The demand for bodily parts such as organs is increasing, and individuals in certain circumstances are responding by offering parts of their bodies for sale. Is there anything wrong in this? Kant had arguments to suggest that there is, namely that we have duties towards our own bodies, among which is the duty not to sell parts of them. Kant's reasons for holding this view are examined, and found to depend on a notion of what is intrinsically degrading. Rom Harré's (...) recent revision of Kant's argument, in terms of an obligation to preserve the body's organic integrity, is considered. Harré's view does not rule out all acts of selling, but he too ultimately depends on a test of what is intrinsically degrading. Both his view and Kant's are rejected in favour of a view which argues that it does make sense to speak of duties towards our own bodies, grounded in the duty to promote the flourishing of human beings, including ourselves. This provides a reason for opposing the sale of bodily parts, and the current trend towards the market ethic in health care provision. (shrink)

Recent research on the cognitive abilities and emotional capacities of animals has fueled the animal rights movement and renewed debate over the differences between human and non-human animals. This debate has not been central to sociology, although George Herbert Mead drew a very hard line between humans and animals by asserting that the latter were not capable of symbolic interaction. Sociologists are now beginning to question this assumption, and this article falls within this new line of research. We begin by (...) presenting alternative interpretations of symbolic interaction that allow for the possibility of such activity in non-human animals. We review recent research on symbolic interaction between humans and dogs, and we present our own research findings on human-feline interaction. We conclude that there is growing evidence that symbolic interaction is widely distributed throughout the animal kingdom, and that it enables animals to survive more effectively in a wide variety of environments. (shrink)

This study explores the value of traditional ethnographic methods in sociology for the study of human-animal and animal-animal interactions and culture. Itargues that some measure of human-animal intersubjectivity is possible and that the method of participant observation is best suited to achieve this. Applying ethnographic methods to human-cat and cat-cat relationships in a no-kill cat shelter, the study presents initial findings; it concludes that the social structure of the shelter is the product of interaction both between humans and cats and (...) cats and cats and that the observed structure represents, to a large degree, choices made by the cats. The study also concludes that, within the cat community of the shelter, a distinctive cat culture has emerged, which represents the cats' adaptation to the particular conditions of shelter life. Specifically, the shelter allows for the emergence of higher order needs and goals that stress affection, friendship, and social cohesion among the cats rather than territoriality and conflict. The study further argues that traditional animal researchers have mistaken the relative equality of cat colonies for a lack of social structure, as opposed to a different structure from that found in sharply ranked nonhuman animal communities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.4 (2004) 299-301 [Access article in PDF] The Right Not to Know: A Challenge for Accurate Self-Assessment Ruth F. Chadwick Anderson and Lux present a very interesting and thought-provoking argument for the view that accurate self-assessment is a requirement for personal autonomy. What I want to suggest is that although this may be helpful in the context with which these authors are primarily concerned, (...) namely psychiatry and brain dysfunction, it is of less value to an account of autonomy more widely construed. I want to look at a possible counterexample, taken from another area of medicine, namely genetics.Toward the end of their article Anderson and Lux consider three objections to their position. I shall not discuss them all. My concern is with the third, that inaccurate self-assessment sometimes promotes autonomy, because knowing the truth about one's weaknesses is sometimes very debilitating. It is commonly argued that "you can if you think you can" and vice versa. As they point out, there are some complex issues involved here, in that if the result of the positive thinking is the ability to do the thing in question, then how can the self-assessment be deemed to have been inaccurate in the first place? They go on, however, to say that "it is unclear that inflated self-assessments yield benefits in contexts where what is required is not just effort but competence" (290).Now it has been argued, by some, in the context of genetics, that the proper understanding of autonomy may imply a "right not to know" facts about oneself. In other words, this is not just a matter of accurate or inaccurate assessment of the relevant facts about oneself; rather, what may be involved is a deliberate decision not to have access to facts that may be relevant to that assessment. There are clearly cases in which genetic information appears to be pertinent to an accurate self-assessment, as the following example suggests. Suppose there is information "available", through genetic testing, that would affect one's chances of having children, or of having children without a particular genetic disorder, and, knowing that such information is available, a couple decides not to avail themselves of this. This is clearly an inaccurate self-assessment, but is their autonomy compromised?It might be thought that the reasons for this decision not to know could be relevant. If they have no family history of any particular genetic disorder, it could be regarded as subjectively reasonable to decline such testing as might be offered. Anderson and Lux, however, argue that whether or not a self-assessment is accurate depends on externalities. In other words, A's self-assessment is not to be assessed as accurate, or [End Page 299] not, according to what it is subjectively reasonable to believe; it has to be measured against the facts. The more that the possibilities of genetic testing increase, the more that "facts" of this nature will be available, including in the context of psychiatry.It might be objected that genetic information is not the type of information that is relevant in this context. In so far as it is predictive and probabilistic it is, arguably, different from the type of diagnostic information involved in the cases discussed by Anderson and Lux. It is not the place here, however, to discuss in general terms the thesis of "genetic exceptionalism" with regard to medical information. The important point is refusal of access to information that may be relevant to an accurate self-assessment. Historically, people have been mistaken in their self-assessment because of lack of information—for example, lack of understanding of facts about the reproduction process has led individuals automatically to blame the woman partner of a couple for infertility. And, as Anderson and Lux rightly point out, being autonomous is compatible with making mistakes, and indeed requires the freedom to make mistakes, it would look rather different if a person continued to hold this without any attempt to avail himself of the relevant—and now available—information... (shrink)

