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Solidarity
Abstract
This entry first presents some of the definitions and theoretical approaches to solidarity. Then, five different uses of solidarity within global bioethics are discussed: public health, welfare, universal health care, a right to health care, and a focus on the vulnerable.
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When people in Europe are interviewed about the values, which they consider fundamental for the design of their health and social care systems, they often refer to the values of equity and solidarity. While equity may be a term for which most people have a quite similar and clear-cut understanding, solidarity is a less familiar notion that is subject to divergent interpretations and reflections. In general, the idea of solidarity is associated with mutual respect, personal support and commitment to a common cause. These interpretations come to the fore when Europeans in large-scale surveys are questioned about their understandings of this idea of solidarity. Their verbal answers to these kind of questions reflect notions as ‘belonging together’, ‘mutual understanding’, ‘support of the weak and needy (benevolence)’, ‘shared responsibility’ and commitment to the common good. To explain these notions, solidarity is often juxtaposed against individualistic and even egoistic behaviour or contrasted with the alleged self-centred individualism that is often superficially associated with the cultural habits, societal norms and liberal values of the United States. For example, the plain evidence that forty-five millions of inhabitants of the United States lack any sort of health care insurance is for many Europeans, especially on the leftist stance, writing on the wall. In contrast to the alleged irresponsibility and lack of concern that is generally associated with this kind of individualism, Europeans proudly refer to the notion of solidarity and how it shaped their national health and social care systems. How ill-defined solidarity often is, the basic understanding is that everyone is assumed to make a fair financial contribution to a collectively organised insurance system that guarantees equal access to health and social care for all members of society. This equally applies to other systems of social protection, which are operating in Europeans welfare states, such as social insurance systems covering the financial risks of unemployment and work related illness and disability, as well as old age insurance systems and pension schemes.
This paper, which is based on an extensive analysis of the literature, gives a brief overview of the main ways in which solidarity has been employed in bioethical writings in the last two decades. As the vagueness of the term has been one of the main targets of critique, we propose a new approach to defining solidarity, identifying it primarily as a practice enacted at the interpersonal, communal, and contractual/legal levels. Our three-tier model of solidarity can also help to explain the way in which crises of solidarity can occur, notably when formal solidaristic arrangements continue to exist despite 'lower tiers' of solidarity practices at inter-personal and communal levels having 'broken away'. We hope that this contribution to the growing debate on the potential for the value of solidarity to help tackle issues in bioethics and beyond, will stimulate further discussion involving both conceptual and empirically informed perspectives.
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.
Experiences of solidarity have figured prominently in the politics of the modern era, from the rallying cry of liberation theology for solidarity with the poor and oppressed through feminist calls for sisterhood to such political movements as Solidarity in Poland. Yet very little academic writing has focused on solidarity in conceptual rather than empirical terms. Sally Scholz takes on this critical task here. She lays the groundwork for a theory of political solidarity, asking what solidarity means and how it differs fundamentally from other social and political concepts like camaraderie, association, or community. Scholz distinguishes a variety of types and levels of solidarity by their social ontologies, moral relations, and corresponding obligations. Political solidarity, in contrast to social solidarity and civic solidarity, aims to bring about social change by uniting individuals in their response to particular situations of injustice, oppression, or tyranny. The book explores the moral relation of political solidarity in detail, with chapters on the nature of the solidary group, obligations within solidarity, the "paradox of the privileged," the goals of solidarity movements, and the prospects for global solidarity. Copyright
Solidarity in Europe is a comprehensive study of the idea of solidarity from the early nineteenth century to the present. It covers social and political theory, Protestant and Catholic social ethics, and the development of the concept of solidarity in eight European nations - Germany, United Kingdom, France, Italy, Spain, Sweden, Norway and Denmark. Steinar Stjernø examines how solidarity has been defined, and how this definition has changed since the early nineteenth century. He analyses different aspects of solidarity: what is the foundation of solidarity? Is it personal or common interest, 'sameness', altruism, religion, empathy, or cognition? What is the goal of solidarity? How inclusive should it be? The book also compares the different concepts of solidarity in social democratic, Christian democratic, communist and fascist parties.
