wow-inequalities/02-data/intermediate/wos_sample/ac52cfe134300c2909b7f56d4fd98105-derpmann-simon/info.yaml

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abstract: 'Political struggles not only change social institutions and conventions,
they also often shape normative language. Moral notions of lasting
significance are like geological formations insofar as they are usually
not formed in a void but under considerable pressure. While some notions
are fundamentally linked to legal documents or academic treatises,
others are mainly advanced in songs, pamphlets, or manifestos.
Philosophical attempts to define these evolved notions are often
sensitive to their particular histories in order to avoid detachment
from common pre-theoretical usage. After all, moral theory would be
ill-advised to rid itself of considered conceptual intuitions unless
there are strong grounds for revision. Even though theoretical
reflection may produce reasons to deviate from prevailing understandings
of core moral notions, it must eventually rely on some form of a
semantic orientation. The line between reconstructing and redefining
moral notions is particularly hard to draw when it comes to
comparatively young and polymorphic notions, such as solidarity. It is
difficult to provide a finite definition of `solidarity'', as the term
has been appropriated in the pursuit of a variety of causes. Different
theoretical reconstructions explicate solidarity as a form of unity,
fraternity, civic friendship, charity, humanity, or camaraderie. Instead
of reflecting on this variety of meanings, the present contribution
examines the reference to solidarity within a specific context of moral
debate. There are recurring calls for solidarity in contemporary
oppositions to the erosion of the protective reliabilities of society,
as it becomes manifest in the reduction, privatization, or
stratification of both social security in general and health care in
particular. In this context, solidarity is invoked as a relation that
connects all members of society, providing a reason to accept or support
the introduction or continuation of universal health care. In the
following, I am concerned with the adequacy of the moral terminology
implied in this line of reasoning. My claim is that - at least relative
to the purpose of moral philosophy to provide a systematic,
comprehensive, and fine-grained account of moral obligation - a specific
partisan notion of solidarity is of greater systematic value to moral
terminology than the alternative universal notion. At least one central
strain of moral references to `solidarity'' does not conceive it as a
notion of universal moral inclusion, but of communal relatedness. This
conception of solidarity imprints the term with a specific
community-related perspective, i.e. the distinctive normative and
motivational force of solidarity relations is taken to reside in a
specific form of partiality toward significant groups like unions,
cooperatives, parties, committees, etc. Ralph Chaplin''s Solidarity
Forever, for instance, memorably assigns the distinctive strength of
references to solidarity to union''s inspiration. In this understanding,
the reference to solidarity bears a specific moral and political
relevance because it conveys a normative insight to members of specific
communities, explicating why they may be obliged to take a stand for a
common cause, even if this involves going well beyond what can be
expected of them merely qua moral subjects. I aim to show that a
conception of `solidarity'' that confines it to this decidedly partisan
moral relation provides a significant contribution to moral philosophy
because it grasps a specific and important facet of moral obligation.
In the following, this structural feature of solidarity is discussed
with regard to the moral foundation of health care policies. I argue
that the demand to universal access to health care should be conceived
as a matter of justice, decency, or humanity, rather than of solidarity,
because the failure or refusal to provide adequate health coverage does
not disregard individuals as members of specific communities, but as
moral subjects. My argument for this terminological suggestion comes in
three sections. The first section establishes a normative notion of
solidarity as a source of - essentially partisan - communal obligations
reflecting on shared identificatory attributes like convictions, social
positions, or significant histories. Under this description, solidarity
is understood to pose a particular type of special obligations, creating
moral requirements that obtain apart from and beyond the demands of
universal morality. The reference to solidarity unfolds a particular
theoretical potential when it captures a distinct form of communality.
The second section locates the normative foundation of calls for
universal health care in the domain of justice by understanding the
provision of basic health care as a right of every moral subject that is
independent of normatively significant commonalities. The third section
concludes that solidarity is a notion that does have a place in
health-related norms, but that does not provide the best moral
foundation of demands for universal health care. Rather, relations of
solidarity establish forms of moral obligations that are indispensable
when social systems fail to provide justice or reach their legitimate
limits. The first step of the argument brings `solidarity'' into view as
a systematic term of moral philosophy as opposed to its role in
sociology or political theory. This perspective focuses on solidarity as
a relation that provides specific moral reasons, such as the reason to
accept and obey practices of mutual assistance, to put oneself at risk
or at a disadvantage for the benefit of others, to endure hardships for
the common good, etc. Thus, the reference to solidarity within moral
justification bears a discursive force in its own right. The main
difficulty in the appropriation of solidarity to moral philosophy is to
individuate and explicate a defining set of features of recognized uses
of the term. Due to the variety of relations, attitudes, and
dispositions that are commonly referred to as solidarity, no coherent
notion can be expected to be able to simultaneously capture obligations
toward humankind, or the exploited and the poor, among comrades and
sisters in arms, and between the members of parties, teams, clubs,
gangs, unions, collectives, and social movements. One reaction to this
diagnosis is to accept that solidarity is a pluralistic notion that
cannot be reduced to either of these meanings. However, this approach
would possibly have to allow a very broad understanding of `solidarity''
that could render the notion empty or incoherent. Such a conception of
solidarity may pose no difficulties within everyday language, but it can
be argued to be unsuitable for the kind of justification sought in moral
philosophy. There are legitimate doubts about the confinement of moral
notions like solidarity to the narrow boundaries of philosophical
concepts for systematic purposes. However, if the language of moral
philosophy is not to become artificial, it has to adopt notions of our
common language and alter them to avoid incoherences.