This volume contains essays which cover a range of aspects in the debate over genetic testing. It looks at both the advantages and disadvantages involved in knowing or not knowing whether one is a carrier of certain genetic traits.

Every body cell of an animal or human being contains the same complete set of genes. In theory any of these cells can be used to start a new embryo. The technique has been employed in the case of frogs. The nucleus is taken out of a body cell of a frog and implanted in an enucleated frog's egg. The resulting egg cell is stimulated to develop into a normal frog, and will be an exact copy of that frog which (...) provided the nucleus with all the genetic information. In normal sexual reproduction, two parents each contribute half their genes, but in the case of cloning, one parent passes on all his or her genes. (shrink)

In this revised edition with a new preface from the editor, leading scientists explain the nature and goals of `test tube' reproduction and genetic engineering, and their eugenic implications. In contrast to the Warnock report, the extended commentary considers the issues in the context of a social ethic rather than the individualist viewpoint.

Imagine you were running a medical non-governmental organization (NGO) established to preserve the lives of poverty-stricken people in resource poor countries. Your NGO is also usually among the first to provide emergency assistance in case natural emergencies such as tsunamis strike. However, you did notice that agencies evaluating your efficiency1 give you a below-average ranking. That is a worry to your fundraising staff, mostly because you rely on donations and such ratings are said to impact eventually negatively, on your capacity (...) to raise cash. You investigate what the problem is, and it turns out that the ratings agency is critical of your policy of responding mostly in cases of high-impact disasters such as earthquakes, floods or civil wars, because they invariably require a highly resource intensive intervention. The agency's verdict is that, on the same capital outlay, you could preserve more lives in developing countries if you aimed at establishing medium- to long-term health delivery solutions, including setting up primary health care facilities, beginning vaccination programs, and other such relatively low-cost means. Chartering private jets to fly emergency teams in response to disaster also preserves lives deserving to be rescued, the ratings agency says, but it demonstrably results in a substantially lower number of lives preserved than you could preserve if you dropped such actions in favor of working toward better health care delivery infrastructure in the countries you usually serve. (shrink)

The question of what counts as a successful outcome of the process of genetics counselling has recently become central because of the increasing calls for efficiency in health care, and for means of measuring efficiency. Angus Clarke has drawn attention to this trend, and has argued against both a measure in terms of the number of terminations of pregnancy performed as a result of counselling, and an assessment in terms of the contribution of genetics counselling to a national eugenics policy. (...) He suggests instead a measure of workload. There are good arguments for supporting Clarke's position up to a point. In looking for an appropriate measure, much turns on how genetics counselling is defined. It is here understood in the context of an autonomy model of health care. It is argued that there is a contradiction between such an interpretation and the termination measure of outcome. The political philosophy underlying this outcome is also defective. Workload is not sufficient as a measure of outcome however; it is essential to look at the proper goals of an activity. It is argued that these must be connected in some way with the genetic health of the population; that the promotion of reproductive autonomy itself is not sufficient as a goal. The concern for genetic health, however, is interpreted in a way that avoids Clarke's concerns about a national eugenics policy. (shrink)

This book examines the ethical concepts which lie at the heart of journalism, including freedom, democracy, truth, objectivity, honesty and privacy. The common concern of the authors is to promote ethical conduct in the practice of journalism, as well as the quality of the information that readers and audience receive from the media.