The term “solidarity” has its roots in the Roman law of obligations. Here the unlimited liability of each individual member within a family or other community to pay common debts was characterized as obligatio in solidum. Since the end of the 18th century, this principle of mutual responsibility between the individual and society, where each individual vouches for the community and the community vouches for each individual, has been generalized beyond the law of obligations context and applied to the field of morality, society and politics.1 “Solidarity” is now comprehended as a mutual attachment between individuals, encompassing two levels: a factual level of actual common ground between the individuals and a normative level of mutual obligations to aid each other, as and when should be necessary. Without clearly acknowledging the difference between the two levels or their relationship to one another, it has repeatedly been supposed that factual common ground is sufficient justification for normative obligations. This supposition has been made easier by the assumption that actual common ground is not simply objective, but has an emotional dimension: from common ground a feeling of obligation thus spontaneously emerges, bridging the gap between what is and what ought to be.
Recently, there has been a growing interest in public health and public health ethics. Much of this interest has been tied to efforts to draw up national and international plans to deal with a global pandemic. It is common for these plans to state the importance of drawing upon a well-developed ethics framework and we argue that this framework should reflect the values and insights of feminist relational theory. More specifically, we argue that pandemic planning must be squarely situated in the larger realm of public health and that an ethics framework for public health will be one that recognizes the need to pay particular attention to the vulnerability of subpopulations lacking in social and economic power. We propose an ethics framework for public health that builds on the notions of relational personhood (including relational autonomy and social justice) and relational solidarity. In this way, we aim for a public health ethics that, as appropriate, promotes the public interest and the common good.
After exploring the relationship between solidarity and human rights, I argue that, when considering civic solidarity, the right to solidarity as a human right may be understood as the negative right not to be hindered by social vulnerabilities in the exercise of citizen rights. I define
social vulnerabilities as those vulnerabilities that result from structures of society. As a negative right, the right to solidarity shifts attention away from what is necessary for basic flourishing and toward what social structures hinder full participation in other civic or political obligations
and rights. The analysis of a human right to solidarity provides a useful framework for understanding the crisis in solidarity in the European Union and helps to elucidate the obligations of other regional and global solidarity relations.
The concept of solidarity has achieved relatively little attention from philosophers, in spite of its signal importance in a variety of social movements over the past 150 years. This means that there is a certain amount of preliminary philosophical work concerning the concept itself that must be undertaken before one can ask about its potential use in arguments concerning the provision of health care. In this paper, I begin with this work through a survey of some of the most prominent bioethical, political philosophical and intellectual historical literature concerned with the project of determining a philosophically specific and historically perspicacious meaning of the term 'solidarity'. This provides a conceptual foundation for a sketch of a four-tiered picture of social competition and cooperation within the nation-state. Corresponding to this picture is a four-tiered account of health care provision. These two models, taken together, provide a framework for articulating the conclusion that, while there are myriad examples of solidarity in claiming health care for some, or even many, the concept does not provide a basis for claiming health care for all.
Within European countries, particularly on the Continent, there is a widespread belief that health care systems should be based on the value of solidarity. The social origin of this idea can be found in the nineteenth and early twentieth century development of social security and health care benefits for workers. These initiatives usually originated from local and smallscale groups: guilds, religious groups, workers unions and ethnic groups. They were based on commonality and mutuality: the accent was on very concrete forms of solidarity with others to whom you felt directly connected as members of the same church, profession or union. In the long run though, maintenance of an adequate level of financing and provisions generally proved to be possible only under the care of the state, which could enforce obligatory contributions. Such developments should not be misconstrued as a transition from Gemeinschaftto Gesellschaft, from one principle of solidarity to another. Prudence was a strong drive in the voluntary associations and we need not doubt that governmental arrangements were partly motivated by a genuine sense of fellowship with and compassion for the needy. The welfare system did not originally require an alternative value system as compared to voluntary arrangements. Welfare arrangements expressed an attempt to attain the goals of earlier arrangements by other means. From a historical point of view, the form of solidarity embodied in the provision of care and access to care in European societies has thus seen radical change. The spontaneous voluntary solidarity in reciprocal arrangements of support and care within well-defined groups and communities has given way to comprehensive systems of organised and enforced solidarity that have evolved within modern welfare states. With the collectively financed risk-sharing arrangements of care, covering all citizens, each with equal right to care, solidarity has assumed the form of contractual solidarity in welfare:
Real-libertarianism, as it is expressed in Philippe Van Parijs' recent monograph Real Freedom for All is characteristically committed to both self-ownership and 'solidarity with the infirm or handicapped. In this article it is argued that the conception of (real) freedom that is used to endorse self-ownership is inconsistent with the conception of (social) freedom or opportunity that is used to justify transfer payments to those with no or low earning capacity. The problem turns around the question whether one's freedom consists in the access one has to a share of the social product or in the measure of economic self-sufficiency one enjoys. Accordingly the role of private property in external resources as a condition for freedom is unclear: is it the basis of people's capacity for self-determination or is it the basis of people's bargaining power? Van Parijs' commitment to self-ownership suggests the former, his commitment to solidarity suggests the latter. A similar ambivalence is pointed out in his argument for a universal basic income, for which Real Freedom for All is so well-known.