A moral account of solidarity is only of systematic value if the
reference to `solidarity'' captures a specific type of obligation that
can be distinguished from other moral obligations. Without an
explanation in what regards obligations of solidarity are different
from, go beyond, or are more specific than obligations of justice,
humanity, charity, fidelity, or loyalty, there is arguably no need for a
distinct theory of solidarity within moral philosophy. Thus, a
convincing exposition of solidarity should fulfill a condition of
conceptual discriminability, and of irreducibility. If it is to play any
significant role in moral philosophy, `solidarity'' has to refer to a
moral relation sui generis. Once some defining features of solidarity
are established, the meaning of references to solidarity in debates
about public health care can be addressed. In approaching a sound notion
of solidarity, different accounts can be distinguished with regard to
their position on its normative scope, i.e. with regard to the extension
of the groups within which subjects are considered to have mutual
obligations and corresponding claims of solidarity. The main dividing
line that is relevant to the present context - to the analysis of the
systematic function of references to solidarity within moral philosophy
- must be drawn between universalist and partisan accounts of
solidarity. Some prominent accounts of moral solidarity conceive it as a
universal relation that extends to all humanity, or to all members of
society, making solidarity the basis of a universal form of moral
obligation. David Wiggins and Jurgen Habermas, for instance, invoke
different notions of universal solidarity for different conceptual
reasons. While Wiggins refers to solidarity in order to designate a
fundamental form of a pre-reflective universal recognition implying
negative duties, Habermas describes solidarity as a non-formal positive
attitude of care complementing formal requirements of justice. Both
accounts provide valuable insights into the nature of political and
moral obligation. Yet, the competing understanding of solidarity as
specific by virtue of its partiality comes with considerable systematic
advantages. Wiggins understands solidarity as a fundamental moral
relation that is characterized, among other things, by its universality.
In this understanding, solidarity is a particular form of recognition
that forms the basis of morality altogether. This form of recognition
entails deontological constraints, but these constraints are not solely
based on demands of reason. Thus, solidarity resembles Kantian respect
in terms of the demands it poses, but with regard to the underlying
attitude, solidarity resembles Humean sympathy. In the course of
outlining obligations of solidarity, Wiggins identifies solidarity as
`the {[} horizontal ellipsis ] thing that any human being owes to any or
all other human beings, namely the solidum that is presupposed to the
ordinary morality of all interaction between human beings''. As the very
bedrock of moral relatedness, solidarity must extend to every moral
subject alike. Solidarity is the basic form of recognition that
interconnects moral subjects through their mutual consideration as
bearers of a point of view that commands respect. Habermas brings forth
a different account of solidarity, but he also uses the term to denote a
relation with a universal extension.
In this account: Solidarity {[} horizontal ellipsis ] is rooted in the
realization that each person must take responsibility for the other
because as consociates all must have an interest in the integrity of
their shared life context in the same way. Justice conceived
deontologically requires solidarity as its reverse side. Habermas
distinguishes the fundamental moral demands of justice that are directly
based on the principles of discourse from complementary demands of
sympathy or care that are based on solidarity. While justice
substantiates negative obligations, solidarity requires moral subjects
to strive at promoting the welfare of others. Thus, Habermas supplements
the discourse theory of morals with the relation of solidarity in order
to be able to account for materially rich notions of social relatedness.
However, in this description the `shared life-context'' relevant to
solidarity is not economic class, social position, or political stance
but society as a whole. For Habermas, justice and solidarity differ with
regard to the content of their obligation, yet they are similar in their
universal scope, as solidarity is conceived of as extending toward all
members of society. While both accounts capture an important aspect of
moral and political obligation, their recourse to `solidarity'' is not
without problems. There is no incontestable argument that would be
sufficient to reject these two notions of universal solidarity. While
there is no `separate essence'' of solidarity that could be referred to
in order to argue for the conceptual necessity of solidarity''s
partiality, some features may reasonably be stipulated as being
essential to solidarity with a view to its systematic function within
moral philosophy. Thus, I aim to uncover some systematic disadvantages
of assigning `solidarity'' in the description of a universal relation
within moral philosophy. The universal notion of solidarity misses - or
deliberately excludes - something that is at the core of a competing
account of solidarity. What is this feature of solidarity that is lost
in its universalization? As indicated before, influential references to
solidarity identify unity, cohesion, or community as essential elements
of solidarity. The idea that is at the core of this understanding of
solidarity can be illustrated with reference to a terminological
precursor of `solidarity''. A legal construction of Roman civil law, the
obligatio in solidum, describes a joint liability, or a liability for
the whole, that is incurred when individual debtors assume
responsibility for a collective loan. Accordingly, one can argue that
obligations of solidarity require a solidum, i.e. some form of an
entirety or a whole that serves as a point of reference in the content
of solidary obligations. Wiggins understands the solidum to refer to the
firmness of solidarity by making the relation of solidarity `the root of
the ethical'', or the hard core of morality. For Habermas, the solidum
may be society as a whole comprising moral subjects viewed as
consociates. These references to a solidum, however, have to be
distinguished from those that base solidarity in communal relations
entailing significant forms of relatedness that go beyond the
obligations of moral subjects qua moral subjects. Solidarity qua
partisan relation refers to a morally significant solidum in terms of a
wholeness or unity of distinct communities.
