Over the last half century, United States debates about abortion focused at first on the question whether the fetus is a person with rights and later on whether involuntary conception—for instance, as a consequence of sexual assault—might mitigate a woman’s responsibilities toward the fetus she carries. This article argues that, whatever one’s position on these two questions, a third, morally salient dimension of most US women’s experiences of unwanted pregnancy deserves more attention: both abortion and birth burden women with their (...) inevitable moral failure to fulfill their responsibilities to persons who frequently have de facto last‐resort and unavoidable claims on them. Using Lisa Tessman’s work on moral failure and Pope Francis’s interventions on abortion and mercy, I argue that this moral anguish is not a simple emotional remainder. Structural evil, not necessity, is the primary driver of forced pregnancy choices that injure women and their children both materially and morally. Consequently, whether they abort or carry to term, women with unwanted pregnancies need mercy or forgiveness. But they also need compassionate solidarity: prophetic, active efforts to transform the social structures that make material harm and moral failure, and consequent moral anguish and moral injury, inevitable for many pregnant women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Compassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice by Christopher D. MarshallGlen StassenCompassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice CHRISTOPHER D. MARSHALL Eugene, OR: Cascade Books, 2012. 386 pp. $33.60Christopher Marshall is known to Society of Christian Ethics members for his highly acclaimed book on restorative justice, Beyond Retribution, and for his (...) plenary address at the SCE annual meeting published in the JSCE 27, no. 2 (2007). The plenary address forms one chapter of the present Compassionate Justice. Well [End Page 221] informed on ethics, criminal justice, and human rights, Marshall is a New Testament scholar at Victoria University in New Zealand.Marshall points out that the two best-known of Jesus’s parables—the Compassionate Samaritan, and the Prodigal Son—have been the most influential of Jesus’s parables in Western culture and legal theory. The Compassionate Samaritan is Jesus’s response to a lawyer’s question that answers a central legal question of the time: Who is my neighbor, whom I am obligated by Leviticus 19:7 to love as myself? In the Prodigal Son, the three main characters in legal offense are clearly portrayed as the offender, the victim, and the law-abiding community; in turn, as Marshall points out, “the older brother’s reaction centers directly on the justice of his father’s actions” (192–93). Marshall argues that present legal theory can learn from careful dialogue with these two parables. These parables are not only historically influential but also so insightfully and beautifully crafted that dialogue with them can bring incisive insights. In addition, dialogue with them presses Anglo-Saxon liberalism where it is weak and needs to grow.The parable of the Compassionate Samaritan opens up questions about the need for Good Samaritan laws that defend persons who come to the aid of a person in danger of death (e.g., from an accident, fire, or drowning) against liability for inadvertently and unintentionally causing damage. Under present Anglo-Saxon law, such good Samaritans can be sued for damages. This is not the case, however, in most European countries. Similarly, most European and Latin American countries have bad Samaritan laws: Where “victims are in mortal danger and unable to save themselves,” there is a legal duty for “those who are consciously aware of the victim’s predicament, who are close enough to intervene, and who have the effective means of intervention available to them” to come to the aid of the victims. “The most glaring exception to this pattern,” Marshall argues, “occurs in Anglo-American legal systems” because of liberalism’s maximization of individual liberty even against coercion to come to the aid of persons who would die if no help arrives (155). Samaritan laws “give formal expression to the supreme value of human life, to the bonds of solidarity and empathy that comprise human identity and that bind people together in social community, and to ongoing need human beings have to be committed to one another’s rescue and restoration when severe harm befalls them” (174).Responding to the parable of the Prodigal Son, Marshall argues that both compassion and repentance are crucial for understanding the humanity and the sufferings of persons being defended or judged by law. This does not replace the standard tools of legal interpretation; it takes account of the more holistic context (288–90). In fact, “unreflective compassion can be dangerous and distorting” (296). Marshall discusses the complications insightfully and in a balanced [End Page 222] way. He concludes with an extensive discussion and refutation of perhaps the most important book-length criticism of restorative justice.Marshall’s interpretation of these two parables surpasses any other that I have read. His sensitive and thoughtful analysis of the experience of victimization goes beyond any other interpretation of the Compassionate Samaritan that I have seen. In this he resembles Daniel Philpott’s interpretation of victimization in Just and Unjust Peace (Oxford University Press, 2012). His description of the shameful rupture of relationship with father, family, and community by the prodigal son goes well beyond what I have seen previously. I think... (shrink)

