Solidarity within a group facing adversity exemplifies certain human goods, some instrumental to the goal of mitigating the adversity, some non-instrumental, such as trust, loyalty, and mutual concern. Group identity, shared experience, and shared political commitments are three distinct but often-conflated bases of racial group solidarity. Solidarity groups built around political commitments include members of more than one identity group, even when the political focus is primarily on the justice-related interests of only one identity group (such as African Americans). A (...) solidarity group is more than a mere political coalition or alliance. Two other forms of political- commitment solidarity groups are ones devoted to racial justice more generally, and social justice even more generally. Racially plural political solidarity groups realize values beyond the afore-mentioned solidaristic ones, in meeting the challenges of different races working together. (shrink)

Swedish welfare has for decades served as a role model foruniversalistic welfare. When the economic recession hit Swedish economyin the beginning of the 1990s, a period of more than 50 years ofcontinuous expansion and reforms in the welfare sector came to an end.Summing up the past decade, we can see that the economic downturnenforced rationing measures in most parts of the welfare state, althoughmost of this took place in the beginning of the decade. Today, most ofthe retrenchment has stopped and (...) in some areas we can see tendencies ofrestoration – but more so in financial benefits than in the caringsectors. In the article this process is discussed as a process ofreallocation where general principles of solidarity become manifest.Various levels of decision making are discussed within the context ofsocio-political action. Current transitions in Swedish health care aredescribed with respect to coverage rates, content, marketisation anddistribution. Basic principles of distribution are highlighted in orderto analyse the meaning of social solidarity in a concrete allocativesetting. The significance of popular opinion – it's shifts anddeterminants – is also considered. The article concludes with adiscussion of how the (once salient) features of universalism inwelfare and health care provision have been affected by the developmentsin the past decade in Sweden. (shrink)

Political argument and institutions in the UnitedKingdom have frequently been represented as the products of ablend of nationalistic conservatism, liberal individualism andsocialism, in which consensus has been prized over ideology. This situation changed, as the standard story has it, with therise of Thatcherism in the late 1970s, and again with the arrivalof Tony Blair's ``New Labour'' pragmatism in the late 1990s. Solidarity as an element of political discourse makes itsappearance in the UK late in the day. It has been most (...) stronglylinked to the Third Way debate, as framed most influentially inthe work of Prof. Anthony Giddens.In this paper we review the history and pre-history of the debateon solidarity in the UK, focussing mostly on its implications forwelfare state reform. In particular we discuss the proposals forthe long-term care of the Elderly issued by the Royal Commissionon long-term care in 1999. In this context we critically examinethe idea that solidarity is a new concept in British politicalculture, and that it is a concept which has real political ``bite''in the project of welfare reform. We examine this through aconsideration of Giddens's attempted synthesis of politicalargument and social theory. (shrink)

This article presents various developments in Dutch health care policy toward a greater role for individual financial responsibility, such as cost-control measures, priority setting, rationing, and market reform. Instead of the collective responsibility that is characteristic of previous times, one can observe in government policies an increased emphasis on the need for individuals to take care of one’s own health and health care needs. Moreover, surveys point to decreasing levels of public support for “unlimited” solidarity and “irresponsible” health behavior. This (...) article attempts to answer the question of how these policies and public attitudes are limiting the ethical principles of solidarity and equal access to care that have long guided Dutch health care policy making. The authors argue that from a moral point of view, the increased emphasis on individual responsibility is acceptable as long as it does not affect solidarity with those weak and vulnerable groups who are not able to take individual responsibility, such as the demented and mentally handicapped. (shrink)

The Universal Declaration on Bioethics and Human Rights adopted by the United Nations Educational, Scientific, and Cultural Organisation on 19 October 2005 is an important step in the search for global minimum standards in biomedical research and clinical practice. As a member of UNESCO International Bioethics Committee, I participated in the drafting of this document. Drawing on this experience, the principal features of the Declaration are outlined, before responding to two general charges that have been levelled at UNESCO’s bioethical activities (...) and at this particular document, are outlined. One criticism is to the effect that UNESCO is exceeding its mandate by drafting such bioethical instruments—in particular, the charge is that it is trespassing on a topic that lies in the responsibility of the World Health Organization. The second criticism is that UNESCO’s reliance on international human rights norms is inappropriate. (shrink)