The question with regard to universal solidarity is what the reference
to a solidum contributes normatively beyond the consideration of others
as mere moral subjects. In the case of partial solidarity, significant
commonalities determine the range and the dimension of specific
obligations of solidarity. If a solidary community is of moral
significance, then it must entail a relevant distinction between
subjects as members of the community and others as - mere - moral
subjects, just like friends, comrades, or family members have to make
this distinction in order to satisfy the normative implications entailed
in friendship, camaraderie, or family. The moral significance that is
missing in accounts of universal solidarity concerns the role of
expressions like `my'' or `our'' as irreducible constituents of moral
reasons that are indicative of communal obligation. In this manner, the
reference to others as `my friend'', `my sister'', or `my ally'' expresses
a structural characteristic of morally significant relations within a
community. Thus, the obligation toward one''s own community is not merely
an obligation toward some community based on a neutral moral property
but on a reason that necessarily entails a reference to the bearer of
the obligation. This demonstrates that the universal relation that
Wiggins and Habermas have in mind cannot be regarded as one specific
form of - a human or a moral - solidarity that may coexist with narrower
forms of national, ethnic, cultural, or political solidarities. The
problem is that human solidarity lacks the significant reference to a
solidum. While there is a difference between characterizing someone as a
friend or a comrade and referring to her as one''s own friend or as my
comrade, it is plainly difficult to comprehend what would distinguish
someone as `my fellow human'' from someone as merely `a human''. The
solidarity within civil rights movements or political unions requires a
reference to others in relation to the subject of solidarity exposing
their significant commonality as feminists, homosexuals, workers,
anarchists, etc. Thus understood, relations of solidarity, and the
entitlements and obligations associated with them, only extend to those
who are related via significant commonalities, and the content of
solidary obligations is explained and limited by these commonalities as
well. This structural difference between agent-relative and neutral
moral reasons suggests that the notions of universal and partisan
solidarity are incompatible; but this does not imply that the universal
notion has to give way to the partisan notion of solidarity. My argument
rests on the assumption that, while the notion of partisan solidarity
captures a specific moral phenomenon for which there is no comparable
alternative, the partisan conception does not take anything away from
those accounts that refer to universal solidarity, because other
established moral notions like humanity, charity, or beneficence suffice
to capture what appears to be invoked in references to universal
solidarity. While it is impossible to pre-decide this issue for all
potential conceptions of universal solidarity, the relation that Wiggins
has in mind may be re-described as humanity, compassion, or
fellow-feeling, or maybe as a basic form of moral recognition.
At any rate, other terms than `solidarity'', which is commonly associated
with a much more specific meaning, may be conceived as fitting to
describe such a fundamental form of moral relatedness. Similarly, one
may concede that Habermas makes a valid material point to emphasize
positive obligations between all members of society. Yet, there may be
alternative notions, like care, mutual concern, or civility, that
capture what Habermas has in mind. If using the term solidarity to
describe universal moral relations leaves a specific form of moral
obligation without a label, more needs to be said about the
distinctiveness of the communality that is supposed to be entailed in
this form of moral obligation. Solidarity is often regarded as an
inherently inclusive ideal to counter the narrowness of commitments to
blood, soil, and nation. This appears to be incompatible with the
defense of an essentially partial, and thus exclusive, notion of
solidarity. However, solidarity cannot only be distinguished from
universally inclusive obligations, but also from immediate and exclusive
forms of moral relatedness like patriotism, friendship, or loyalty. Thus
conceived, solidarity comprises a very specific strain of a wider set of
what may be considered associative obligations. These obligations, in
turn, belong to a wider class of special obligations comprising
contractual duties, reparative duties, and duties of gratitude.
Solidarity''s normative force depends on meaningful commonalities like a
joint struggle, a common ideal of a good life, or a social utopia, in
relation to which a solidary subject positions herself, while being
aware that others do the same. Solidarity is special insofar as it
contains a shared partisan involvement with a group that is not
strategic, but that is nonetheless `mediated by thought and belief''. Due
to its normative foundation in reflected commitments, solidarity tends
to be more inclusive than immediate ties of kith and kin. Even though
solidarity is - inevitably - more exclusive than humanity, it allows for
inclusion of those who are willing to join with an identificatory
commitment. If solidarity relations pertain to a specific form of
communal obligation which holds some significance in moral life, and for
the description of which moral philosophy possesses no viable
alternative, then abandoning this notion noticeably impoverishes moral
language. This pragmatic argument about philosophical terminology does
not question the existence of universal obligations, but it suggests
that the term solidarity is misplaced in the denotation of universal
obligations or affiliations; or at least that the decision to understand
solidarity as universal is accompanied by a systematic disadvantage to
moral philosophy. In the remainder, I am interested in the possible
normative role of this account of solidarity within bioethics and health
justice. The previous argument does not, by itself, show that the term
solidarity is misplaced in the formulation of moral demands for
universal health care. In order to substantiate this thesis, more needs
to be said about the vindication of health-related claims and
obligations. My terminological suggestion presupposes that public health
care is not - or at least not primarily - a matter of communal or
partisan obligation, even though the prevalent vocabulary of health care
entails some conceptual vicinity to notions like solidarity.
