Publicly-funded health systems, including those national health services and social or National Health Insurances, are institutionalized solidarity in health. In Europe, solidarity originated from the legacies of labor movements, the Judeo-Christian traditions, and nationalist sentiments in the re-construction Era after the WWII. In middle-to-high income East Asian countries, such as Japan, Taiwan, Korea, the health systems were built on different grounds and do not have such ethical origins of solidarity. As health systems in Europe and East Asia (...) are both facing sustainability crises due to aging population, stagnant economy, changing boundaries, and advancing medical technologies, how those systems with the European solidaristic ethical traditions can be revived and how those without the European traditions could survive become a matter of theoretical interests and an urgent policy problem to be addressed. Drawing on contemporary theories of solidarity, this essay analyzes the boundary problem and its impact on the sustainability of the health system in Taiwan. It then considers two plausible origins of solidarity in Taiwan. One is the re-emerged civic nationalism, and the other is an ethos of common life. It is argued that after years of implementation, the National Health Insurance in Taiwan might have shaped the social values and people’s habits and formed an ethos of common life. Such ethos could be an ethical origin of solidarity in non-western societies and help the health systems endure the prolonged sustainability crises. (shrink)

Encompassing health care systems in modern welfarestates embody several forms of solidarity: between thesick and the healthy, the old and the young andbetween those who take good care of their health onthe one hand and fellow citizens who choose to risktheir lives by smoking or unsafe sex on the other. Thelatter form is called lifestyle solidarity. In theNetherlands this type of solidarity has become theobject of a debate between medical ethicists. Mostmedical ethicist seem to want to uphold lifestylesolidarity. Most (...) Dutch citizens agree with them. TheDutch government, however, embarked on a project tochange the health care system by transferring stateresponsibilities to other actors (employers, insurers,individuals). This changing policy may diminish ordestroy lifestyle solidarity despite the fact that noone intended this to happen. (shrink)

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

Health care policy in the Netherlands has long been guided by the values of solidarity and equality. As a result of several forces, particularly the scarcity of resources, the retreat of the Welfare State and the introduction of market forces in health care, both values are increasingly under strain. Next to solidarity and equality, freedom of choice and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch heaith care between two (...) tiers, one basic tier giving access to a basic package of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thesis of the article is that a two-tier system is morally justified on the condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity. (shrink)

Health care policy in the Netherlands has long been guided by the values of solidarity and equality. As a result of several forces, particularly the scarcity of resources, the retreat of the Welfare State and the introduction of market forces in health care, both values are increasingly under strain. Next to solidarity and equality, freedom of choice and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch heaith care between two (...) tiers, one basic tier giving access to a basic package of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thesis of the article is that a two-tier system is morally justified on the condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity. Keywords: access to health care, health insurance, resource allocation, solidarity CiteULike Connotea Del.icio.us What's this? (shrink)

Charles de Gaulle once famously complained about the difficulty of governing a nation with 250 different kinds of cheese. His comment is a true description of France’s diversity and its population. We are like a loud, unruly family always arguing among ourselves. However, as much as we disagree, there is one thing on which we French stand united—we love our healthcare system and do not want it changed, even as economic realities make it increasingly difficult to maintain.

Background In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the. Main text In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the (...) NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access. Conclusion A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a solidaristic healthcare system. (shrink)

Volume 20, Issue 5, June 2020, Page 67-69.

The purpose of the present contribution is to explore how the ECJ seeks to respect the principles underpinning national welfare systems, notably social solidarity, whilst ensuring that Member States comply with the substantive law of the European Union, in particular with the Treaty provisions on the fundamental freedoms and EU citizenship. It is submitted that in order to reconcile those two interests the ECJ has taken the view that nationals of the host Member State must show a certain degree (...) of financial solidarity with the nationals of other Member States who have established a ‘genuine or real link’ with the society of that State. With a view to establishing the existence of such a link, national authorities of the host Member State must engage in a case-by-case assessment of the personal circumstances of the EU citizen claiming social benefits. However, Förster is an important exception to the individual application of the ‘genuine or real link’ test. Although Förster does not overrule Bidar as a matter of principle, it exempts the host Member State from examining the personal situation of economically inactive students who apply for maintenance grants or student loans but have not yet completed a five-year period of residence. (shrink)

