Solidarity is presumed to underpin the redistributive health and welfare systems in modern democracies; however, it is often considered a Western—or more specifically, European—concept. While health and welfare systems have been transplanted successfully to many non-Western developed countries, whether the solidarity necessary for such systems exists or is intellectually available remains under debate. Using an East Asian country with the Confucian tradition as an illustrative case, I first argue that the Confucian tradition has special theoretical and sociological importance for health (...) and welfare solidarity. Then, through investigating the classic Confucian writings, I propose transformed interpretations of the essential concepts of Confucian thought, namely filial piety, benevolent governance and the mandate of heaven. With these interpretations, the differentiated family-based solidarity and the people-rooted thought in Confucianism could be reimagined to fit with the modern liberal-democratic political regime and welfare arrangements. I call this model Confucian welfarism, which I argue could form the intellectual origins of solidarity for people who believe in or have an affinity to Confucian ethos. (shrink)

Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the notion of sustainability by reviewing the discourses in the representative reports and literature from different periods. Three sets of ideas are proposed: inter- and intra-generational equity, stability of public systems, and a sense of solidarity, which confirms the scope of community and functions as a precondition for the previous two ideas. This essay uses the case of a health (...) system in a hypothetical country to illustrate that, besides securing financial sustainability, a genuinely sustainable public system must also meet the three normative ideas of sustainability. This essay also finds that these three ideas may create intrinsic tensions within the prevalent policy-making model—democracy. The pursuit of sustainability is not only the responsibility of a democratic government, but also a shared moral obligation of the body politic. (shrink)

Under the influence of concerns about sustainability, health system reforms have targeted institutional designs and have overlooked the role of socio-political factors like solidarity—a concept that is generally assumed to underpin the redistributive health system. The purpose of this research is to investigate users’ perceptions of the National Health Insurance as a system, their senses of solidarity and their views on the sustainability of the system in Taiwan. Using the descriptive ethics approach, qualitative in-depth interviews were conducted with typical case (...) sampling of 17 participants in the Taipei Metropolitan. The framework approach was used to analyze the interview transcripts. The research finds that despite great differences between users’ perceptions of the NHI, most users could share a notion of mutual relationship among each other. Three types of reasons are used to justify the obligations of mutual aid imposed by the NHI. These reasons are embedded within divergent conceptions of solidarity. The research also finds that government’s performance, the stability of decision-making and users’ personal experiences engaging with the system are important conditions for the users’ supportive attitude toward the system. Solidarity is a plausible concept in sustaining a non-Western social health insurance such as Taiwan’s NHI. (shrink)

The workers’ compensation system in Taiwan cannot provide sufficient coverage for all workers. This essay adopts a solidaristic approach to address this issue by analyzing the reasons why workers’ compensation is underdeveloped in Taiwan and what could be done to persuade more key actors to support the reform for a more just policy arrangement. First, through comparison with the healthcare system, it is argued that the lack of solidarity and the perception of relevant similarities could explain the underdevelopment of workers’ (...) compensation. Second, the essay turns to the normative aspect of the issue. Compared with other normative political theories, Iris M. Young’s social connection model provides specific normative guidance that is useful for justifying the allocation of responsibility for a more just workers’ compensation reform. (shrink)

The article discusses the impact different concepts of solidarity can have on debates on models of consent for non-interventional research. It introduces three concepts of solidarity that have been referenced in bioethical debates: a purely descriptive concept, a concept that claims some derivative value for most but not all practices of solidarity, as well as a clearly normative concept where solidarity is tied to justice and taken to ground moral duties. It shows that regarding the rivalling models of study-specific consent, (...) tiered consent and broad consent, the first two concepts can be taken to favour tiered consent while only normative solidarity supports a model of broad consent—or an argument to allow non-interventional research without requiring consent at all. As normative solidarity is tied to considerations of justice, however, the argument appears less straightforward than one might expect: It presupposes that the research contributes to overcoming existing social injustices. (shrink)