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that (...) health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. (shrink)

A multiracial, socioeconomically diverse sample of 45 lesbians describe power relations in both satisfactory and problematic health care encounters with physicians. Whether doctors act in solidarity or dominate them is pivotal to lesbians' health care experiences. Solidarity means compassionate competence, empowering information exchange, and negotiated action. Domination takes form in the withholding of information, doomsaying, defensive dismissals, sexist comments, body sculpting, reproductive regulation, and bodily transgression.

Unusual among Western philosophers, Schopenhauer explicitly drew on Hindu and especially Buddhist traditions inhis moral philosophy. He saw plurality, especially the plurality of human persons, as a kind of illusion; in reality all is one, and compassionate acts express an implicit recognition of this oneness. Max Scheler retains the transcendence of self aspect of compassion but emphasizes that the subject must have a clear, lived sense of herself as a distinct individual in order for that transcendence to take place (...) properly. This feature is absent in the Buddhist tradition. Feminist philosophers of the early second wave built on this insight (only occasionally drawing it from Scheler) to recognize ways women are often not socialized to develop this distinctive sense of self, therefore harming their ability to engage in compassion and other forms of care for others. Iris Murdoch adds a Freudian-inspired (though Freud influenced Scheler also) pessimism about the ability of humans to keep their identities sufficiently distinct from the other to allow a clear view of the other, and thus real care and help to the other to take place. But in her later work, Murdoch explicitly recognizes and draws on the Buddhist tradition of oneness and transcendence of the self. Group solidarities can partake of aspects of Buddhist oneness and self-transcendence, for example the sense of fellowship in a social justice movement in which Blacks draw on a shared identity to experience connection, compassion, empathy, and solidarity with one another. But social justice movements also allow for a solidarity across racial lines, grounded in the shared commitment to justice, including justice for one of the groups in the solidarity community. (All these issues are powerfully portrayed in the 2014 film, Selma.) None of these solidarities, however, express the universalistic dimension of Buddhist oneness. (shrink)