Cet article analyse les liens entre les SEL et l'économie solidaire. Les SEL sont définis comme des associations au sein desquelles des personnes échangent services et biens au moyen d'une comptabilité interne tenue en une monnaie propre ; elles émergent en 1983. SEL et économie solidaire partagent certains objectifs communs. Les SEL revendiquent en effet par leurs actions l'institution de nouveaux rapports économiques procédant d'une solidarité sous la forme d'une proximité relationnelle et spatiale, à laquelle ne répondent pas l'échange marchand (...) et la redistribution étatique. Cependant les SEL peuvent voir leur projet solidaire remis en cause, en particulier pour deux raisons : le risque d'instrumentalisation politique d'une part, la contrainte juridique et sociale d'autre part.This article analyzes links between LETS and a civil and solidarity-based economy. LETS are defined as associations in which individuals exchange services and goods by means of an internal accounting system based on its own currency. The first LETS appeared in 1983. These LETS and the new social economy share some common purposes. By their actions, LETS aim to set up a new system of economic relations based on solidarity proceeding from relational and spatial proximity. Market exchanges and State redistribution do not provide an efficient response to these needs. However, there are certain threats to the solidarity aimed at by LETS such as firstly the risk that politicians may instrumentalize these initatives and secondly legal and social constraints. (shrink)

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

The first National Health Service (NHS) was introduced in the United Kingdom providing free universal health care (UHC) at the point of use. Within decades, increasing European countries adopted the same intervention to improve the health of citizens on the entire life span. Today, several reasons put at risk (1) empirically, the sustainability and fairness of these systems, (2) theoretically, the same consistency of solidarity, as vulnerable patients struggle most to receive essential care. Preserving solidarity from the pressure of (...) modern medicine and society needs to identify a fair and sustainable type of coverage at the same time. This paper aims (1) to describe the short circuit of solidarity in European NHSs; (2) to discuss alternative versions of UHC and support redistributive neo-universalism; (3) to promote the role of medical humanities in implementing this solution. (shrink)

In recent years, the relation between studying and learning has been a topic of debate. This article is mainly interested in a concept of study practices, conceived of as practices that are strongly engaged with issues of living together in a superdiverse city. Such practices firstly require to think the relation between studying and learning in other-than-oppositional terms, and secondly, to raise questions concerning the political role of education. The aim of the article is double in that it wants to (...) further elaborate the concept of study practices in relation to a concrete practice on the one hand, and, on the other, that it has the objective to rethink in educational terms the notion of solidarity—deeply entwined with matters of living together in superdiversity. These aims are pursued based on an analysis of the study practice of System_D, a film festival in the disadvantaged neighborhoods of Brussels, drawing on the work of Isabelle Stengers and Donna Haraway. (shrink)

This paper is an empirical study of what solidarity in a Western European healthcare system means today. Drawing upon empirical research on the 2015 refugee cohort's health needs and their health-seeking behaviour, it unites claims from the literature on solidarity in the fields of migration and healthcare. I argue that the Austrian healthcare system not only is an example of ‘civic solidarity’ in the form of institutionalised obligations to citizens but that it also enacts political forms of solidarity and produces (...) political inclusion for marginalised groups such as refugees. My findings show that being entitled to and accessing services in the healthcare system holds meaning beyond the provision of care: It enables to act autonomously, to build familiar relationships with Austrian institutions, inclusion via the personal electronic health card and to support others in the same solidaristic system. These insights can be used to raise awareness about the inclusional function of healthcare services among practitioners. They also show how solidarity-based healthcare systems can be a motor for shaping positive relationships between immigrants and the host country, and point to additional modes of solidarity in the context of forced migration next to civil society and nonstate support structures. This paper builds upon ethnographic data that were collected between 2018 and 2020 in Vienna, Austria (observational notes before, during and after medical consultations with refugees; interviews with them; interviews with healthcare practitioners and other care providers). (shrink)

Publicly-funded health systems have traditionally been presumed to be underpinned by solidarity among the users. To which extent such solidarity presents and associates with what factors is understudied in the non-western countries. This article explores the distribution of health sector solidarity and its relationships with sociopolitical factors in Taiwan. Data was collected in 2021 through a national representative, cross-sectional survey with a sample size of 1272 included in the final analysis. The survey shows that solidarity regarding the National Health (...) Insurance in Taiwan was prevalent in 2021, with 76.6% of Taiwanese willing to carry the cost to enhance the quality of care through the system, while ten years ago, in 2011, that figure was only 49.1%. Nationalist sentiments, belief in differentiated social responsibility, and political partisanship are found to be the main factors associated with this supportive attitude, while familial values are not. The supportive attitude toward the health system remains strong and has increased during the past ten years, implying that the clinical and social effectiveness of the system itself may help further forge health sector solidarity in Taiwan. (shrink)

