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Standardisation is intended to promote quality, efficiency and equality in healthcare, yet it may unintentionally produce structural inequality for people with disabilities. This essay draws on social justice theory and disability studies to analyse how organisational logics shape conditions of participation and influence nursing’s ability to realise its ethical obligations. We distinguish between impairment as a functional variation and disability as a restriction on participation, with both outcomes arising from the point where individual and
environmental barriers meet. Through this perspective, we show how standardised patient pathways, time structures, and communication formats can reproduce ableist norms and limit equitable access for people with cognitive, psychosocial, or communication-related impairments. Reducing inequality requires organisational flexibility, specialised relational knowledge, and the active involvement of people with disabilities as co-creators. Equality is not uniformity; it is differentiated participation.