The Spiral Staircase, Karen Armstrong’s self-narrative, shows the limitations of theological or religious reflections within a specific religious community. Leaving the Sisters of Charity for a tumultuous academic life, historian of religion Karen Armstrong lives a wrenching ontological dislocation that originates in her undiagnosed epilepsy and negative body experiences. Using semiotician Algirdas Greimas’s ‘Semiotic Square’ as an interpretive strategy, the unresolved tensions and contradictions exposed in the deep narrative structure of this non-traditional conversion memoir are resolved by ‘compassion’ at the (...) manifest level. Armstrong’s experiences, both in and out of the convent, will inform her academic study and lead her to compassionate solidarity with the marginalized. Armstrong’s memoir reveals various internal and external forces that shape an individual woman’s way of being in the world, and that inform her investigation of multiple faith practices and beliefs. In a time of mass refugee migration and ‘homelessness’, the one woman, the one ‘other’, matters in how one thinks about the body and about God. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Asian American Christian Ethics: Voices, Methods, Issues eds. by Grace Y. Kao and Ilsup AhnAlex MikulichAsian American Christian Ethics: Voices, Methods, Issues Edited by Grace Y. Kao and Ilsup Ahn WACO, TX: BAYLOR UNIVERSITY PRESS, 2015. 355 PP. $44.95This volume opens new horizons in Christian ethics. Editors Grace Y. Kao and Ilsup Ahn suggest two ways of conceptualizing Asian American Christian ethics. They describe the first as "agency- (...) or advocacy-centered" and the second as "bringing Western and Asian philosophical, theological, and cultural traditions together in critical dialogue and for selective retrieval for Asian American Christian ethics" (11). While the contributors to this book rightfully develop agency and advocacy-centered approaches within complex histories of colonialism and oppression, they also emulate Michael Walzer's "connected critic" who is not naïvely or uncritically "neutral" or dispassionate. The contributors appropriately use co-critical approaches that make possible "new and creative 'traditioning'" that does not uncritically reinscribe some "purer" Asian past or "undefiled by Western contact" (15).Nearly every chapter unpacks the deeply problematic term "Asian American" that was originally employed by activists who sought a new identity as "self-determining subjects rather than as 'oriental objects' in the United States" (4). But the term obfuscates multiple diversities within richly divergent national, geographical, colonial, and cultural histories and traditions.Hoon Choi explores the complexity of gender and sexual identities through a richly textured intersectional approach, examines how these identities become intertwined in double and triple binds, and reinterprets Christ as the fullness of humanity against Western hegemony and Eastern sexism. Choi's vibrant reinterpretation of Jesus Christ is complemented by a wise and compassionate pastoral approach.Sharon M. Tan calls for a reinterpretation both of Christian and Asian traditions of marriage, family, and parenting that will "entail a bicultural approach to life" and "creative new ways of retelling their stories and imagining their futures" (42). Tan underscores the difficulty of describing a Pan-Asian approach to marriage, family, and parenting by exploring the complexities of "Tiger Mothers," multigenerational households, the "special case of refugees," transnational families, and biculturality and adaptation.Hannah Ka deconstructs a wide range of Christian approaches to environmental ethics and reinterprets Sallie McFague's Body of God ecological theology through a distinctive Asian American approach. Drawing on beautiful and challenging stories from her own family as well as Confucian and Taoist [End Page 215] thought, Ka suggests a reinterpretation both of existential and functional indebtedness between human beings and all living things. She contends that "humans cannot survive even a day without … all other inorganic and organic existents on earth, while [other existents] can flourish without humans. The life of the human species is not merely interdependent with, but utterly indebted to, all the other existents on earth, rendering humans more vulnerable than others" (221).These are only a few examples of how this volume exemplifies clear, cogent, and constructive Christian ethics. Chapters by Ilsup Ahn ("Virtue Ethics"), Keun-Joo Christine Pae ("Peace and War"), Christina A. Astorga ("Wealth and Prosperity"), Ki Joo (KC) Choi ("Racial Identity and Solidarity"), SueJeanne Koh ("Health Care"), Hak Joon Lee ("Immigration"), Irene Oh ("Education and Labor"), and Jonathan Tran ("Cosmetic Surgery") all expand the horizons of contemporary ethics. I highly recommend this text for scholars to engage new horizons of Christian ethics and to use for a wide variety of upper level undergraduate and graduate courses in Christian ethics as well as constructive and pastoral theology.Alex MikulichLoyola University New OrleansCopyright © 2017 Society of Christian Ethics... (shrink)

Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the (...) series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude—compassion—is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient’s dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as “empathic compassion” can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of “care” that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions. (shrink)

This article is a collective discussion with undergraduate students about their work in a second-year gender studies course. The discussion shares how active engagement in collective art production for social change can provide the seeds for decolonial, anti-racist and anti-ableist pedagogical practice. The course encourages students to actively engage in the classroom, raise questions and concerns about social justice, and implement ways to challenge social relations of power. Students work collectively on projects using a range of alternative ways of knowing, (...) including sensory, heart, intellectual, and spiritual knowledge, to connect with the course material in creative ways. The article is a conversation with three students in the course and the work they produced. They discuss the various mediums they used, including poetry, collaging, and a case study of artists’ street art. The students touch on the politics of joy, self-care, heart knowledge, politics of suffering, and accessibility, illustrating how combining art with various ways of knowing has helped them develop deeply analytic, compassionate, and relational work for social change. The work affirms ways of knowing that have often evolved outside the colonial academic institution. The anti-racist, anti-colonial, anti-ableist, feminist and Indigenous pedagogies used in the course help to pluralize constructive capacities for more decolonizing, equitable, inclusive, anti-racist and expansive educational futures. (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