이 논문은 ‘자율과 연대’의 의미를 동아시아 사유에 나타난 존재론적 각도에서 접근한다. 당초 ‘자율’과 ‘연대’가 현대적으로 두드러지게 이슈가 된 것은 프랑스 68혁명에서 기원한다. 그 이후 중앙정부 차원에서 획일적으로 금지하는 모든 것을 금지한다는 모토 하에 개인의 자율을 확보하고 그 자율을 위한 연대의 문제가 부각된다. 주로, 칸트가 말하는 도덕적 자율과 달리 개별자의 자치를 의미하는 자율과 내부적 결속이나 외부와의 연대의 시선에서는 중심 권력, 중앙 정부, 당국자의 일변도의 정책에서 벗어나려 한다. 주변성이나 로컬적인 것이 중요한 것이 된다. 거기에서 개별자적 가치, 자기 운동성, 자기 이익을 접근하고 그것을 (...) 효율적으로 보장받기 위한 연대는 매우 중요한 것이 된다. 동아시아 사유, 특히 도가철학의 자연주의에서는 이 같은 문제를 한층 존재론적으로 접근한다. 정체성이나 국가와 사회의 획일화된 정책 속에 ‘자기’ 본질을 매몰하지 않고 조화로운 공동체를 이루는 것을 매우 자연스럽고 의미 있는 것이 된다. 사물의 존재를 유기적으로 보려는 ‘만물일체’도 그렇거니와, 자연공간에서 자기 소리를 내는 가운데 결과적으로 ‘화음’을 이루는 일종 ‘연대’를 기대한다. 이런 의미에서 개별자가 갖는 자기특성이 말살되거나 억압되어서는 안 되는데, 최한기 같은 사람은 그 같은 제약 공간을 넘어 역동적인 합리성, 사물의 운동성이 펼쳐 질 수 있는 근대적 합리성의 공동체 정신을 지향한다. 현재 우리 사회를 볼 때 어디를 가도 공동체요, 자율이니 연대니 하는 용어가 유행한다. 이 논문은 이 같은 상황에 비추어 자율과 연대의 의미에 대하여 보다 연원적이면서 존재론적인 접근을 시도한다. (shrink)

Health care systems in different countries and cultures differ and tend toreflect the particular values and, therefore, the particular socialstructure of a given society. Each of these has ethical problems unique toitself. Some of these problems are briefly discussed. So as to have anindividual ethical problem in the context of medical care, access tomedical care needs to be assured. It is argued that individual problems arethe primary issue in societies in which there is fair access whereas theyare of lesser (...) importance in societies which have thus far failed toprovide fair access. (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)

Solidarity is analysed in contradistinction from two adjacent concepts - justice and sympathy. It is argued that unlike the other two, it is essentially local , partial and reflective . Although not to be confused with justice, solidarity is presented as underlying any contract-based system of justice, since it defines the contours of the group within which the contract is taking place. Finally, due to the fact that health is a typically universal value and being a primary good it is (...) something which should be distributed justly, solidarity seems not to have any central role in bioethics. (shrink)

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, (...) I will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant to approaches rooted in Hegel. In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it. (shrink)

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

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, (...) I will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant (with emphasis on autonomy and individual rights) to approaches rooted in Hegel (with emphasis on individual relations of recognition). In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it. (shrink)

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, (...) I will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant to approaches rooted in Hegel. In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it. (shrink)

The aim of this article is to show how both Jan Patočka and Jürgen Habermas, starting from a reinterpretation of the idea of «lifeworld», engaged a critique of modern civilisation, aiming (with different outcomes) at a redefinition of the concept of political community. In order to achieve this goal, I firstly focus on Patočka’s understanding of modern rational civilisation and its attempt to fix the fracture between «life» and «world». At this stage, I take also advantage of Hans Blumenberg’s distinction (...) between these two terms, in order to better clarify Patočka’s stance on this problem. Secondly, I analyse Habermas’ ideas of lifeworld and system, and their uncoupling in modern societies, as well as the reemergence of this issue in Habermas’ recent works on the European economic and political crisis. Finally, I focus on the very different ways in which Patočka and Habermas tackled the ideas of conflict and crisis in contemporary world, also in view of a possible path out of this crisis through a re-constitution of Europe. (shrink)