The extent to which the moral demand to universal health care can be
argued to be based on solidarity depends on the general nature of the
normative foundation of the provision of public health care. According
to the broad WHO definition, universal health care or coverage exists
when `all individuals and communities receive the health services they
need without suffering financial hardship''. Beyond safeguarding access
to health services, which can be realized through different types of
government interventions from providing health services to structuring
public and private insurance schemes, universal health coverage also
extends to public health measures addressing disease prevention or
health equality. In the first instance, universality is defined in
relation to existing societies, requiring all members, citizens, or
residents to be adequately protected against the contingency of disease
and infirmity. Solidarity is often invoked in this context because it is
considered to be closely connected to core mechanisms of health
protection, such as the mutual assistance and the socialization of the
costs of health protection and health services. Depending on the extent
of commodification, i.e. on the absence of government intervention
regarding premiums, redistribution, coverage, compulsory membership,
etc., some health care regimes rely on conventional insurance models,
while others operate through different forms of government intervention.
The fundamental distinction to be made concerns different ideas of the
socialization of health-related burdens and risks. Many forms of
protection against disability, fire, theft, debt default, etc. are
covered through insurance policies that are privately offered on
markets. In these schemes, individuals pay risk-equivalent premiums to a
common fund in order to pool resources that are distributed to
individuals suffering the harm covered by the respective scheme of
collective protection. The principle underlying these forms of insurance
- an idea that increasingly governs systems of private health insurance
as well - does not rest on a moral notion of solidarity at all, as the
rationale for participation is fully reducible to a non-moral motivation
of self-interest. In fact, one of the major criticisms of the
privatization of health insurance is directed at the loss of solidarity
involved in individualization and the crowding out of poor-risk
patients. In contrast to the market model of health insurance, most
forms of state-regulated or state-run health care are not organized in
the form of a collection of risk-equivalent premiums but entail some
redistributive measures, such as the provision or support of social
health insurance or tax-based financing of health services. Public
health systems deliberately ignore factors like age, gender, social
status, or pre-existing health conditions that have an impact on the
estimated costs of health services to be covered in the case of
maternity, illness, or injury. This renunciation to select, isolate, and
exclude poor risks may be considered an institutionalization of a
genuinely moral form of solidarity. This moral notion of solidarity as a
measure to socialize risk and burdens is ubiquitous in the development
of the welfare state. Thus, references to solidarity in the context of
health provision may be considered rudiments of the normative frameworks
of initial efforts to establish social health care that were conceived
to replace vanishing traditional forms of social protection.
Toward the establishment of universal public health care, local
protective institutions like the family, tribe, or village are gradually
supplemented or replaced by initially delineated communities of a
company''s workforce, the members of a cooperative, a union, craft, or
class. The history of the development of public health care is permeated
with references to solidarity as an ideal of moral inclusion. Thus, the
historic achievement of the modern welfare state could be seen in its
incorporation of numerous local solidarities into a single
all-encompassing system of solidarity as it may be found in programs of
social health insurance and tax-based health systems. If original forms
of social protection are describable as forms of solidarity, then the
public provision in systems of universal health care may be argued to be
an extension of the initially limited forms of group solidarity toward a
universal solidarity within society as a whole. One could argue that the
development of a separation of privately organized insurance schemes
from a universal system of health care runs contrary to the modern
process of expanding health insurance and solidarity instead of
fragmenting or restricting it. Thus conceived, solidarity would be an
adequate normative reference condemning trends toward atomization and
self-reliance, and away from the collectivization of health risks.
Despite the initial plausibility of this description, the previous
distinctions suggest that the relations of solidarity within initially
separate schemes of insurance and social protection undergo a
substantial transformation by being universalized, thus possibly calling
for a description in a different moral vocabulary. The normative
innovation that is entailed in the shift from communal toward universal
inclusion in health care provision is decisive to the present argument
regarding moral terminology. It suggests that universal health care is
better justified in a different vocabulary than that of solidarity.
There is a fundamental argument that casts conceptual doubt on the idea
of understanding solidarity as a foundation of universal health
coverage. Even though many factual instances of health care provision
may be described as based on solidarity, there is a decisive difference
to the moral foundation of universal health care. In order to conform
with the previous understanding, the reference to solidarity in
arguments supporting universal health care would require a commonality
that serves as the solidum substantiating health-related obligations of
solidarity. However, the principle of universal inclusion appears to
contradict the supposition of a solidum that would substantiate a
distinction between members and non-members. One evident candidate for
such a commonality would be the human vulnerability to disease,
infirmity, or injury. In this line of argument, health claims could be
considered to be based on a shared vulnerability that transcends
individual claims of justice stemming from general attributes. However,
the attempt to base health-related moral claims on a commonality of
human vulnerability that unites all human individuals is not convincing.
Rather than some form of a commonality, the universal presence of a
morally relevant feature appears to do the normative work here. It is
hard to comprehend how the universal vulnerability to disease and
infirmity would serve as an identificatory point of reference to
substantiate moral obligations toward others beyond their significance
as moral subjects.
