Solidarity and Responsibility in Health Care

Abstract

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

Ethics of Vaccination in Childhood—A Framework Based on the Four Principles of Biomedical Ethics

“…Giving up one’s own interests to serve the common good is the idea of solidarity, which cannot be considered as a synonym or alternative to the rights-based concept of justice, but as a necessary complement to it [ 88 ]. Features of solidarity are reciprocity and commitment to action, which brings also responsibilities to the participants [ 89 ]. Although vaccine allocation is an important issue, especially in the times of a pandemic, we will in this section focus on just contribution to herd immunity.…”

Sharing Responsibility: Responsibility for Health Is Not a Zero-Sum Game

“…But in fact huge inequalities exist within populations and therefore the state has reasons of justice to take on responsibility for healthy nutrition. Other normative grounds for health policies include the prevention of harm to others or the protection of public goods within a solidaristic health system (Davies and Savulescu, 2019). Promoting healthy nutrition via information, education or nudges will clearly not push aside or diminish the reasons that individuals have to care about their own nutrition.…”

“…Kathryn Mackay reflects on their proposal and indicates a potential weakness in their view (Mackay, 2019). The connection between responsibility and solidarity is discussed by Davies and Savulescu: they argue that health care systems that are grounded in solidarity, under certain conditions, have the right to penalize some users who are responsible for their poor health (Davies and Savulescu, 2019). Davies and Savulescu’s normative analysis offers an interesting counterpoint to Gloria Traina’s empirical study of Norwegian citizens’ views of personal responsibility for health.…”

COVID-19 Capitalism: The Profit Motive versus Public Health

“…Individuals do have the right to behave imperfectly, even in solidaristic settings ( Davies and Savulescu, 2019 ), however, this particular variant of imperfect behavior keeps other individuals—healthcare workers and others—from being able to obtain commodities necessary for health. In effect, like (in)ability-to-pay on the demand side, the profit motive is a supply-side force that can render individuals incapable of responsibility for their health ( Levy, 2019 ).…”