Global Solidarity and Collective Intelligence in Times of Pandemics Some of the existential threats we currently face are global in the sense that they affect us all, and thus matter of global concern and trigger duties of moral global solidarity. But some of these global threats, such as the COVID-19 pandemic, are global in a second, additional, sense: discharging them requires joint, coordinated global action. For that reason, these twofold global threats trigger political – not merely moral – duties of (...) global solidarity. This article explores the contrast between these two types of global threats with the purpose of clarifying the distinction between moral and political duties of global solidarity. And, in the absence of a fully developed global democratic institutional system, the article also explores some promising ways to fulfill our global political duties, especially those based on mechanisms of collective intelligence such as CrowdLaw, which might provide effective solutions to these global threats while enhancing the democratic legitimacy of public decision-making. (shrink)

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long‐running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher‐quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries (...) apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high‐quality, affordable health care. (shrink)

ABSTRACT This article examines the two carceral novels (The Walls of Water and The Hole) of the Mexican philosopher, writer and labor activist José Revueltas using as a lens Richard Rorty’s views on solidarity—particularly, Rorty’s views on what solidarity consists in, how it is developed and the effects it has, and this article argues that, if Rorty’s views on solidarity are correct, Revueltas’s carceral novels have a remarkable ability to expand our solidarity in virtue of their raw portrayal of the (...) shared humiliation and suffering endured by prisoners within the Mexican penal system, which Revueltas was well acquainted with. Specifically, this article shows that Revueltas’s characters in the two novels develop solidarity in virtue of a common susceptibility to pain and humiliation, that they show what solidarity consists in since they share common selfish hopes about small things that are woven into their final vocabulary and, finally, that they illustrate the effects of solidarity as they are forced to live in environments where all traditional differences (e.g., race, tribe, religion, etc.) eventually fade. (shrink)

The coronavirus pandemic has impacted health care, economies and societies in ways that are still being measured across the world. To control the spread of the virus, governments continue to appeal to citizens to alter their behaviours and act in the interests of the collective public good so as to protect the vulnerable. Demonstrations of collective solidarity are being consistently sought to control the spread of the virus. Catchphrases, soundbites and hashtags such as ‘we’re all in this together’, ‘stronger together’ (...) and other messages of unity are employed, invoking the sense of a collective struggle. However, this approach is fundamentally challenged as collectivist attitudes run contrary to the individualism of neoliberal ideology, to which citizens have been subjected. This paper argues that attempting to employ the concept of solidarity is inherently challenged by the deep impact of neoliberalism in health policies and draws on the work of Durkheim to examine the concept in a context in which health care has become established as an individual responsibility. The paper will argue that a dominant private-responsibility model and an underfunded public system have eroded solidarity weakening its effectiveness in generating concerns for the collective. (shrink)

In medical ethics, an appropriate national healthcare system that meets the requirements of justice in healthcare resource allocation is a major concern. Japan is no exception to this trend, and the pros and cons of introducing a two-tier healthcare system, which permits insured medical care services to be provided along with services not covered by social health insurance, have been the subject of debate for many years. The Supreme Court ruled in 2011 that it was valid for the government to (...) ban mixing medical treatments and both the Ministry of Health, Labour and Welfare and Japanese Medical Association oppose the introduction of such a system. In this paper, we examine the main arguments against the introduction of a two-tier healthcare system and ideas that form their basis, which can be broadly divided into opinions based on the importance of equality and those derived from the logical conclusion that the outcomes would be detrimental. We point out issues and shortcomings of each standpoint and argue that the introduction of the system would not necessarily threaten equality and social solidarity in Japanese society, and that abuses of a self-pay tier would be controllable to a certain extent. Then, the authors—who do not actively promote the introduction of a two-tier healthcare system—conclude that the allegation that is completely devoted to one side and the theory that social healthcare is collapsing, which makes the public excessively nervous, cannot be accepted. (shrink)