In contrast to the universal fragility, the commonality of the specific
situation of persons with AIDS or cancer can be conceived as such a
point of reference, which is reflected in the membership of patient
associations. Another problem of accounts of health-related universal
solidarity is that they seem unable to show what this basal
identification would add to our idea of moral obligation. If all humans
share this vulnerability to disease and infirmity, then all that they
could be said to owe to one another as vulnerable subjects is already
encompassed in their obligations toward one another as human beings. The
alternative to understanding moral demands on health care as stemming
from some morally significant commonality is to devise them as
universally dispersed entitlements of justice. In this understanding,
claims to health do not go beyond the basic forms of moral obligation,
and thus require no special obligation. They are neither supererogatory
nor are they based in some special form of communality. This idea is
reflected as a right to health, which - even though more has to be said
about its peculiar object - is widely regarded as a fundamental human
right. While the borders of nation-states inevitably set a frame for the
political implementation of moral demands to health, the justification
of these demands does not depend on the reference to this contingent
frame. The reference to a `human right'' to health suggests that moral
claims to health are not morally based in membership, or citizenship,
but in the status of moral persons. There are two conceptual advantages
to conceiving of claims to health in terms of justice, rather than
solidarity. First, based on the distinction between communal and
universal forms of obligation, solidarity remains available as a
powerful reference to a specific form of communal obligation that
obliges members of specific groups like unions, civil rights movements,
political associations, cultural collectives, etc. toward each other
beyond neutral morality. Second, the moral significance of
health-related claims is reflected in the fact that they are not
inferred from a commonality complementing the fundamental demands of
morality, but they are situated at the center of social morality.
Condemning the absence of sufficient health services by bemoaning a lack
of solidarity may not be misconceived entirely, but it does not address
the gravity of the moral offense entailed in violating or neglecting
demands of justice. The rights-based argument for universal health care
can be approached in different ways. It can be interpreted as stemming
from a right to a specific health status, as a right to a range of
health care services, or as the right to the opportunity to participate
in an adequate system of health protection. While these distinctions are
of importance when it comes to evaluating health systems, the point in
the context of the present analysis is that there is a vindication of
moral claims to the provision of health care that is independent of
considerations of solidarity, because these claims are independent of a
normatively relevant solidum. In theories of justice, health is widely
understood as a universally valued good that is worthy of protection,
and whose importance generates strong obligations for society,
obligations to corresponding rights. However, the reference to a right
to health, if understood as a right to be healthy, arguably contains a
mistake about the possible objects of moral entitlements.
The crucial issue is that the adequate object corresponding to a right
cannot be a status, but it must be an action, or a set of rules or an
institution. While societies do have an impact on population health
through measures of environmental awareness, workplace safety,
education, etc., health is something that cannot be unconditionally owed
to a person. The right to a certain health status at any rate poses an
unreasonable, or even an unrealizable demand. This problem leads to the
assumption that there is no right to health, but only to health-related
resources and services like vaccines and vaccinations, X-rays,
counseling, appendectomies, etc. Accordingly, legal interpretations of
the right to health acknowledge that it `must be understood as a right
to the enjoyment of a variety of facilities, goods, services, and
conditions necessary for the realization of the highest attainable
standard of health''. This further criterion regarding the range of
health services by reference to their adequacy to achieve the `highest
attainable standard'' of health is particularly instructive, because it
shows that the mere reference to a right to health care is incomplete.
The modified reference to a health status that is not absolute but
relative to specific personal and social conditions serves the purpose
of delineating a reasonable, but possibly comprehensive, standard of
what can be reasonably required in the promotion of health. The reason
not to understand the right to health by reference to a fixed catalogue
of health services is that the legitimate requirements on health systems
depend on the available resources. The right to health as a right to the
highest attainable standard of health can thus be understood as a right
to the opportunity to achieve a standard of health that is realizable
under the prevailing social circumstances. The point that is crucial to
the present inquiry is that these justifications of the provision of
public health care may - or even should - forgo references to a form of
solidarity that is based on significant commonalities. Basic health care
can be argued to be a demand of justice, and should not be translated to
a demand of solidarity, as this shift of terminology has moral
implications. There is a justified demand for universal health care that
does not appeal to our specific commonality as beings that are
vulnerable to disease and injury or to our membership in specific
communities, but that is simply based on the fundamental intrinsic and
instrumental importance of health. As the main topic of the present
inquiry is moral terminology, my primary aim is not to substantiate the
material commitments regarding health-related moral claims that have
been incurred along the way but to specify the role of solidarity in the
justification of public health care. An admittedly surprising result is
that the foundation of moral claims to health via health rights may be
subsumed under the Habermasian conception of solidarity. However, my
disagreement with Habermas does not concern his substantiation of
universal claims to positive measures of assistance but the choice of
terminology relative to the functions of moral theory. Thus, my concern
regarding the universalization of the term solidarity, and its
subsequent suitability to communal obligations, remains.
The problem of the universal notion of solidarity in this context
consists of the dilemma of either providing an insufficient
substantiation of fundamental health-related moral claims or of diluting
a notion of communal relatedness that is relevant in other situations.
Two more points should be made in order to better grasp the potential
role of references to a moral notion of solidarity. The previous
characterization of solidarity indicates that philosophical conceptions
of solidarity remain relative in at least three regards. First, the
field of obligations associated with solidarity depends on normative
background assumptions incurred in philosophical accounts of morality.
Relations of partial solidarity do not necessarily replace or outweigh
universal forms of moral obligation. They constitute merely one
dimension in a complex fabric of interpersonal moral relations. If
solidarity is conceived of as a type of a special duty, i.e. as a form
of obligation that exceeds the demands of neutral morality, then the
potential range of obligations of solidarity depends upon what is
included in the sphere of general moral obligation, and what is not.