The article deals with the issue of solidarity in health care,with particular reference to the Italian context. It presents thedifficulties of the Italian NHS and assesses the current proposalto counter the crisis of the Welfare State by giving upinstitutional arrangements, in order to favour the so-called`social private'. Moreover, it addresses the question ofprioritisation and targeting in the context of health care,arguing for the insufficiency of the standard approach of neutralliberalism, and showing how the concept of solidarity might helpto develop a (...) different account. Lastly, it discusses the case oforgan transplantion in Italy, as an example ofsolidarity-inspired health care policy. (shrink)

Health care services are constantly assessed by their ability to accommodate values popular in contemporary societies. Autonomy, justice, and human dignity have for some time been among such values in the affluent West. Relative newcomers in the field are the notions of and which seem to attract, in particular, Continental European ethicists. a.

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not (...) clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of ``European'', or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it. (shrink)

We analyse solidarity as a mixture of social justice on the onehand and a set of cultural values and ascriptions on the otherhand. The latter defines the relevant sense of belonging togetherin a society. From a short analysis of the early stages of theDutch welfare state, we conclude that social responsibility wasoriginally based in religious and political associations. In theheyday of the welfare state, institutions such as sick funds,hospitals or nursing homes became financed collectively entirelyand became accessible to people of (...) all denominations. Solidaritywas transformed in a more general category, related to the statusof Dutch citizenship. Responsibility was transformed tocollective responsibility.Financial pressures on the Welfare State have resulted in adebate on choices in health care and in a number of systemreforms, so far relatively small. In the surrounding discourse,justice was linked to private responsibility. Both fromgovernment officials and from participants in the societaldebate, moralistic overtones could be heard concerning the threatof overburdening of the health care system by citizens.In this paper, we develop a concept of reflexive solidarity thatlinks elements of social justice to conceptualisations ofresponsibility that address policy makers and health careinstitutions as well as citizens, in their role of carereceivers. A short analysis of the phenomenon of personal budgetsin care services should prove that our concept of reflexivesolidarity is not empty. Linked to, but beyond the concept ofjustice, issues of social responsibility can be addressed withoutmoralistic overtones. (shrink)

This article explores solidarity as an ethical concept underpinning rules in the global health context. First, it considers the theoretical conceptualisation of the value and some specific duties it supports (ie: its expression in the broadest sense and its derivative action-guiding duties). Second, it considers the manifestation of solidarity in two international regulatory instruments. It concludes that, although solidarity is represented in these instruments, it is often incidental. This fact, their emphasis on other values and their internal weaknesses diminishes the (...) action-guiding impact of the solidarity rules. The global health and human subject research scene needs a completely new instrument specifically directed at means by which solidarity can be achieved, and a reformed infrastructure dedicated to realising that value. (shrink)

Two arguments apparently support the thesis that collective identity presupposes an Other: the recognition argument, according to which seeing myself as a self requires recognition by an other whom I also recognize as a self (Hegel); and the dialogic argument, according to which my sense of self can only develop dialogically (Taylor). But applying these arguments to collective identity involves a compositional fallacy. Two modern ideologies mask the particularist thesis’s falsehood. The ideology of indivisible state sovereignty makes sovereignty as such (...) appear particularistic by fusing “internal” with “external” sovereignty; nationalism imagines national identity as particularistic by linking it to sovereignty. But the concatenation of internal sovereignty, external sovereignty, and nation is contingent. Schmitt’s thesis that “the political” presupposes an other conflates internal and external sovereignty, while Mouffe’s neo-Schmittianism conflates difference (Derrida) with alterity. A shared global identity may face many obstacles, but metaphysical impossibility and conceptual confusion are not among them. (shrink)