By imperial design, the Caribbean region was created as uneven yet interconnected archipelagos of Black dispossession, devaluation and dehumanisation. On this basis, Caribbean leaders have initiated calls for reparatory justice, demanding restitution for longstanding systemic inequalities stemming largely from plantation slavery, colonialism and native genocide. This paper interrogates the Caribbean program for reparatory justice drawing out its political strategies and ideological underpinnings. This analysis shows that the current eliteled “reparations-for-development” project reproduces a narrow modernizing form of economic reparations that is (...) premised on redress by accumulation and the continuation of the postcolonial liberal state despite its limited sovereignties, ongoing exclusions of marginalized Caribbean peoples, and racially and class oppressive dispositions. With limited community rootedness and consideration of increased marginalization of Caribbean communities in the face of climate hazards, this narrow approach critically ignores the ways in which Caribbean communities build solidarities and mutual care, or reparative ecologies, in response to external capitalist and socio-ecological pressures. This paper argues for an anti-systemic approach that considers the borderless nature of climate change, yet its specific oppressions and effects on Caribbean communities, which includes anti-imperialist and anti-neoliberal climate justice agenda that expands collective “freedom” spaces and recognizes reparative ecologies may contribute a more emancipatory approach. (shrink)

This paper offers a normative exploration of what exploitation is and of what is wrong with it. The focus is on the critical assessment of the exploitation of workers in capitalist societies. Such exploitation is wrongful when it involves a contra-solidaristic use of power to benefit oneself at the expense of others. Wrongful exploitation consists in using your greater power, and sometimes even in making other less powerful than you, in order to get them to benefit you more than they (...) ought to. This account of exploitation is appealing because it simultaneously captures three morally significant dimensions of exploitation—its material and social background, the relational (interpersonal and systemic) attitudes it enacts, and the final distributive results it generates. Exploitation is indeed a multidimensional social process. The flipside of the proposed critical characterization of this process is a positive ideal of solidaristic empowerment in the allocation and use of economic power, which the paper articulates in terms of the socialist Abilities/Needs Principle (“from each according to their abilities, to each according to their needs”). The Abilities/Needs Principle is grounded in human dignity. (shrink)

Satirical cartooning in Vietnam is subject to a complex dynamic: an increasingly liberalised and internationalised economy, and the rise of social media in a one-party state. This article examines what state-sanctioned satirical cartoons can reveal about the representation and management of political criticism in such a context. We find a growing trend of depicting corruption as a systemic problem, which is present in 45 per cent of the sample and in 70 per cent of the 20 most-viral cartoons in one (...) of Vietnam’s most popular magazines, Tuoi Tre Cuoi (Youth Humour). This trend can be interpreted as a change in the sensibility of audiences and a shift toward a more tolerant media landscape. The trend, however, may also be a worrying sign of the dual dangers of cynicism in Vietnamese politics: the development of apathy among audiences and the cynical use of art by authorities. Despite these concerns, we argue, political cartoons in Vietnam provide an important public avenue for collective political reflection and everyday social solidarity. (shrink)

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

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

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually advantageous (...) cooperation. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by (...) some high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

Germany has just started a public debate on priority-setting, rationing and cost-effectiveness due to the cost explosion within the German health care system. To date, the costs for German health care run at 11,6 % of its Gross Domestic Product (GDP, 278,3 billion €) that represents a significant increase from the 5,9 % levels present in 1970. In response, the German Parliament has enacted several major and minor legal reforms over the last three decades for the sake of cost containment (...) and maintaining stability of the health care system. The Statutory Health Insurance—SHI (Gesetzliche Krankenversicherung—GKV) is based on the fundamental principle of solidarity and provides an ethical and legal framework for implementing equity, comprehensiveness and setting the principles and rules for financing and providing health care services and benefits. Within the SHI system, several major actors can be identified: the Federal Ministry of Health, the 16 state ministries of health, the Federal Joint Committee (G-BA), the physicians (with their associations) and the hospitals (with their organizations) on the provider side, and the sickness funds with their associations on the purchasers’ side. This article reviews the structure and complexities of the German health care system with its major players and participants. The focus will be put on relevant ethical, legal and economic aspects for prioritization, rationalization, rationing and cost-effectiveness of medical benefits and services. In conclusion, this article pleads for open discussion on the challenging subject of priority-setting instead of accepting the implicit and non-transparent rationing of medical services that currently occurs at many different levels within the health care system, as it stands today. (shrink)

A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in part, (...) realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes. (shrink)

