Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to (...) evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity. (shrink)

BackgroundDignity is a central human value supported by nurses’ professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing’ roles, but little is known about dignity among public health nurses and primary care settings.PurposeThis study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland.Research designAn inductive qualitative descriptive approach (...) with semi-structured focus group interviews was utilised.Participants and research contextTwenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings.Ethical considerationsBefore data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews.FindingsBased on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users’ trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors.Discussion and conclusionProfessional dignity is simultaneously an essential prerequisite and an outcome of public health nurses’ work. In future, more information would be needed to implement strategies in primary health care to foster nurses’ professional dignity also in international public health arenas. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

We argue that an unqualified use of the term solidarity in public health is not only equivocal but problematic toward the ends of public health. The term may be deployed normatively by public health advocates to strengthen the bonds among public health practitioners and refer to an ideal society in which the importance of interdependence among members ought to be acknowledged throughout the polity. We propose an important distinction between partisan solidarity and societal solidarity. Because any moralized belief in a (...) vision of a broad societal solidarity will be a contested political ideal, political reality would limit solidarity based on such a vision to partisan solidarity. An idealized vision of societal solidarity is simply not politically feasible in pluralistic, liberal, democratic societies. However, although societal solidarity is unlikely with respect to any particular policy, it might be hoped for with respect to constitutional procedures that provide boundaries for the agon of the political process. We suggest that moralizing assertions of a solidaristic ideal in a pluralistic society might be counterproductive to generating the political support necessary for public health per se and establishing legitimate public health policy. A pragmatic political approach would be for public health advocates to generate sufficient strong political support for those public health policies that are most amenable to the political and social realities of a time and place. (shrink)

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the (...) workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions. (shrink)

The idea of solidarity is in vogue, especially since the eruption of the COVID-19 pandemic. However, the term “solidarity,” as used in nursing, is imprecise and vague, lacking clear definition and connoting a variety of general meanings. Based on the original meaning of “solidarity” in ancient Roman law, this article captures the archetypical idea of solidarity from a historical and interdisciplinary perspective. This archetypical or primary meaning comes before the development of any other meanings of the word, and it is (...) therefore authentic and genuine because it does not derive from something else. After establishing the archetypical meaning of solidarity, the article translates this meaning into the area of nursing and demonstrates a deep connectivity between healthcare and solidarity. The second part of the article offers and develops a new definition of nursing solidarity as the responsibility for the healthcare of a person shared as a whole by that person and a nurse or a nursing team. This new definition has some implications for nursing practice and education, since the definition emphasizes the idea that solidarity helps to foster respect and avoid discrimination, promote cohesion in health communities, increase individual responsibility and a spirit of service, stimulate motivation, improve communication, create an engaging workplace, and develop leadership. (shrink)

At a time when ethical and political philosophy were thought passé, John Rawls gave serious attention to ethical questions, providing them with a renewed academic legitimacy. This helped fields of practical ethics such as bioethics become established in higher education and in public affairs. This essay addresses the influence Rawls has had on bioethics through both the style and the substance of his ethical argumentation. The essay argues that his distinctive rhetorical strategy and tone attempted to rein in the scope (...) of normative commitments in order to make an equilibrium between refined understandings of freedom and equality possible and sustainable. Bioethics has been strongly influenced by this approach to maintaining social stability in a liberal society that has become highly stratified and culturally diverse. Bioethics continues to echo the Rawlsian call for a calmly reasoned political life but finds that call increasingly difficult to answer. (shrink)

COVID-19 deeply affects many spheres of life. Lockdown measures implemented worldwide have accentuated mental wellbeing changes in the population from the perspectives of space and social relations. These changes leave lasting imprints on individuals and communities. This article draws upon solidarity and care ethics in exploring their role in rebuilding mental wellbeing in the light of constraints arising from lockdown. The diversity of responses to physical and social isolation during the pandemic illuminates the distinctly relational nature of human beings, offering (...) the opportunity for care and solidarity to respond to mental wellbeing challenges in an inclusive and context-sensitive way. (shrink)