Is freedom and capability enough to sustain our well-being? For human flourishing to progress, defer, and avoid decline, managers as persons must grow in virtue to transcend to the ultimate source of the good. In our definition of a person we develop an anthropology of gift through the communication of one self to another and whose form is love, the willing the good of the other. We ask four questions about the humanistic manager as a person: what is the goal, (...) end, good; what form, structure guides the manager; what materials, resources, technology, and context does the manager use within the structure to meet the end and exceed the goals, what is the means of effecting the change needed to meet the manager’s goals. Each of these questions form the basis to construct a philosophical anthropology of humanistic management. To these four questions we add three types of finality: the usual absolute terminal and horizontally immanent finalities plus the vertical finality of every growing and developing person among other persons in community. The need for a philosophical anthropology derives from a concomitant ethical requirement of what does and ought the manager, as person, undertake. What and how the person knows, wills, acts on provides the reality within which the manager, as person, operates. Along the way we will visit topics of transcendence, secularism, vulnerability, authentic personhood, and virtue. We conclude with a description, which is a dynamically evolving scheme of the meaning of a manager in the world, the social, and perhaps, the terminal goods of order. We move far from the _homo farber_ of a technology-led world whose thought conforms being. We have begun to extend our manager into the species _homo transcendens_ where being conforms thought and responsible action. We conclude with a sketch on the emerging role of spirituality in the workplace with connections to compassionate leadership, organizations as sites for healing and growth, and examples from the experience of humanistic organization who seem to have survived and thrived centuries of global operations. From an anthropology of gift we can identify several implications for managers. Humanistic management education would subsume the rational choice hegemony of economic modeling to a technological subset of tools, subject to the goals and nature of human persons. The scientism of thinking that psychology, sociology, political science, and economics would suitably describe, explain, and model human decisions would be replaced by an overarching framework leading to higher levels of knowledge, especially wisdom based educational experiences and content based on the natural integrity of human beings as learners. Since all technology follows, rather than leads, persons in an anthropology of gift, workplace practices would be founded in the structures immanent in persons and communities of persons. This would imply practices which transcend appraisal and assessment of performance to heights of contemplation and implementation of meaning in every task. Instead of beginning with a deficit of “what’s in it for me?” practices can begin with the surplus “how can I help you?” Proposed are practices which impound wisdom-based attributes of compassion, active listening, alterity, mercy, companionate and agapic love in decision analyses, interpretations of results, and incentives. The objective of the humanistically managed organization under the aegis of an anthropology of gift would be to minimize the maximum grief for the the most vulnerable. The objective would be applied as a policy across all authorities delegated by jurisdictions over organizations, and by boards, oversight groups, over decisions within organizations. This view from an anthropology of gift is consonant with emerging definitions of organizations as healing spaces where a balance of solidarity and subsidiarity guide decisions as opposed to simplistically applying supply and demand trade-offs. (shrink)

Images of human violence to animals challenge us both psychologically and morally. Sometimes images are so graphic, the treatment they capture so degrading and cruel, that they approach the pornographic. How can we responsibly approach them? Is it more respectful to witness such suffering, or to look away? I explore the notion of bearing witness to animal suffering as a manifestation of respect. I begin by asking why it is important to bear witness to human atrocities such as the Holocaust. (...) Some rationales are forward-looking and consequentialist. We bear witness in the spirit of “never again”: to stir moral motivation and preventive action. But there are also backward-looking and expressive reasons: to show respect for the dead, to express our solidarity and grief, to affirm the moral value of both the lost and the saved. Some might argue that differences between human and nonhuman victims of violence make the latter rationales irrelevant when animal victims are in question. The animal dead did not value being remembered; animal survivors do not share a degrading collective memory of horror and do not care if we acknowledge it. Yet obligations of memory do find a foothold here. Bearing witness to human-animal violence affirms the moral status of animals; it expresses respect and is part of constitutive justice. Bearing witness, however, carries moral risks, so that it matters greatly how one does so. One problem is that witnesses’ “testimony” - usually visual documentation of animal abuse - does not find its way only to compassionate audiences, but also to others who will use it in pernicious ways and some who are simply voyeurs. In this way, the witness can unwillingly become “a pornographer of pain.” Given the motive of paying respect to the animal dead, this is the last outcome a moral witness desires. Yet showing atrocities done to animals in all their horrific detail is among the most powerful ways of gaining allies in the struggle to end animal abuse. In light of such dilemmas, I explore the importance of bearing witness in private and as communal activity, of who attends to animal suffering, and of how and through what media we do so. (shrink)