This points to a second relativity of solidarity as a moral notion. As
indicated before, the moral force of obligations of solidarity depends
on the moral legitimacy of the commonalities generating solidarity
relations. On the one hand, moral obligations stemming from solidarity
can be overridden by demands of justice, but, on the other hand, they
also have to meet an internal criterion of moral adequacy. The partisan
conception of solidarity does not imply that any form of commonality can
be invoked to establish a special obligation toward the members of a
group. From a sociological perspective, the cohesion within the mafia or
among White supremacists may be described as solidarity, but in virtue
of the repulsiveness of their ideological foundation, these relations do
not have to be accounted for as morally binding because the immoral
content of a common conviction can operate as a defeating reason to the
moral validity of its role as an identificatory commonality. In this
sense, solidarity is normatively dependent without being reducible to
neutral morality. Finally, the importance of relations of solidarity is
dependent on the social environment in which they arise. This may, in
part, explain the current social reversion to the vocabulary of
solidarity. Within just societies, solidarity provides a reference point
in the self-location of individuals within identificatory communities.
This function is important to the generation and embedding of individual
personalities. However, under non-ideal circumstances, solidarity may
assume a core function in the enforcement of basic moral claims, and in
the compensation of the shortfalls of social institutions. Two reasons
appear to be pressing for conceptual clarity when making reference to
solidarity. First, there is a danger of underrating the moral weight of
claims to health care. In the understanding defended above, solidarity
is imprinted with the idea that its obligations are special insofar as
they go beyond what persons owe one another as moral subjects.
Overstretching this notion opens the possibility of understanding the
inadequate provision of health care as something that is regrettable,
but that is outside the domain of justice. Solidarity marks those
obligations that stem from their relatedness as members of morally
significant communities.
The obligation to provide a social system of protection against the
harms caused by disease and injury extends to persons irrespective of
their class, heritage, or belonging. Meeting this basic demand does not
mark the solidarity of a society, but its decency. It is not something
that must be justified by reference to an additional condition like a
morally significant commonality. Second, relations of solidarity provide
extremely important normative and motivational resources of social
engagement. The preceding argument does not imply that solidarity is
dispensable when it comes to analyzing and posing moral demands and
corresponding obligations that are related to health. Beyond this,
solidarity as a social relation and the obligations that it generates
can be argued to be particularly relevant in times of crisis. Solidarity
is less likely to be invoked in societies that manage to avoid the
emergence of grave inequalities, discrimination, or injustice, than in
societies that are unwilling or unable to provide adequate frameworks
for just cooperation. The normative and motivational force of the ties
invoked by solidarity is particularly relevant when basic moral demands
are not met, and all non-ideal societies are in need of these kinds of
solidarities. When Greece was hit by economic crisis and austerity, food
solidarity centers, social kitchens, and solidarity clinics emerged
throughout the country to countervail the gaps left after the retreat of
government from the provision of welfare. In this manner, local
solidarities may prove crucial in mitigation the effects of social
regression. Similarly, the civil society in the United States may be
forced revert to these mechanisms of social protection when those with
no or low income and those vulnerable to disease and infirmity - i.e.
the poor and the poor-risks - are effectively deprived of access to
health care through market expansion and government retreat. The call
for the emergence of solidarity in these contexts, however, should be
strictly distinguished from the indignation about the absence of
justice. It is in these contexts that a precise notion of solidarity is
required so that it can unfold its full normative potential and the
motivational force of union''s inspiration. The main concern of the
previous argument is that a notion of universal solidarity is employed
at the cost of the ability to give expression to a different moral idea
of a wide but nonetheless thick communality. Ralph Chaplin considered
solidarity to be able to summon a power greater than hoarded gold and
greater than the might of armies, and it seems like the power of
establishing this form of communality is one of the reasons for the
ubiquity of references to solidarity. The actual relations of solidarity
may not vanish due to a lack of vocabulary to refer to them, but their
potential to generate moral action may decrease as a result of our
inability to discern them. The author declares no conflict of interest.
See e.g. Stjerno, S. (2005). Solidarity in Europe. The history of an
idea. Cambridge, UK: Cambridge University Press. A topography of the
term is offered in Bayertz, K. (1999). Four uses of ``solidarity{''''}. In
K. Bayertz (Ed.), Solidarity (pp. 3-28). Dordrecht, The Netherlands:
Kluwer Academic.See e.g. ter Meulen, R., Arts, W., \& Muffels, R.
(Eds.). (2001). Solidarity in health and social care in Europe.
Dordrecht, The Netherlands: Kluwer Academic.
The famous first lines run as follows: `When the union''s inspiration
through the workers'' blood shall run, there can be no power greater
anywhere beneath the sun. Yet what force on earth is weaker than the
feeble strength of one, for the union makes us strong''. Chaplin, of
course, does not just refer to a principle of unity or union, but to the
union as a form of political organization. However, union - qua relation
of unity - is a defining principle of the type of organizations - like
trade unions or cooperatives - that Chaplin praises.A similar argument
can be found in Butler, S. (2012). A dialectic of cooperation and
competition: Solidarity and universal health care provision. Bioethics,
26, 351-360. Butler understands solidarity as one of the four tiers of
social competition and cooperation. His conclusion is that `whatever
justifications might exist for universal health care provision, none of
them are properly referred to as being based in solidarity'' (ibid: p.
351). Another defense of a partisan conception of solidarity is advanced
in Heyd, D. (2015). Solidarity:A local, partial and reflective emotion.