This book examines the ethical concepts which lie at the heart of journalism, including freedom, democracy, truth, objectivity, honesty and privacy. The common concern of the authors is to promote ethical conduct in the practice of journalism, as well as the quality of the information that readers and audience receive from the media.

This book examines the ethical concepts which lie at the heart of journalism, including freedom, democracy, truth, objectivity, honesty and privacy.

Looks at ethical procedure in the choices and decisions made by nurses with regard to such questions as obeying doctors, covering up of a colleague's mistakes, recent developments in foetal surgery and whether the nurse's advocate role is tenable in practice. These questions are taken from the personal case studies recounted by 450 nurses in Britain and North America. The issues are to be found in many hospital situations and are faced in day-to-day practice by student and qualified nurses. A (...) commentary is provided on the ethical principles involved. (shrink)

In this revised edition with a new preface from the editor, leading scientists explain the nature and goals of `test tube' reproduction and genetic engineering, and their eugenic implications. In contrast to the Warnock report, the extended commentary considers the issues in the context of a social ethic rather than the individualist viewpoint.

This collection examines how the field of ethics has developed over the past fifty years, by bringing together those articles that have been seminal in the development of the subject. Each of the six volumes carries an introduction presenting the historical context of the material, and a new index is provided to identify key philosophical themes and trends within the collection. The volumes are organized thematically, and include: * Vol.1: Nature and Scope * Vol. 2: Ethical Issues in Medicine, Technology (...) and the Life Sciences * Vol. 3: Ethical Issues in Medicine, Technology and the Life Sciences II * Vol. 4: Environment * Vol. 5: Business/Economics * Vol. 6: Politics. (shrink)

This collection brings together many of the most influential criticisms of Kantian philosophy, from his own time to the present day. Volume I is historical, including Kant criticism from Schiller to Buchdahl. It contains some previously untranslated material. Volumes II, III and IV include recent essays on Kant, covering the major aspects of his work. Volume II looks at the Critique of Pure Reason , Volume III at Kant's moral and political philosophy, and Volume IV at the Critique of Judgement (...) and the relation of the third Critique to the other two. The volumes will be of great value to anyone with a serious interest in Kant's philosophy. (shrink)

This collection brings together many of the most influential criticisms of Kantian philosophy, from his own time to the present day. Volume I is historical, including Kant criticism from Schiller to Buchdahl. It contains some previously untranslated material. Volumes II, III and IV include recent essays on Kant, covering the major aspects of his work. Volume II looks at the Critique of Pure Reason, Volume III at Kant's moral and political philosophy, and Volume IV at the Critique of Judgement and (...) the relation of the third Critique to the other two. The volumes will be of great value to anyone with a serious interest in Kant's philosophy. (shrink)

This collection brings together many of the most influential criticisms of Kantian philosophy, from his own time to the present day. Volume I is historical, including Kant criticism from Schiller to Buchdahl. It contains some previously untranslated material. Volumes II, III and IV include recent essays on Kant, covering the major aspects of his work. Volume II looks at the Critique of Pure Reason, Volume III at Kant's moral and political philosophy, and Volume IV at the Critique of Judgement and (...) the relation of the third Critique to the other two. The volumes will be of great value to anyone with a serious interest in Kant's philosophy. (shrink)

This collection brings together many of the most influential criticisms of Kantian philosophy, from his own time to the present day. Volume I is historical, including Kant criticism from Schiller to Buchdahl. It contains some previously untranslated material. Volumes II, III and IV include recent essays on Kant, covering the major aspects of his work. Volume II looks at the Critique of Pure Reason, Volume III at Kant's moral and political philosophy, and Volume IV at the Critique of Judgement and (...) the relation of the third Critique to the other two. The volumes will be of great value to anyone with a serious interest in Kant's philosophy. (shrink)