The role and importance of solidarity for effective health provision is the subject of lengthy and heated debate which has been thrown into even sharper relief by the COVID-19 pandemic. In various ways, and by various authorities we have all been asked, even instructed, to engage in solidarity with one another in order to collectively respond to the current crisis. Under normal circumstances, individuals can engage in solidarity with their compatriots in the context of public health provision in a number (...) of ways, including paying taxes which fund welfare state initiatives, and avoiding others when ill. While there has been significant engagement in solidarity worldwide, there have also been high profile examples of refusals and failures to engage in solidarity, both by individual agents, and governments. In this paper I examine the consequence of these failures with reference to the actions of the current British government, which has failed to deliver an effective response to the crisis. This failure has effectively devolved responsibility for responding to the crisis to people who are simultaneously more vulnerable to infection, and less able to do anything about it. I argue that such responses represent mismanagement of a public health crisis, and a rejection of important democratic and egalitarian norms and values. (shrink)

Current and past pandemics have several aspects in common. It is expected that all members of society contribute to beat it. But it is also clear that the risks associated with the pandemic are different for different groups. This makes that appeals to solidarity based on technocratic risk calculations are only partially successful. Objective ‘risks of transmission’ may, for example, be trumped by risks of letting down people in need of help or by missing out certain opportunities in life. In (...) this paper we argue that a rapprochement of the insights of standpoint epistemology with pandemic science and pandemic policy making may be an important step toward making pandemic science more accurate and pandemic calls for solidarity more effective. (shrink)

BackgroundA key ethical question in genomics research relates to whether individual genetic research results should be disclosed to research participants and if so, which results are to be disclosed, by whom and when. Whilst this issue has received only scarce attention in African bioethics discourse, the extension of genomics research to the African continent has brought it into sharp focus.MethodsIn this qualitative study, we examined the views of adolescents, parents and caregivers participating in a paediatric and adolescent HIV-TB genomic study (...) in Botswana on how solidarity and reciprocity obligations could guide decisions about feedback of individual genetic research results. Data were collected using deliberative focus group discussions and in-depth interviews.ResultsFindings from 93 participants demonstrated the importance of considering solidarity and reciprocity obligations in decisions about the return of individual genetic research results to participants. Participants viewed research participation as a mutual relationship and expressed that return of research results would be one way in which research participation could be reciprocated. They noted that when reciprocity obligations are respected, participants feel valued and not respecting reciprocity expectations could undermine participant trust and participation in future studies.ConclusionsWe conclude that expectations of solidarity and reciprocity could translate into an obligation to feedback selected individual genetic research results in African genomics research. (shrink)

This article provides a concise overview of the history of scholarship on solidarity in Europe and North America. While recent decades have seen an increase in conceptual and scholarly interest in solidarity in North America and other parts of the Anglo-Saxon world, the concept is much more strongly anchored in Europe. Continental European politics in particular have given rise to two of the most influential traditions of solidarity, namely, socialism and Christian ethics. Solidarity has also guided important public instruments and (...) institutions in Europe. Despite the much stronger affinity of continental European societies to solidaristic thinking, we argue that solidarity has much to offer for addressing societal challenges on both sides of the Atlantic and beyond. After proposing a working definition of solidarity that highlights its utility for guiding policy and practice, we give an example of how a solidarity-based perspective can shape instruments for the governance of data use. (shrink)