People experiencing similar conditions may make different decisions, and their belief systems provide insight about these differences. An example of high‐stakes decision‐making within a complex social context is the Arab Spring, in which large numbers of people decided to protest and even larger numbers decided to stay at home. This study uses qualitative analyses of interview narratives and social media addressing individual decisions to develop a computational model tracing the cognitive decision‐making process. The model builds on work by Abelson (...) and Carroll (1965), Schank and Abelson (1977), and Axelrod (1976) to systematically trace the inferences connecting beliefs to decisions. The findings show that protest decisions were often based on positive emotions such as pride, hope, courage, and solidarity, triggered by beliefs about successful protest and self‐sacrifice. By contrast, decisions to stay at home were triggered by beliefs about safety, state approval, and living conditions. As one participant said, “When I heard about the revolution in Tunisia, my heart was filled with solidarity for the people.” In the words of a non‐participant: “When people are killed, we must be careful. There are more important things than protest: safety and stability.” This study of individual explanations about events identifies the role of emotions in high‐stakes decision‐making within complex social environments. (shrink)

The new Hungarian Labour Code allows informal payments to be accepted, subject only to the prior permission of the employer. In Hungary, the area most affected is Health Care, where informal payments to medical staff are common. The article assesses the practice on ethical terms, focusing on organisational justice. It includes an analysis of distributional injustice, that is, of non-equitable payments to professionals, on the distribution of payments depending on the specialisation and status of the doctor, on his or her (...) rights to allocate Health Care resources and/or on how assertive he or she is. We show, by means of a content analysis of internet postings and of interviews with physicians, the feelings and attitudes of both patients and doctors—thus enabling us to trace interactional and procedural injustice and portray the main driving forces of informal payment with causal loops. We use a new approach (a system dynamics computer simulation) to demonstrate how informal payments influence therapy procedures. The example of treating the common skin disease of psoriasis examines the specific behaviour of doctors in their everyday practice and estimates the extent to which the prescription of unnecessary or more expensive therapy increases the costs. With this multi-method approach, we demonstrate that the legislation allowing informal payment represents bad ethics, since it enforces organisational injustice, creates mistrust between physicians and patients, decreases performance and increases the total costs paid both by society and the Health Insurance Fund. Informal payments distort the allocation of resources, enforce discrimination based solely on money, violate the concept of solidarity and limit Human Rights in terms of health. (shrink)

Civic food networks increasingly seek to increase their impact in building fairer and more sustainable food systems through solidarity financing. This represents a counterpoint to financialisation in industrialised food systems through alignment with the values and practices of solidarity economy such as localisation, reciprocity, cooperation, resilience and food justice. Of growing interest is the potential for sourcing finance from the wider community; people who may be willing to contribute to civic initiatives’ goals and share in their risks and (...) opportunities. Crowdfunding is one such approach in solidarity finance, appealing to both new and seasoned investors interested in supporting local sustainable food initiatives. This paper considers two case studies of equity crowdfunding in Australia to examine the relationships emerging between solidarity financing and food producers, consumers and investors in civic food networks, and the implications for progressing food democracy. Our findings describe the investors and their financial and non-financial motivations to participate in solidarity financing, and specifically to support crowdfunding; and the goals, strategies, and governance structures that characterise the experiments under study. These themes reveal how crowdfunding financiers assess the potential impacts of investments, especially on ecologies and food justice outcomes. We argue that these cases of solidarity financing are producing new forms of ‘citizen-financiers’, in parallel to the growing networks of ‘citizen-consumers’ and ‘citizen-producers’ that underscore shifts towards food democracy. Understanding the characteristics of this emerging category of civic actors contributes new understandings of the potential for food system transformation through solidarity economy, alternative finance and civil society. (shrink)

This paper explores the issue of whether an international system of nation‐states can be defended from a global perspective of impartiality. At present, it seems as if the nation‐state were the only suitable institutional location for the realization of effective systems of social justice. Provided that national politics is indeed disposed to promote the freedom and well‐being of its citizens, a decentralized system of nation‐states is likely to produce beneficial effects. Experience, however, teaches that national politics has in many (...) instances had decidedly negative effects. For that reason, the existing system of nation‐states cannot be defended from a global point of view. Hence, the question turns on whether a system of nation‐states could conceivably find the support of rational persons if it incorporated substantive restrictions on national politics. This paper discusses the liberty to migrate as one of the many options potentially available for the correction of the existing international regime. As the closer inspection of the underlying philosophical question reveals, the problem can only be resolved with reference to a normatively relevant understanding of the kind of persons we take ourselves to be. From the conclusion that the freedom to migrate is to be understood as a fundamental liberty, the discussion then turns to the legitimate limitations that might be imposed by national immigration policies. It is argued that—in order to accommodate what is demanded by both global impartiality and national solidarity—open admission policies must not in effect place at a disadvantage those who are already relatively worse off under a present distribution, for this would violate basic conditions for the development and confirmation of socially acquired self‐esteem. (shrink)