A collection celebrating some of the best essays from the Blackwell journals, Bioethics and Developing World Bioethics. Contributors include Helga Kuhse, Michael Selgelid and Baroness Mary Warnock, former Chair of the British Government’s Committee of Inquiry into Human Fertilization and Embryology’s. Traces some of the most important concerns of the 1980s, such as the ethics of euthanasia, reproductive technologies, the allocation of scarce medical resources, surrogate motherhood, through to a range of new issues debated today, particularly in the field of (...) genetics. Includes contributions that are still as hotly debated today as they were 20 years ago and serves as a salutary reminder that free and open discussion is vital to the health of the discipline itself. Includes eight sections comprising some of the journals' best publications in methodological issues, the health care professional-patient relationship, public health ethics, research ethics, genetics, as well as beginning- and end-of-life issues. Will serve the academic bioethicists as well as students of bioethics as an excellent source book. (shrink)

This authoritative Handbook brings together experts with backgrounds in philosophy, sociology, law, public policy and the health professions and reflects the increasing impact of globalization and the dynamic advances in the fields of ...

In lieu of an abstract, here is a brief excerpt of the content:A FAOT ABOUT THE VIRTUES A. CHADWICK RAY Oentrai OoUege Peila, Iowa PHILIPPA FOOT remarks in Virtues and Vices that "with the nota;ble exception of Peter Gea;ch hardly 100.yone sees ·any difficulty in the thought that virtues may sometimes be di·splayed in bald ructions." 1 That a man may use his courage to deplorable ends; that 'a tea.ah.er ma.y show charity in igiving a miudent undeserved credit-these seem (...) to ibe hardly problema.tic possibilities. Yet Aquinas upholds •a definition of morrul virtue as " a good quality o[ the mind, by which we live rightly, of whioh no one cain make bad use,..."2 And Aristotle's conception of the man Ol:f p:riactica:l reason as the standard of moral virtue likewise seems to p!'lec1ude a virtue 's being misused.3 Times change, and rupparently eV'en virtue is not what it used to be. Nevertheless I mean here to survey the resour.ces of moral psyichology in the tradition of.Airistotle to see what sort of grounding can be found for the no-bad-use thesis. Presumably Geach stamds wlmost 1 afone today on this question, because the more traditional view would seem defensible only if it is taken as analytic. We could stipulate that an action wilil be called virtuous only if on balance it is the wisest alternative aivaifaible to the agent, but the utility of such a l Philippa Foot, Virtues and Vices (Berkeley: University of California Press, 1978), 15. In After Virtue (Notre Dame: University of Notre Dame Press, 1981), 216, Macintyre finds Hume, Kant, Mill, and Rawls taking virtues as dispositions to conform to certain rules. To the extent that rules are unreliable, the virtues will be too. 2 Aquinas, Summa theoiogiae, I-II, q.55, a.4. a Aristotle, Nioomaohean Flthios 1106b36-7a2, 1113a30-31. 430 A. CHADWICK RAY concept would be doubtfrnl, and 'virtue' would seem to name no real thing. The'1'e are, after aH, appwrently anomalous cases, as wihen a teacher is moved to indulgence by an undeserving student's plea and seems to show kindness to a fault. The deifense oif the no-bad-use thesis requires us to deny that real kindness is shown here. But if no better justification for the denia~ can be offered than that the action is wrong and so cannot be virtuous, the thesis wil:l express only an a11bitrary decision about how to use 'virtue ' and related terms. But if such deni1als can he justified by appeal to facts about human nature, then the no.:brud-use thesis itself may perhaps be taken a;s descriptive of certain realities constitutive of human life. After considel'ing some of the conditions of vir:tuous action and the possibility of degrees of virtue (section III), I shaill argue (IV and V) that the opening sentence of Aristotle 's Nicomachean Ethics affords a bctua:l ba;sis for sustaining the no-had-use thesis as descriptive of virtues as we find them; that if "every action and pursuit, is thought to aim at some good " is perhaps an overstatement, still the humanness and intelligibility of an action would seem to depend on its aiming at some good; and that it is largely by trying to consider actions independently of the goods they aim a;t that we imagine virtues able to se1we unworthy ends. Payffig fuH rega11d to the purposiveness of human action and the desires expressed in it will also make it possible (VI) to avnid oonoluding with Aristotle that the virtues are inseparable from eaich other. I conclude (VII) with some brief refteetion on the meaning of my departures from Aristotle. Before offering my own interpretation of the Aristotelian resources, though, I briefly contend for the reality of moral virtues (as tiraditiona1ly understood ) against conventioIJJa1ist interpretations ('section I) and then (H) consider an ailtemative account (roughly Geach's) of the nature of the virtues that would sa¥e the no-bad-use thesis. A FACT ABOUT THE VIRTUES 431 I. Virtues as Teleological Di8}Jositions Why indeed speak of vi1rtues at a1l? Behavior would seem to be describahle and e:x:p1a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A FAOT ABOUT THE VIRTUES A. CHADWICK RAY Oentrai OoUege Peila, Iowa PHILIPPA FOOT remarks in Virtues and Vices that "with the nota;ble exception of Peter Gea;ch hardly 100.yone sees ·any difficulty in the thought that virtues may sometimes be di·splayed in bald ructions." 1 That a man may use his courage to deplorable ends; that 'a tea.ah.er ma.y show charity in igiving a miudent undeserved credit-these seem (...) to ibe hardly problema.tic possibilities. Yet Aquinas upholds •a definition of morrul virtue as " a good quality o[ the mind, by which we live rightly, of whioh no one cain make bad use,..."2 And Aristotle's conception of the man Ol:f p:riactica:l reason as the standard of moral virtue likewise seems to p!'lec1ude a virtue 's being misused.3 Times change, and rupparently eV'en virtue is not what it used to be. Nevertheless I mean here to survey the resour.ces of moral psyichology in the tradition of.Airistotle to see what sort of grounding can be found for the no-bad-use thesis. Presumably Geach stamds wlmost 1 afone today on this question, because the more traditional view would seem defensible only if it is taken as analytic. We could stipulate that an action wilil be called virtuous only if on balance it is the wisest alternative aivaifaible to the agent, but the utility of such a l Philippa Foot, Virtues and Vices (Berkeley: University of California Press, 1978), 15. In After Virtue (Notre Dame: University of Notre Dame Press, 1981), 216, Macintyre finds Hume, Kant, Mill, and Rawls taking virtues as dispositions to conform to certain rules. To the extent that rules are unreliable, the virtues will be too. 2 Aquinas, Summa theoiogiae, I-II, q.55, a.4. a Aristotle, Nioomaohean Flthios 1106b36-7a2, 1113a30-31. 430 A. CHADWICK RAY concept would be doubtfrnl, and 'virtue' would seem to name no real thing. The'1'e are, after aH, appwrently anomalous cases, as wihen a teacher is moved to indulgence by an undeserving student's plea and seems to show kindness to a fault. The deifense oif the no-bad-use thesis requires us to deny that real kindness is shown here. But if no better justification for the denia~ can be offered than that the action is wrong and so cannot be virtuous, the thesis wil:l express only an a11bitrary decision about how to use 'virtue ' and related terms. But if such deni1als can he justified by appeal to facts about human nature, then the no.:brud-use thesis itself may perhaps be taken a;s descriptive of certain realities constitutive of human life. After considel'ing some of the conditions of vir:tuous action and the possibility of degrees of virtue (section III), I shaill argue (IV and V) that the opening sentence of Aristotle 's Nicomachean Ethics affords a bctua:l ba;sis for sustaining the no-had-use thesis as descriptive of virtues as we find them; that if "every action and pursuit, is thought to aim at some good " is perhaps an overstatement, still the humanness and intelligibility of an action would seem to depend on its aiming at some good; and that it is largely by trying to consider actions independently of the goods they aim a;t that we imagine virtues able to se1we unworthy ends. Payffig fuH rega11d to the purposiveness of human action and the desires expressed in it will also make it possible (VI) to avnid oonoluding with Aristotle that the virtues are inseparable from eaich other. I conclude (VII) with some brief refteetion on the meaning of my departures from Aristotle. Before offering my own interpretation of the Aristotelian resources, though, I briefly contend for the reality of moral virtues (as tiraditiona1ly understood ) against conventioIJJa1ist interpretations ('section I) and then (H) consider an ailtemative account (roughly Geach's) of the nature of the virtues that would sa¥e the no-bad-use thesis. A FACT ABOUT THE VIRTUES 431 I. Virtues as Teleological Di8}Jositions Why indeed speak of vi1rtues at a1l? Behavior would seem to be describahle and e:x:p1a... (shrink)