The aftermath of the European refugee crisis can be said to have sparked a crisis of solidarity. Despite abundant demonstrations of solidarity with refugees and asylum seekers, what many saw as an exercise of their duty to help was made illegal. The critical term that emerged to refer to this conjuncture was “criminalization of solidarity”. In order to include this term in the academic debate, this article starts by disclosing the embedded claims present in its rhetorical usage. (...) The article then scrutinizes the design of the politics of criminalizing solidarity and its consequences. It argues that at least three aspects of the politics of criminalizing solidarity plausibly indicate the possibility that regulating the aid in question will produce and reinforce consequences for the EU that are not only unintended, but also damaging. This is because, first, what I refer to as the blending aspect might spread the perception of illegality among several types of immigrants; second, the moral aspect can discharge people from their duty to help foreigners by conditioning this duty to group membership and belonging; and third, the polarizing aspect might exacerbate the existing divide between citizens and immigrants currently causing conflicts and social fragmentation. (shrink)

Volume 20, Issue 7, July 2020, Page 89-92.

This commentary defines what shared yet differentiated ethical responsibilities to tackle antimicrobial resistance (AMR) mean, by introducing a threefold principled account of AMR global governance. It argues that the principles of solidarity, subsidiarity, and stewardship can be especially helpful for further justifying some of the universal, differentiated, and individual responsibilities that Van Katwyk et al propose. The upshot of my threefold principled account of AMR global governance is a less ambitious AMR treaty, one that can only justify (i) universal (...) duties of global coordination (as per the principle of solidarity); (ii) differentiated duties to local communities, which bear the primary AMR responsibilities (as per the principle of subsidiarity); and (iii) individualized duties for ensuring truthful, evidence-based, consistent, and timely shared accountable communication (as per the principle of stewardship). (shrink)

The concept of lifestyle-related diseases and individual responsibility for health has played an important role in debates on the fair allocation of increasingly scarce health-care resources. In this article, we examine this discussion through the prism of solidarity. Based on an understanding of solidarity as shared practices reflecting a collective commitment to carry ‘costs’ (financial, social, emotional or otherwise) to assist others, we analyse frequent arguments in the debate and, in particular, the tool of risk-stratification. We then offer (...) a solidarity-based approach to understanding risk in the context of lifestyle-related diseases, and draw a number of conclusions on how health policy informed by solidarity should approach priority setting in health care. (shrink)

The euro crisis has hit “Europe” (the European Union, or EU) at its root. Economic harshness, social unrest and political turmoil betray a deeper problem: a weak pan-European sense of belonging — a common political identity thanks to which European citizens may regard each other as equals, and therefore as deserving of recognition, trust, and solidarity. This paper explores interculturalism from an analogical perspective, looking at the harmonious interplay between human rights and cultural plurality, as a possible source of (...) trust and solidarity among European citizens. Only a common — even if analogical — political identity, whereby European citizens regard each other, if not as “siblings” at least as “cousins,” can make the sacrifices required to overcome the crisis meaningful — and therefore less unlikely to happen. (shrink)

The global impact of Dobbs v. Jackson Women’s Health Organization and the backlash towards reproductive justice that it represents warrant a global feminist response informed by broad theoretical and geopolitical lenses. We consider how a solidaristic, transnational feminist movement might learn from Latin American feminist movements that have been successful in uniting broad coalitions in the fight for reproductive justice as situated within far-reaching political goals. The success of such a global movement must be decolonial and must contend with the (...) fact that overlapping realities of global inequality, severe poverty, extractivism, and western-backed violence are fundamentally implicated in reproductive justice. (shrink)

In this article we explore how female sympathy and solidarity can be forged between transnational subjects and spectators. In particular, we place cinematic depictions of minority female suffering in the contexts of current feminist and postcolonial praxes. The aim is to demonstrate the ways in which world cinema can produce a transnational feminist solidarity through forms and narratives that reflect the experiences of women as gendered postcolonial subjects. Amongst the female and feminist theorists drawn upon, central to our (...) understanding of a transnational feminist solidarity is Sandra Lee Bartky's ‘mitgefühl’. From this understanding we suggest bonds of sympathetic solidarity between audiences and diegetic female subjects that bridge their ontological separation, without conflating the two, in relation to Rachida and Frontière. In combining film-philosophy, cinematic affect and feminist theory we formulate a radically new way of understanding and envisioning the construction of female suffering onscreen: as a means of producing transnational forms of spectator solidarity. (shrink)

