advance are among the most effective ways to reduce that risk. The clinic will work with the county jail so that people with opioid use disorder leave with medication and an appointment, which also addresses the justice concern that incarcerated people are among those least likely to receive treatment.
Fairness also applies inside the clinic. Appointment times that suit only people with daytime flexibility, intake forms that assume literacy in English, and rules that discharge people for missed visits all fall hardest on those with the fewest resources, and the clinic reviewed each of them.
Conclusion
Justice asks who receives treatment and why. In a rural county with one prescriber, evidence of racial, economic and geographic disparities in buprenorphine access becomes a local reality. Fair allocation of scarce slots, based on risk and applied transparently with checks for bias, is a necessary short-term response. Expanding capacity and advocating for policy change are the long-term ones. Practical wisdom in this setting means acting fairly within real constraints while working to change them.
References
Andrilla, C. H. A., Moore, T. E., Patterson, D. G., & Larson, E. H. (2019). Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: A 5-year update. The Journal of Rural Health, 35(1), 108-112. https://doi.org/10.1111/jrh.12307
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Lagisetty, P. A., Ross, R., Bohnert, A., Clay, M., & Maust, D. T. (2019). Buprenorphine treatment divide by race/ethnicity and payment. JAMA Psychiatry, 76(9), 979-981. https://doi.org/10.1001/jamapsychiatry.2019.0876
PAC 415 Module 4 instructions, in plain terms
Aspen's PAC 415 names justice among the core concerns of medical ethics, and this module generally asks students to apply it to access to addiction treatment. As the fourth module's prompt is shared with the class only, this example analyzes access in one rural county. Explain what justice asks, including more than one theory of fairness. Use evidence of who receives treatment and who does not. Identify the specific barriers in your setting and who they affect most. Address allocation when resources are scarce, with criteria that are transparent and checked for bias. Distinguish what can be done now within constraints from what requires changing them. Include the roles of both the organization and the individual professional.
How the PAC 415 Module 4 example is put together
The paper opens with the county's numbers. It explains utilitarian, egalitarian and priority-to-the-worst-off views of justice. The evidence section draws on a JAMA Psychiatry study of buprenorphine treatment by race and payment and a Journal of Rural Health study of prescriber availability by county type, noting that the federal waiver was removed in 2023. A three-column table pairs five barriers, from a single prescriber to pharmacy stocking limits, with fairer responses. The allocation section sets risk-based criteria with naloxone and telehealth bridges for everyone waiting, and a quarterly review of who is admitted. Sections on expanding capacity, jail release, clinic practices, the counselor's role and advocacy with county officials close the paper.
PAC 415 Module 4 rubric: what earns full marks
Instructors assessing a justice paper look for sound theory, evidence on who is left out, allocation that is both fair and workable, and a realistic sense of what can change and how fast. This example applies several theories of justice rather than assuming one. It cites Beauchamp and Childress on justice, the JAMA Psychiatry study of racial and payment disparities in buprenorphine treatment and the Journal of Rural Health analysis of prescriber availability. The allocation criteria are written, risk-based and checked for bias, which answers the question instructors ask first about rationing. Separating short-term fairness within constraints from long-term work to change them shows the judgment a practical wisdom course looks for.
PAC 415 Module 4 help from the desk
A frequent weakness is discussing justice in general terms without data on who is left out. Find evidence on disparities in your area of practice. Another is proposing allocation rules without saying how bias will be checked. Make criteria explicit and describe a review. Consider everyday practices, such as appointment times and discharge rules, that affect fairness quietly. Include advocacy, since some barriers are policy problems. Be careful with statistics; report what studies found without exaggerating. Remember that justice also concerns how each client is treated in person. Theories of justice become clearer when you test each against your own case; a tutor can work through that comparison with you before you commit to a position.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More PAC 415 and Psychology and Addiction Studies sample papers
- PAC 415 Module 1: Practical Wisdom in Ethics
- PAC 415 Module 2: Autonomy and Capacity
- PAC 415 Module 3: Beneficence and Client Goals
- PAC 415 Module 5: Confidentiality and Its Limits
- PAC 415 Module 6: Harm Reduction Ethics
- PAC 415 Module 7: A Complex Case, Several Principles
- PAC 415 Module 8: Reflection on Practical Wisdom
- PAC 115 Module 1: Roots, Prefixes and Suffixes
- PAC 310 Module 4: Court Involvement and Legal Requests
PAC 415 Module 4 questions, answered
What does PAC 415 Module 4 usually ask for?
Aspen's PAC 415 examines justice among the core concerns of medical ethics in addiction contexts, so a paper on justice and access to treatment is a typical fourth assignment. Follow your classroom prompt.
Are there disparities in access to buprenorphine?
Yes. Research has documented buprenorphine treatment concentrated among white patients and those paying privately, and rural counties more often lacking a prescriber.
How should a clinic allocate scarce treatment slots fairly?
With written criteria based on need and risk, applied consistently, reviewed for bias, and combined with interim support such as naloxone and regular contact for everyone waiting.
Where can I find a free PAC 415 Module 4 sample paper?
The complete paper appears above, with evidence on disparities in buprenorphine access and a table pairing five local barriers with fairer responses.
What theories of justice apply to health care?
Utilitarian views that maximize overall benefit, egalitarian views that emphasize equal access and views that give priority to the worst off each suggest different ways to share scarce resources.