News that the first draft of a map of the human genome had been completed was received with great excitement but fears persist about how this knowledge will be used. Such concerns were the basis for an international conference held in Preston, England in December 1997. The issues addressed were non-existent when many of those attending the conference were born, but they are among the most pressing ethical problems we face today. They are philosophically challenging, and the way we deal (...) with them will have far reaching consequences for both individuals and society. The proceedings of the conference are now available in this book. Thirty authors, almost exclusively from Western Europe and North America, have written about the important issues of eugenics, insurance, the effects of market forces and the question of patents, public awareness of genetics and a variety of psychosocial and ethical concerns. Readers with …. (shrink)

Le débat du 24 mars 1944 peut s'interpréter comme l'achèvement d'une lutte qui remonte aux premières heures de la Révolution et comme l'aboutissement d'un processus législatif de courte durée. Ainsi, il convient de jouer sur les différents niveaux d'analyse pour comprendre exactement le sens de cet événement qui s'inscrit dans le débat général sur l'organisation des pouvoirs publics à la Libération ; le document met en exergue la discussion de l'article 16 sur la capacité civique des F...

Le débat du 24 mars 1944 peut s'interpréter comme l'achèvement d'une lutte qui remonte aux premières heures de la Révolution et comme l'aboutissement d'un processus législatif de courte durée. Ainsi, il convient de jouer sur les différents niveaux d'analyse pour comprendre exactement le sens de cet événement qui s'inscrit dans le débat général sur l'organisation des pouvoirs publics à la Libération ; le document met en exergue la discussion de l'article 16 sur la capacité civique des F...

In this paper I want to do the following things. First I want to show that in the part of the Theaetetus where the relationship between knowledge and perception is examined, the concept of knowledge that is in question is very clearly characterized. We are left in no doubt as to what is to count as knowing. Secondly I want to unravel in some detail the case that Socrates puts on Protagoras’ behalf where he draws on what Protagoras actually wrote (...) (151 E-152C); as opposed to what he may have taught secretly to his pupils (152C-160D). Thirdly I wish to argue that if we let the dialogue speak for itself, it is manifest that this case put up on Protagoras’ behalf at 151 E-152C is not overthrown; it is not even shaken. (shrink)

Née en 1943 à Alger, Andrée Job-Querzola poursuit des études de lettres à Aix-en-Provence puis à Paris dans les années 1960. Devenue enseignante, elle gravite dans la mouvance féministe et d’extrême gauche et participe activement aux événements de Mai. Marquée par les luttes féministes des années 1970, en particulier celles du MLF, du MLAC, du MFPF, elle souhaite rendre hommage aux femmes de sa génération – « une génération rebelle » qui, selon elle, sonne le glas de « générations (...) de femmes f... (shrink)

Because anticipated and retrospective regret play important roles in practical deliberation and motivation, better understanding them can illuminate the contours of human agency. However, the possibility of self-ignorance and the fact that we change over time can make regret—especially anticipatory regret—not only a poor predictor of where the agent will be in the future but also an unreliable indicator of where the agent stands. Granting these, this paper examines the way in which prospective and, particularly, retrospective regret can nevertheless yield (...) important insight into the sorts of creatures we are, both generally and individually. The experience of retrospective regret can show a person she values something in a way she did not know or that she is (or was) a different person than she had thought, insights which can factor into forward-looking, or prospective, deliberation. Such instances of revelatory regret reveal something to the agent about herself as agent. I examine two cases of agential self-ignorance. In the first, the experience of regret reveals what the agent values, not only to others but even to the agent himself. In the second, the agent anticipates experiencing regret for an action but does not experience the regret, suggesting that the agent did not value the rejected alternative in the way she thought. Anticipatory regret is forward-looking and can play an important role in practical deliberation. But insofar as anticipatory regret flows from one’s imperfect judgment and prospection about oneself, retrospective regret can be an important corrective in helping the agent understand her own standpoint. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. [16] Kathryn M Leifheit et al., “Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality,” American Journal of Epidemiology 190, no. 12 (December 1, 2021): 2503–10, https://doi.org/10.1093/aje/kwab196. [17] Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215 [18] Maximilian Agostini and Martijn van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.,” Psychological Bulletin 147, no. 7 (July 2021): 667–700, https://doi.org/10.1037/bul0000256. [19] Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (HHS/CDC), “COVID Data Tracker,” 2023, https://covid.cdc.gov/covid-data-tracker. [20] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)