Recent work has stressed the importance of the concept of solidarity to bioethics and social philosophy generally. But can and should it feature in documents such as the Universal Declaration on Bioethics and Human Rights as anything more than a vague notion with multiple possible interpretations? Although noting the tension between universality and particularity that such documents have to deal with, and also noting that solidarity has a political content, the paper explores the suggestion that solidarity should feature more centrally in international regulations. The paper concludes with the view that when solidarity is seen aright, the UDBHR is an implicitly solidaristic document.
Swedish welfare has for decades served as a role model for universalistic welfare. When the economic recession hit Swedish economy in the beginning of the 1990s, a period of more than 50 years of continuous expansion and reforms in the welfare sector came to an end. Summing up the past decade, we can see that the economic downturn enforced rationing measures in most parts of the welfare state, although most of this took place in the beginning of the decade. Today, most of the retrenchment has stopped and in some areas we can see tendencies of restoration--but more so in financial benefits than in the caring sectors. In the article this process is discussed as a process of reallocation where general principles of solidarity become manifest. Various levels of decision making are discussed within the context of socio-political action. Current transitions in Swedish health care are described with respect to coverage rates, content, marketization and distribution. Basic principles of distribution are highlighted in order to analyse the meaning of social solidarity in a concrete allocative setting. The significance of popular opinion--it's shifts and determinants--is also considered. The article concludes with a discussion of how the (once salient) features of universalism in welfare and health care provision have been affected by the developments in the past decade in Sweden.
We analyse solidarity as a mixture of social justice on the one hand and a set of cultural values and ascriptions on the other hand. The latter defines the relevant sense of belonging together in a society. From a short analysis of the early stages of the Dutch welfare state, we conclude that social responsibility was originally based in religious and political associations. In the heyday of the welfare state, institutions such as sick funds, hospitals or nursing homes became financed collectively entirely and became accessible to people of all denominations. Solidarity was transformed in a more general category, related to the status of Dutch citizenship. Responsibility was transformed to collective responsibility. Financial pressures on the Welfare State have resulted in a debate on choices in health care and in a number of system reforms, so far relatively small. In the surrounding discourse, justice was linked to private responsibility. Both from government officials and from participants in the societal debate, moralistic overtones could be heard concerning the threat of overburdening of the health care system by citizens. In this paper, we develop a concept of reflexive solidarity that links elements of social justice to conceptualisations of responsibility that address policy makers and health care institutions as well as citizens, in their role of care receivers. A short analysis of the phenomenon of personal budgets in care services should prove that our concept of reflexive solidarity is not empty. Linked to, but beyond the concept of justice, issues of social responsibility can be addressed without moralistic overtones.
There are quite a number of rocky roads on which the ‘old continent’ has embarked. There is, first, a harmonization of cultures and attitudes in the creation of a common European market of values and valuables, a harmonization undertaken
in order to survive in an increasingly competitive global market. Second, there is a reactivation of specific European traditions in discourse, peaceable hermeneutics, solidarity, subsidiarity, tolerance in both conflict
reduction and solution, and respect for self-determination and self-responsibility. Third, there is an integration of theory and practice, of visions and reality, of national identity or pride and common European rights, and of obligations
and cultural heritages. Last but not least, there is a question about the definition of ‘European’ in a world which, at least in part, has been developed by successful European missionary work in the distribution
of Age-of-Reason principles such as personal autonomy and social and ideational tolerance, the promotion of science-based
technologies, and the creation of global markets for goods and services.
During the last decade a "technical" approach has become increasingly influential in health care priority setting. The various country reports illustrate, however; that non-technical considerations cannot be avoided. As they often remain implicit in health care package decisions, this paper aims to make these normative judgements an explicit part of the procedure. More specifically, it aims to integrate different models of distributive justice as well as the principle of solidarity in four different phases of a decision-making procedure, and to identify important moral choices which present themselves. First four important justice models are discussed, then a justification is given for their inclusion in a four-step decision making procedure. This is followed by a discussion of different justice and solidarity problems--with their inherent conceptual difficulties in each of these stages. The paper concludes with a summary of the major moral choices that are to be made in health care package decisions.
Political solidarity. State College
- S Scholz
European Commission: The charter of the fundamental rights of the European Union
- Europa