In this paper I engage with the notion that Covid-19 can be seen as the ‘great equalizer’, in virtue of the widespread sense of uncertainty it has caused and the fact that it has forced us to recognize our shared human fragility. Against the view that Covid-19 is the ‘great equalizer’, I argue that, on the contrary, the pandemic reflects existing vulnerabilities and, in many cases, exacerbates them. I do so by offering first a definition of both ontological and relational (...) vulnerability and discussing some important ethical and political dimensions of vulnerability in conditions of uncertainty. I then claim that understanding vulnerability in both ontological and relational terms allows us to see the differential impact of the pandemic on differently situated individuals. More specifically, I argue that vulnerability in conditions of uncertainty can threaten individuals’ sense of self, and thus their autonomy – both understood in relational terms. I consider what kind of response human vulnerability in times of crisis calls for. In particular, I maintain that a promising way to counteract uncertainty would be to adopt a solidaristic approach to public health, based on an understanding of solidarity as a relational concept. In other words, I argue that it is through solidarity that individuals’ vulnerabilities can be mitigated, and their autonomy promoted, even during the most uncertain times. I finally discuss two objections that could be raised against the solidaristic approach defended in my paper. First, the approach may fail to find the support of individuals who are unwilling to care for others when their own interests are under threat. Second, there might be those who deny that the virus constitutes a serious enough threat to warrant or justify the restrictions on individual freedoms imposed by governments in the name of solidarity. I conclude by arguing that while a commitment to solidarity can be easily undermined by scepticism towards political and other authorities, and by the failures of those authorities themselves, it is paramount that societies strive for it as the best means to preserve individuals’ health, autonomy, and well-being. (shrink)

In the present paper, we discuss the ethics of compassionate psychedelic psychotherapy and argue that it can be morally permissible. When talking about psychedelics, we mean specifically two substances: psilocybin and MDMA. When administered under supportive conditions and in conjunction with psychotherapy, therapies assisted by these substances show promising results. However, given the publicly controversial nature of psychedelics, compassionate psychedelic psychotherapy calls for ethical justification. We thus review the safety and efficacy of psilocybin- and MDMA-assisted therapies and claim (...) that it can be rational for some patients to try psychedelic therapy. We think it can be rational despite the uncertainty of outcomes associated with compassionate use as an unproven treatment regime, as the expected value of psychedelic psychotherapy can be assessed and can outweigh the expected value of routine care, palliative care, or no care at all. Furthermore, we respond to the objection that psychedelic psychotherapy is morally impermissible because it is epistemically harmful. We argue that given the current level of understanding of psychedelics, this objection is unsubstantiated for a number of reasons, but mainly because there is no experimental evidence to suggest that epistemic harm actually takes place. (shrink)

IntroductionThis paper employs Confucianism to illustrate a kind of differential or benevolent love, which people give in accordance with their relations and roles. In this sense, Confucian benevolent love is more of a duty to create mutual belonging than an emotion of solidarity.1 This benevolent love contrasts with the universal love of liberalism and the resultant solidarity that those who express this form of love feel for one another—these people often being the distant and unacquainted—whose presence would puzzle (...) Confucian leaders in terms of their roles and duties. Confucian roles are, in comparison, contextual, evolving, and reciprocal in order to cope with encountered strangeness. The liberal belief in everyone being ontologically equal and free de-emphasizes the relevance of experiencing the other’s strangeness. As a result of this, a Confucian’s and liberal’s love for one another may ironically cause, in both, a moral outrage qua deprived belonging.2. (shrink)

Solidarity between more and less vulnerable groups is fundamental to an effective public health response to a global pandemic. Yet in the case of COVID-19, a focus on deciding who can and who cannot be protected from harm has shaped the pandemic experience and continues to determine the post-pandemic trajectory of life with SARS-CoV-2. In this paper I discuss how this has affected our understanding and acceptance of solidarity.