Prominent tuberculosis (TB) actors are invoking solidarity to motivate and justify collective action to address TB, including through intensified development and implementation (D&I) of technologies such as drugs and diagnostics. We characterize the ethical challenges associated with D&I of new TB technologies by drawing on stakeholder perspectives from 23 key informant interviews and we articulate the ethical implications of solidarity for TB technology D&I. The fundamental ethical issue facing TB technological D&I is a failure within and beyond the TB community (...) to stand in solidarity with persons with TB in addressing the complex sociopolitical contexts of technological D&I. The failure in solidarity relates to two further ethical challenges raised by respondents: skewed power dynamics that hinder D&I and uncertainties around weighing risks and benefits associated with new technologies. Respondents identified advocacy and participatory research practices as necessary to address such challenges and to motivate sustained collective action to accelerate toward TB elimination. We present the first empirical examination of bioethical accounts of solidarity in public and global health. Our study suggests that solidarity allows us better to understand and address the ethical challenges that arrest the D&I of new TB technologies. Solidarity lends credence to policies and practices that address the relational nature of illness and health through collective action. (shrink)

While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs’ ability to respond to the pandemic. We consider pre-existing disease burden and baseline susceptibility, limited disease prevention resources, and unequal access to basic and specialized health care, essential drugs, and clinical trials. Recognizing that ongoing and underlying (...) disparity issues will require long-term correction efforts, this pathway approach is nonetheless helpful to inform ethical responses to this global pandemic. It can facilitate international cooperation during the pandemic to reduce the disparate burdens among different regions without imposing significant burden on any particular contributor. The pathway approach allows international stakeholders in various social positions to respond to different components of the pathway based on their respective strengths and resources to help break the cycle of global health inequity. Guided by the ethical principles of relational and pragmatic solidarity, we argue for a coordinated global division of labor such that different stakeholders can collaborate to foster equitable healthcare access during this pandemic. (shrink)

Debates about effective responses to the COVID-19 pandemic have emphasized the paramount importance of digital tracing technology in suppressing the disease. So far, discussions about the ethics of this technology have focused on privacy concerns, efficacy, and uptake. However, important issues regarding power imbalances and vulnerability also warrant attention. As demonstrated in other forms of digital surveillance, vulnerable subpopulations pay a higher price for surveillance measures. There is reason to worry that some types of COVID-19 technology might lead to the (...) employment of disproportionate profiling, policing, and criminalization of marginalized groups. It is, thus, of crucial importance to interrogate vulnerability in COVID-19 apps and ensure that the development, implementation, and data use of this surveillance technology avoids exacerbating vulnerability and the risk of harm to surveilled subpopulations, while maintaining the benefits of data collection across the whole population. This paper outlines the major challenges and a set of values that should be taken into account when implementing disease surveillance technology in the pandemic response. (shrink)

The COVID-19 pandemic is affecting countries across the globe. Only a globally coordinated response, however, will enable the containment of the virus. Responding to a request from policy makers for ethics input for a global resource pledging event as a starting point, this paper outlines normative and procedural principles to inform a coordinated global coronavirus response. Highlighting global connections and specific vulnerabilities from the pandemic, and proposing standards for reasonable and accountable decision-making, the ambition of the paper is two-fold: to (...) raise awareness for the justice dimensions in the global response, and to argue for moving health from the periphery to the centre of philosophical debates about social and global justice. (shrink)

A recent trend in bioethics has highlighted the decisive role that solidarity plays in global health. However, given the impact and extent of the effects of climate change, which reach beyond present generations, it is important to consider whether this concept can be applied intergenerationally. Does it make sense to talk about solidarity with future generations? The objective of this article is to explore ‘amplified solidarity’, a new concept of solidarity that explains our obligations towards the health and quality of (...) life of future generations. The analysis of this concept is structured as follows: I first establish the moral relevance of future people and then investigate the traits of amplified solidarity, its challenges, and its relationship with other key principles. I propose that amplified solidarity needs both a critical imagination to be projected towards the future and an institutional framework to correct health injustices across an intergenerational timescale. Solidarity forms a potent triangular constellation with responsibility and justice to fight against global and intergenerational injustices. (shrink)

