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Solidarity: Reflections on an Emerging Concept in Bioethics

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Solidarity: reflections on an emerging concept in bioethics Barbara Prainsack and Alena Buyx This report was commissioned by the Nuffield Council on Bioethics (NCoB) and was jointly funded by the Arts and Humanities Research Council (AHRC) and the Nuffield Foundation. The award was managed by the Economic and Social Research Council on behalf of the partner organisations, and some additional funding was made available by NCoB. For the duration of six months in 2011, Professor Barbara Prainsack was the NCoB Solidarity Fellow, working closely with fellow author Dr Alena Buyx, Assistant Director of NCoB. Disclaimer The report, whilst funded jointly by the AHRC, the Nuffield Foundation and NCoB, does not necessarily express the views and opinions of these organisations; all views expressed are those of the authors, Professor Barbara Prainsack and Dr Alena Buyx. The Nuffield Council on Bioethics is an independent body that examines and reports on ethical issues in biology and medicine. It is funded jointly by the Nuffield Foundation, the Wellcome Trust and the Medical Research Council, and has gained an international reputation for advising policy makers and stimulating debate in bioethics. www.nuffieldbioethics.org The Nuffield Foundation is an endowed charitable trust that aims to improve social wellbeing in the widest sense. It funds research and innovation in education and social policy and also works to build capacity in education, science and social science research. www.nuffieldfoundation.org Established in April 2005, the AHRC is a non-Departmental public body. It supports world-class research that furthers our understanding of human culture and creativity. www.ahrc.ac.uk © Barbara Prainsack and Alena Buyx ISBN: 978-1-904384-25-0 November 2011 Printed in the UK by ESP Colour Ltd. Elgin Drive, Swindon, Wiltshire SN2 8XU http://espcolour.co.uk Solidarity: reflections on an emerging concept in bioethics Acknowledgments The authors gratefully acknowledge the funding for this project from the Nuffield Foundation, the Arts and Humanities Research Council and the Nuffield Council on Bioethics (NCoB), as well as the administration of the grant by the Economic and Social Research Council. The Trustees of the Nuffield Foundation, the Nuffield Foundation‘s Deputy Director Sharon Witherspoon MBE, the Chair of the Nuffield Council on Bioethics, Professor Albert Weale FBA, and the Director of the Nuffield Council on Bioethics, Hugh Whittall, all were instrumental in shaping the project and supporting the fellowship. Jonathan Breckon and Robert Keegan from the Arts and Humanities Council and Lesley Lilley from the Economic and Social Research Council administered the fellowship and had important input on the direction of the fellowship. The Nuffield Council on Bioethics supported the organisation of two workshops. The NCoB‘s Secretariat (Sarah Bougourd, Tom Finnegan, Kate Harvey, Carol Perkins, Johanna White, and particularly Varsha Jagadesham and Catherine Joynson) helped with these workshops, with the production of the final document and with the preparation of the launch event. The report benefitted greatly from the insightful comments and constructive feedback from current and former members of the Nuffield Council on Bioethics, in particular Professor Roger Brownsword, Professor Robin Gill, Professor Søren Holm, Dr Tim Lewens, Dr Bronwyn Parry, Professor Nik Rose, Professor Dame Marilyn Strathern FBA and Professor Jonathan Wolff. We thank Professor Christopher Newdick for bringing the Condliff case to our attention and for supplying us with part of the case study (see Chapter 8). The authors also wish to thank all participants at the two workshops in May and July 2011 (a full list can be found at Annex 1), as well as Dr Misha Angrist, Professor Ruth Chadwick, Professor Angus Clarke, Professor SD Noam Cook, Professor Peter Dabrock, Dr Kathryn Ehrich, Dr Roy Gilbar, Dr Beth Greenhough, Dr David Gurwitz, Dr Klaus Hoeyer, Dr Ine van Hoyweghen, Dr Frank J Leavitt, Dr Jeantine Lunshof, Dr Michaela Mayrhofer, Dr Timothy Milewa, Professor Gísli Pálsson, Dr Andrew Papanikitas, Professor Anne Phillips, Dr Andreas Reis, Dr Carmel Shalev, Dr Kadri Simm, Professor Tim Spector, Meike Srowig, Professor Karl Ucakar, Professor Hendrik Wagenaar and Dr Martin Weiß. iii Table of Contents Acknowledgments .................................................................................................................................... iii Summary ................................................................................................................................................. ix Introduction .............................................................................................................................................. 1 Chapter 1 – Solidarity: genesis of a concept ......................................................... 6 1.1 Introduction ........................................................................................................................................ 6 1.2 Early beginnings: classic social theory .............................................................................................. 6 1.3 Solidarity in Christian theory, politics and ethics ............................................................................... 8 1.4 Solidarity in socialist theories and politics ......................................................................................... 9 Chapter 2 – Recent developments and approaches ............................................ 12 2.1 Solidarity and communitarianism ..................................................................................................... 12 2.2 Solidarity and rational choice ........................................................................................................... 14 2.3 Contractual solidarity ....................................................................................................................... 15 2.4 Solidarity and gifts ........................................................................................................................... 16 2.5 Reflective solidarity .......................................................................................................................... 16 2.6 Agonistic solidarity ........................................................................................................................... 17 Chapter 3 – Solidarity in recent bioethical writings ............................................. 20 3.1. Explicit and implicit references to solidarity .................................................................................... 20 3.2 Definitions of solidarity in bioethical writing ..................................................................................... 20 3.3 Solidarity in bioethics: contexts and issues ..................................................................................... 22 3.4 Context 1: Solidarity and public health ethics .................................................................................. 23 The NCoB report on Dementia and the partnership model ............................................................ 23 Public health ethics and solidarity: personalism ............................................................................. 24 Public health ethics and solidarity: stewardship ............................................................................. 25 Public health ethics and solidarity: the relational approach ........................................................... 26 Public health ethics and solidarity: a strong place for (strong) government?................................. 28 3.5 Context 2: Solidarity and healthcare systems ................................................................................. 29 3.6 Context 3: Solidarity and global health ............................................................................................ 30 3.7 Context 4: Solidarity as a European value? .................................................................................... 32 3.8 Criticism of use and application of solidarity ................................................................................... 33 3.9 Main findings and conclusions ......................................................................................................... 35 Chapter 4 – Related terms ...................................................................................... 40 4.1 Responsibility ................................................................................................................................... 40 4.2 Charity ............................................................................................................................................. 41 4.3 Dignity .............................................................................................................................................. 41 4.4 Altruism ............................................................................................................................................ 42 4.5 Reciprocity ....................................................................................................................................... 43 v 4.6 Social capital ................................................................................................................................... 43 4.7 Trust ...............................................................................................................................................
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