ABSTRACTThe aim of this article is to give an account of hope as it was understood by Józef Tischner a public intellectual and a prominent chaplain of the Polish Solidarity movement, which led to the fall of communism in Eastern Europe in 1989. The idea of hope was one of the basic ideas of the Solidarity movement, around which the daily experiences of its members were organized. The author thus offers insight into the intellectual history of the Eastern (...) European dissidence movement of the 1970s and 1980s. Referring to Tischner’s biography she describes some of the ways in which Western ideas crossed the Iron Courtain. Using the example of Tischner’s dialogue with, and critique of, Thomism, she explains how dissidents’ interest in phenomenology interacted with the heritage of European thought. The author shows that despite Tischner’s distancing himself from Aquinas’ thought, he remained under Aquinas’ influence, and his own ideas were not as different and incompatible with Thomism as is often believed. Given the rising interest in the question of the relation between hope and democracy today, the question of the meaning of hope is pending. (shrink)

The grounds for global solidarity have been theorized and conceptualized in recent years, and many have argued that we need a global concept of solidarity. But the question remains: what can motivate efforts of the international community and nation-states? Our focus is the grounding of solidarity with respect to global inequities in health. We explore what considerations could motivate acts of global solidarity in the specific context of health migration, and sketch briefly what form this kind (...) of solidarity could take. First, we argue that the only plausible conceptualization of persons highlights their interdependence. We draw upon a conception of persons as ‘ecological subjects’ and from there illustrate what such a conception implies with the example of nurses migrating from low and middle-income countries to more affluent ones. Next, we address potential critics who might counter any such understanding of current international politics with a reference to real-politik and the insights of realist international political theory. We argue that national governments – while not always or even often motivated by moral reasons alone – may nevertheless be motivated to acts of global solidarity by prudential arguments. Solidarity then need not be, as many argue, a function of charitable inclination, or emergent from an acknowledgment of injustice suffered, but may in fact serve national and transnational interests. We conclude on a positive note: global solidarity may be conceptualized to helpfully address global health inequity, to the extent that personal and transnational interdependence are enough to motivate national governments into action. (shrink)

This paper addresses the importance of words and of surrendering words, and so will consider both the philosophical and axiological potential of ineffability, both of which imply epistemic humility. On the one hand, epistemic humility implicates surrendering ill-fitting and limited constructs; this reflects a project of unknowing, a condition for a more authentic knowing, driven less by rigid categories and argument and more by humility and love. On the other hand, epistemic humility—as an observable phenomenon in the world’s religious traditions—has (...) axiological value and thus should be cultivated: it subverts an arrogant knowing which too often is the seed of destructive conflict. (shrink)

This study tested whether compassionate goals to support others and self-image goals to maintain and defend desired self-images: 1) are equivalent constructs across three cultures ; 2) overlap with interdependent self-construal; and 3) predict relationships and growth measures similarly in each country. We re-analyzed data from American and Japanese students, reported in Niiya et al., along with new data from Poland. Single and multiple group confirmatory analyses showed that the two-factor structure holds across the three cultures. Interdependence correlated with (...) compassionate and self-image goals only in Japan. In all three samples, compassionate goals correlated with non-zero-sum belief, feeling close, growth-seeking, self-compassion, and learning from failures, whereas self-image goals correlated with defensive responses to conflicts and validation-seeking. Our results suggest that compassionate and self-image goals may serve similar functions in relationships and growth across cultures. (shrink)

Many working in bioethics today are engaging in forms of normative interpretation concerning the meaningful contexts of relational agency and institutional structures of power. Using the framework of relational bioethics, this article focuses on two significant social practices that are significant for health policy and public health: the practices of solidarity and the practices of care. The main argument is that the affirming recognition of, and caring attention paid to, persons as moral subjects can politically motivate a society in (...) three respects. The recognition of solidarity and the attention of care can prompt progressive change toward a democratic willingness: (a) to provide for equal respect for rights and dignity; (b) to provide the social resources and services needed for just health and well‐being; and (c) to focus its creativity and wealth on the actualization of potential flourishing of each and all. Solidarity is discussed as a morally developmental stance that moves from standing up for another, standing up with another, and standing up as another. Care is discussed as a morally developmental stance that moves from the attentive rehabilitation of another, attentive companionship with and for another, and attentive commitment to another. (shrink)