Antimicrobial resistance (AMR) in bacterial infections is a growing threat to humanity and a challenge to healthcare systems worldwide. Healthcare professionals have an important role in preventing AMR and the spreading of infections. This article focuses on trade union financed journals for nurses in Scandinavia studying how the journals articulate AMR to its readership. A systematic literature search over an eleven‐year period was conducted, using web‐based national trade union financed journals, searching for ‘bacteria’ and ‘resistance’. A thematic analysis, inspired by (...) Foucault's concepts of power and governmentality, was made of 131 texts to understand, which kind of practices, strategies and policies the journals frame regarding AMR. The time period studied resulted in the recognition of four separate themes: the horror scenario, the ‘dangerous’ other, healthcare professionals as a source of resistance development and AMR as a field of research and producer of research qualifications. The study concludes that the journals tend: to present AMR in apocalyptic terms with more research and pharmaceutical industries needed for avoidance; to point out problems in other countries, populations, and sometimes nurses’ working conditions, but primarily with other professionals’ behaviour; and lastly, to present the nurse as a good fairy and disciplinator of doctors. (shrink)

COVID 19 has highlighted with lethal force the need to re-imagine and re-design the provisioning of human resources for health, starting from the reality of our radical interdependence and concern for global health and justice. Starting from the structured health injustice suffered by migrant workers during the pandemic and its impact on the health of others in both destination and source countries, I argue here for re-structuring the system for educating and distributing care workers around what I call a global (...) ecological ethic. Rather than rely on a system that privileges nationalism, that is unjust, and that sustains and even worsens injustice, including health injustice, and that has profound consequences for global health, a global ecological ethic would have us see health as interdependent and aim at “ethical place-making” across health ecosystems to enable people everywhere to have the capability to be healthy. (shrink)

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

It is often argued that cosmopolitanism faces unique motivational constraints, asking more of individuals than they are able to give. This ‘motivational problem’ is held to pose a significant challenge to cosmopolitanism, as it appears unable to transform its moral demands into motivated political action. This article develops a novel response to the motivational problem facing cosmopolitanism, arguing that self-interest, alongside appeals to sentiment, can play a vital and neglected, transitional role in moving towards an expanded cosmopolitical condition. The article (...) explicates the ‘motivational problem’, analyses the relationship between self-interest and sentimental cosmopolitanism in addressing it, and develops a series of claims that self-interest can be one important component in what we label as ‘transitional cosmopolitanism’. In doing so, we argue that self-interested motivations can be compatible with sentiment-based approaches, rendering them more plausible. In addition, two expected critiques of self-interested ‘transitional cosmopolitanism’ are tackled: (A) That it cannot address feasibility constraints, and (B) That self-interested motivations cannot meet what an ‘authentic’ cosmopolitanism entails. We refute and challenge these critiques and outline three conditions in which self-interest can advance a transitional form of cosmopolitanism, while also being compatible with cosmopolitanism writ large. (shrink)

Are countries especially entitled, if not obliged, to prioritize the interests or well-being of their own citizens during a global crisis, such as a global pandemic? We call this partiality for compatriots in times of crisis “crisis nationalism”. Vaccine nationalism is one vivid example of crisis nationalism during the COVID-19 pandemic; so is the case of the US government’s purchasing a 3-month supply of the global stock of the antiviral Remdesivir for domestic use. Is crisis nationalism justifiable at all, and, (...) if it is, what are its limits? We examine some plausible arguments for national partiality, and conclude that these arguments support crisis nationalism only within strict limits. The different arguments for partiality, as we will note, arrive at these limits for different reasons. But more generally, so we argue, any defensible crisis nationalism must not entail the violation of human rights or the worsening of people’s deprivation. Moreover, we propose that good faith crisis nationalism ought to be sensitive to the potential moral costs of national partiality during a global crisis and must take extra care to control or offset these costs. Thus, crisis nationalism in the form of vaccine nationalism or the hoarding of global supplies of therapeutics during a global pandemic exceeds the bounds of acceptable partiality. (shrink)