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' type: Article 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'