Diametros, 43, 55-64.For the distinction between prescriptive and
descriptive notions of solidarity in bioethics, see Prainsack, B., \&
Buyx, A. (2012). Solidarity in contemporary bioethics - Towards a new
approach. Bioethics, 26, 343-350. See also Kolers, A. (2016). A moral
theory of solidarity. Oxford, UK: Oxford University Press, p. 28.This
implies that solidarity''s role in moral philosophy amounts to more than
that of a `shaping sensibility''. See Jennings, B., \& Dawson, A. (2015).
Solidarity in the moral imagination of bioethics. Hastings Center
Report, 45, 31-38.On this dilemma, see Prainsack \& Buyx, op. cit. note
5, p. 344.This does not only mean that solidarity must be
distinguishable from other norms, but it also excludes accounts of
solidarity that consider it a mere instrument in the pursuit of
superordinate objects like justice or non-discrimination. While some
forms of solidarity may be embedded in struggles for justice, this does
not warrant the strong claim that `justice implicates solidarity'', as
suggested in Jennings \& Dawson, op. cit. note 6, p. 38. If solidarity
was merely instrumental to justice, there would be nothing wrong with
breaches of solidarity, as long as they promote - or are intended to
promote - overall justice.For a discussion of Wiggins, see Nagel, T.
(2010). Wiggins on human solidarity. In T. Nagel (Ed.), Secular
philosophy and the religious temperament: Essays 2002-2008 (pp.
147-152). New York, NY: Oxford University Press. See also Derpmann, S.
(2014). Solidarity, moral recognition, and communality. In A. Laitinen
\& A. Pessi (Eds.), Solidarity: Theory and practice (pp. 105-125).
Lanham, MD: Lexington Books.Wiggins, D. (2009). Solidarity and the root
of the ethical. Tijdschrift voor Filosofie, 71, 239-269.Habermas, J.
(1990). Justice and solidarity: On the discussion concerning stage 6. In
T. E. Wren (Ed.), The moral domain (pp. 224-251). Cambridge, MA: MIT
Press, p. 244. A critical reflection of the universality entailed in
Habermas'' account can be found in Wildt, A. (1999). Solidarity: Its
history and contemporary definition. In K. Bayertz (Ed.), Solidarity
(pp. 209-220). Dordrecht, The Netherlands: Kluwer Academic, p.
216.Regarding the extension of solidarity in Habermas'' conception, see
Rehg, W. (1994). Insight and solidarity.
A study in the discourse ethics of Jurgen Habermas. Berkeley, CA:
University of California Press, pp. 107-111. Rehg does not reject this
account, but he criticizes that Habermas does not sufficiently
distinguish moral solidarity from more concrete lifeworld solidarities.
Beyond this, I argue that the admission of a notion of moral, i.e.
universal solidarity undermines the crucial structure of `lifeworld
solidarities'' as essentially partial.Wildt, op. cit. note 11, p.
218.Both Axel Honneth and Rainer Forst observe that the point of
solidarity is lost in Habermas''s conception due to the absence of an
element of `particularism''. See Honneth, A. (2007). Disrespect. The
normative foundations of critical theory (pp. 99-128). Cambridge, UK:
Polity Press and Forst, R. (2002). Contexts of justice. Political
philosophy beyond liberalism and communitarianism (p. 304, note 21).
Berkeley, CA: University of California Press.Richard Rorty places this
morally significant `we'' at the heart of his conception of solidarity:
`The force of ``us{''''} is typically contrastive in the sense that it
contrasts with a ``they{''''}, which is also made up of human beings''. See
Rorty, R. (1989). Contingency, irony, and solidarity. New York, NY:
Cambridge University Press. A distinction of different meanings of this
`we'' can be found in Dean, J. (1995). Reflective solidarity.
Constellations, 2, 114-140, 124 ff.This is why Heyd rejects ter Meulen''s
notion of a `humanitarian solidarity'' based `on identification with the
values of humanity and responsibility for the other''. See Heyd, op. cit.
note 4, p. 57.For the limits to universal solidarity and the relation
between local, national, and cosmopolitan solidarities, see Derpmann, S.
(2009). Solidarity and cosmopolitanism. Ethical Theory and Moral
Practice, 12, 303-315.Ronald Dworkin defines these obligations as `{[}
horizontal ellipsis ] the special responsibilities social practice
attaches to membership in some biological or social group, like the
responsibilities of family or friends or neighbors''. See Dworkin, R.
(1986). Law''s empire. Cambridge, MA: Harvard University Press, p. 196. A
similar terminology is given by Scheffler, S. (2001). Boundaries and
allegiances: Problems of justice and responsibility in liberal thought.
New York, NY: Oxford University Press, pp. 48-49.See Heyd, op. cit. note
4, p. 59. In a similar manner, Jodi Dean defends a `reflective''
understanding of solidarity. See Dean, op. cit. note 15. Avery Kolers
highlights this aspect as well, as he understands solidarity - as
distinguished from loyalty - to be primarily based on a reason, not on a
prior connection to a group. See Kolers, op. cit. note 5, p. 44
ff.Problematic examples may be those where the common commitment itself
is exclusionary. While anyone may join the cause of suffragettes and
suffragists, tax resisters, guerrilla gardeners, or dadaists, specific
groups are excluded in the very content of the ideologies that unite
White supremacists, sexists, etc.WHO. (2016). Fact sheet: Universal
health coverage (UHC). Retrieved from
http://www.who.int/mediacentre/factsheets/fs395/en/. Accessed on March
6, 2018.See e.g. Borner, S. (2013). Belonging, solidarity and expansion
in social policy. Basingstoke, Hampshire, UK: Palgrave Macmillan, p. 35
ff. and Weale, A. (1990). Equality, social solidarity, and the welfare
state. Ethics, 100, 473-488.