In this essay, Kim Niewolny, current President of AFHVS, responds to the 2020 AFHVS Presidential Address given by Molly Anderson. Niewolny is encouraged by Anderson’s message of moving “beyond the boundaries” by focusing our gaze on the insurmountable un-sustainability of the globalized food system. Anderson recommends three ways forward to address current challenges. Niewolny argues that building solidarity with social justice movements and engendering anti-racist praxis take precedence. This work includes but is not limited to dismantling the predominance of neoliberal-fueled (...) technocratic productivism in agricultural science and policy while firmly centering civil society collective action and human rights frameworks as our guiding imaginary for racial, gender, environmental, and climate justice possibilities for sustainable food systems praxis. She concludes by exploring the epistemic assertion to push beyond our professional and political imaginaries to build a more fair, just, and humanizing food system. (shrink)

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives (...) rise to a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this—currently relatively unknown and unresolved—dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments. (shrink)

Understanding cooperative human behaviour depends on insights into the biological basis of human altruism, as well as into socio-cultural development. In terms of evolutionary theory, kinship and reciprocity are well established as underlying cooperativeness. Reasons will be given suggesting an additional source, the capability of a cognition-based empathy that may have evolved as a by-product of strategic thought. An assessment of the range, the intrinsic limitations, and the conditions for activation of human cooperativeness would profit from a systems approach (...) combining biological and socio-cultural aspects. However, this is not yet the prevailing attitude among contemporary social and biological scientists who often hold prejudiced views of each other's notions. It is therefore worth noticing that the desirable integration of aspects has already been attempted, in remarkable and encouraging ways, in the history of thought on human nature. I will exemplify this with the ideas of the fourteenth century Arab-Muslim historian Ibn Khaldun. He set out to explicate human cooperativeness - "asabiyah" - as having a biological basis in common descent, but being extendable far beyond within social systems, though in a relatively unstable and attenuated fashion. He combined psychological and material factors in a dynamical theory of the rise and decline of political rulership, and related general social phenomena to basic features of human behaviour influenced by kinship, expectation of reciprocity, and empathic emotions. -/- . (shrink)

In an era of fiscal austerity and dualization of social protection, has organized labor become increasingly split along skill and industry lines? Against recent political science accounts of trade union involvement in social policymaking, this paper argues that, in the specific area of pensions, unions representing high-skilled workers and the core industrial sectors of the economy have paradoxically been led to increase their cooperation with unions representing the less privileged segments of labor, in order to improve coverage of private pensions (...) across the board. These unions’ motivations for doing so and the strategies they have employed have nonetheless differed according to the preexisting institutional design of domestic pension systems. The argument is supported with case studies of British, French, German, and Belgian unions’ involvement in contemporary pension reform. (shrink)

In this paper I will juxtapose the concept of the veil of ignorance – a fundamental premise of Rawlsian justice as fairness – and solidarity in the context of the organisation of a healthcare system. My hypothesis is that the veil of ignorance could be considered a rhetorical tool that supports compassion solidarity. In the concept of the veil of ignorance, I will find some crucial features of compassion solidarity within the Rawlsian concept of “reciprocity” – located between “impartiality” and (...) “mutual advantage”. I conclude that, even behind this “thick” veil, some essential, yet “particular” facts on health and wealth redistribution are available to decision makers. Lastly, I discover that by means of the assumption of self-interest in the original position the veil aims to convert egoism into empathy, thus invoking the solidarity of compassion that in turn could be translated into principles of the organisation of a healthcare system. (shrink)

Low-wage migrant workers in Singapore are legally entitled to healthcare provided by their employers and supported by private insurance, separate from the national UHC (universal health coverage) system. In practice, they face multiple barriers to access. In this article, we describe this policy-practice gap from the perspective of HealthServe, a non-profit organisation that assists low-wage migrant workers. We outline the healthcare financing system for migrant workers, describe commonly encountered barriers, and comment on their implications for the global UHC movement’s key (...) ethical concepts of fairness, equity, and solidarity. (shrink)