n this paper, I argue that political solidarity is important to justice. At its core, political solidarity is a relational concept. To be in a relation of political solidarity, is to be in a relation of connection or unity with one’s fellow citizens. I argue that fellow citizens can be said to stand in such a relation when they have attitudes of collective identification, mutual respect, mutual trust, and mutual support and loyalty toward one another. I argue (...) that political solidarity, so conceived, is an integral element of a theory of justice. I argue that there are distinctly social bases for political solidarity and that justice requires that we promote these. Furthermore, as an example of the sort of social and political arrangements that might encourage political solidarity, I discuss Canada’s response to the recent H1N1 pandemic and the failings of this response with respect to members of the Aboriginal community within Canada. I argue that ensuring that members of the Aboriginal community had equal access to the goods they needed to protect themselves against H1N1 infection would have promoted relations of political solidarity and, in turn, would have promoted justice more effectively. (shrink)

Compassionate care: a moral dimension of nursingThis paper focuses on the concept of compassion and its meaning for nursing practice. Compassion is often considered to be an essential component of nursing care; however, it is difficult to identify what exactly comprises compassionate care. To begin with, there is a general discussion of the meaning of compassion and an examination of its common usage. An argument then is presented that compassion is more than just a natural response to suffering, (...) rather that it is a moral choice. The paper outlines the extent to which this concept has implications for nursing care, highlighting some of the obstacles that nurses need to overcome in order to maintain this essential moral value of the caring role. (shrink)

The concept of solidarity has recently come to prominence in the healthcare literature, addressing the motivation for taking seriously the shared vulnerabilities and medical needs of compatriots and for acting to help them meet these needs. In a recent book, Prainsack and Buyx take solidarity as a commitment to bear costs to assist others regarded as similar, with implications for governing health databases, personalized medicine, and organ donation. More broadly, solidarity has been understood normatively to call for (...) ‘standing with’ or assisting fellow community members and possibly also distant others in regard to their needs, whether for its own sake or in order to realize the demands of justice. I argue here that the understanding of solidarity in the existing bioethics literature is unduly restricted by not sufficiently theorizing the notion of structural (or systemic) injustice and its import for understanding solidarity. Extending traditional conceptions of labor and social movement solidarity, I contrast unitary solidarity within a given group with ‘networking solidarities’ across groups. I analyze the meaning of structural injustice and its significance for solidarity, including countering institutionally entrenched inequalities and economic exploitation. I then apply this broadened conception to healthcare, discussing structural problems with the U.S. insurance system and the solidarity movements addressing its deficiencies. I analyze some natural disasters and global health challenges that were aggravated by structural injustices, along with the solidarity movements they engendered. Finally, I revisit the questions of governing health databases and of personalized medicine with the enlarged conception of solidarity in view. (shrink)

Commentators have compared Hans-Georg Gadamer’s focus on tradition in Truth and Method to his focus on solidarity in his later work in order to suggest that the latter signals a move away from ontological toward ethical and political concerns. This paper, however, is guided by Gadamer’s own view that his work, both early, late, and in Truth and Method, was always concerned with ethical and political issues. I therefore want to challenge the idea that his so-called politics of (...) class='Hi'>solidarity marks a new direction in his work. His politics of solidarity does mark a new direction in discussions of solidarity insofar as he disconnects it from any necessary grounding in preexisting affinities such as religion and nationality. Gadamer’s later work may also be more explicitly concerned with the question of differences and the other than is Truth and Method. Nevertheless, I want to argue that rather than signaling a new direction for Gadamer, both his politics of solidarity and his concern with otherness highlight important features already present in his earlier account of tradition. Indeed, I think attention to this earlier account discloses a political dimension to Gadamer’s thought that is more sophisticated than his remarks on solidarity. Attention to this dimension of his earlier account allows us to challenge the now standard objection that it undermines possibilities for critical reflection. (shrink)

Background: Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who are new to the clinical practice environment as part of their educational journey remain unclear. Objectives: The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice. Methods: A descriptive qualitative study design was used involving a semi-structured in-depth (...) interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals. Ethical considerations: Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals. Results: Baccalaureate nursing students defined and characterized compassionate care as a union of “empathy” related to a nurse’s desire to “alleviate patients’ suffering,” “address individualized care needs,” “use therapeutic communication,” and “promote mutual benefits with patients.” Students recognized that the “practice environment” was characterized by nurse leaders’ interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel. Conclusion: Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients. (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)