In many cases, this form of insurance solidarity, however, is far from
being universal. If individuals are granted the opportunity to opt out
of insurance schemes that host high-cost risks, thereby reducing their
own fees as well as the socially available funds for redistribution,
there is no solidarity in a comprehensive sense but rather solidarity
within coexisting social groups.For a systematic account of solidarity
with regard to its relation to health care, see Jaeggi, R. (2011).
Solidarity and indifference. In R. ter Meulen, W. Arts, \& R. Muffels
(Eds.), Solidarity in health and social care in Europe (pp. 287-308).
Dordrecht, The Netherlands: Kluwer Academic.There is a general problem
concerning the term `universal'' in this context, as the universalism of
moral theory is contradicted by the localism of its implementation in
national health systems. Even though quite a number of moral demands are
spelled out in universal terms, the moral claim to health is primarily
implemented through the rights of citizens or residents of nation
states. Thus, one could object that all existing health systems are
partial toward the members of specific societies, and that they may be
regarded to be morally based in national solidarity. The recognition of
a universal demand to health is not exhausted in the protection and
promotion of health of citizens of a particular state but would require
the consideration of any moral subject. I will widely bypass this
fundamental complexity that affects all theories of political justice
and focus on universal health-related moral claims within given
societies. The following section reconstructs the normative foundation
of health systems by reference to a universal right to health as it is
formulated in UN conventions, while its implementation is de facto
translated to the fragmented responsibilities of nation states.This
argument is also made by Heyd, op. cit. note 4, pp. 62-63.For
institutional formulations - and interpretations of this right, see
Committee on Economic, Social and Cultural Rights. (2000). Substantive
issues arising in the implementation of the international covenant on
economic, social and cultural rights. General comment No. 14. ``The
right to the highest attainable standard of health.{''''} Retrieved from
http://www.refworld.org/docid/4538838d0.html. Accessed on March 6,
2018.On this argument, see Hessler, K., \& Buchanan, A. (2002).
Specifying the content of the human right to health care. In R. Rhodes,
M. Battin, \& A. Silvers (Eds.), Medicine and social justice: Essays on
the distribution of health (pp. 84-101). New York, NY: Oxford University
Press.See CESCR, op. cit. note 27, art. 12, sec 9.Daniels recognizes the
need for this extension of his initial account. See Daniels, N. (2008).
Just health. New York, NY: Cambridge University Press, pp. 2-3. On this
topic, see also Wolff, J. (2012). The human right to health. New York,
NY: W. W. Norton \& Company, pp. 13-34. INTRODUCTION: FORGING
`SOLIDARITY'' SOLIDARITY AS A MORAL IDEA Solidarity as a relation sui
generis Solidarity as a form of communal obligation THE MORALS OF HEALTH
CARE Solidarity and universal health care Health and human rights
SOLIDARITY AND HEALTH POLICY The relationality of solidarity The
importance of telling solidarity and justice apart CONFLICT OF INTEREST
Footnotes Solidarity is commonly invoked in the justification of public
health care.
This is understandable, as calls for and appeals to solidarity are
effective in the mobilization of unison action and the willingness to
incur sacrifices for others. However, the reference to solidarity as a
moral notion requires caution, as there is no agreement on the meaning
of solidarity. The article argues that the reference to solidarity as a
normative notion is relevant to health-related moral claims, but that it
does not provide a convincing foundation of claims to universal health
care. References to universal solidarity obliterate an important
distinction between those moral demands that are founded on principles
like justice, recognition, or humanity, and those demands that stem from
partisan relations in communities. While there is no `separate essence''
of solidarity that could be referred to in order to argue for the
conceptual necessity of solidarity''s partiality, some features may
reasonably be stipulated as being essential to solidarity with a view to
its systematic function within moral philosophy. The normative and
motivational force of the ties invoked by solidarity is particularly
relevant when basic moral demands are not met, and societies are in need
of significant forms of communal relatedness.'
affiliation: 'Derpmann, S (Corresponding Author), Westfalische Wilhelms Univ, Philosoph
Seminar, Dompl 23, D-48143 Munster, Germany.
Derpmann, Simon, Univ Munster, Dept Philosophy, Munster, Germany.'
author: Derpmann, Simon
author-email: simon.derpmann@wwu.de
author_list:
- family: Derpmann
given: Simon
da: '2023-09-28'
doi: 10.1111/bioe.12444
eissn: 1467-8519
files: []
issn: 0269-9702
journal: BIOETHICS
keywords: 'health care; justice; partiality; solidarity; universality; welfare
state'
language: English
month: NOV
number: 9, SI
number-of-cited-references: '29'
orcid-numbers: Derpmann, Simon/0000-0002-5851-1298
pages: 569-576
papis_id: 9bddfadad70bb519bf38fac55fb46af3
ref: Derpmann2018unionsinspiration
researcherid-numbers: 'Baldissera, Annalisa/AHD-6334-2022
Fazli, Ghazal/AAE-8320-2022
'
times-cited: '3'
title: 'Union''s inspiration: Universal health care and the essential partiality of
solidarity'
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000450332600005
usage-count-last-180-days: '28'
usage-count-since-2013: '333'
volume: '32'
web-of-science-categories: Ethics; Medical Ethics; Social Issues; Social Sciences,
Biomedical
year: '2018'