Traditional Chinese culture, Confucianism, in particular, has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups—specifically, the family, the clan, the political community and the state—not as atomic individuals as perceived in modern society. The communist ideology since the middle of the last century also emphasizes the significance of ‘the common good’ of the state which describes a specific ‘good’ that is shared and beneficial for all (or most) members (...) of a given community. Nevertheless, marketization and decentralization in China today have significantly challenged the notion of a state-oriented community that directly impacts China's healthcare system, beginning with the dismantling of the rural collectives and state-owned enterprises as part of the reform and opening process. This article will address healthcare challenges in China today, examining the conceptual/ethical issues raised by public healthcare, and contending that public health concerns should go beyond the dichotomy between individualism and collectivism. The article will argue that the family-oriented model of Confucianism offers an alternative way to look at what constitute a community and common goods. The Confucian approach to ethics is relevant to healthcare today. For example, it will be much easier to find a shared idea of common good in terms of complicated issues like healthcare; it would make sense to give a larger role to families via family savings accounts, and not have everything determined by the government. (shrink)

Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the notion of sustainability by reviewing the discourses in the representative reports and literature from different periods. Three sets of ideas are proposed: inter- and intra-generational equity, stability of public systems, and a sense of solidarity, which confirms the scope of community and functions as a precondition for the previous two ideas. This essay uses the case of a health (...) system in a hypothetical country to illustrate that, besides securing financial sustainability, a genuinely sustainable public system must also meet the three normative ideas of sustainability. This essay also finds that these three ideas may create intrinsic tensions within the prevalent policy-making model—democracy. The pursuit of sustainability is not only the responsibility of a democratic government, but also a shared moral obligation of the body politic. (shrink)

Under the influence of concerns about sustainability, health system reforms have targeted institutional designs and have overlooked the role of socio-political factors like solidarity—a concept that is generally assumed to underpin the redistributive health system. The purpose of this research is to investigate users’ perceptions of the National Health Insurance as a system, their senses of solidarity and their views on the sustainability of the system in Taiwan. Using the descriptive ethics approach, qualitative in-depth interviews were conducted with typical case (...) sampling of 17 participants in the Taipei Metropolitan. The framework approach was used to analyze the interview transcripts. The research finds that despite great differences between users’ perceptions of the NHI, most users could share a notion of mutual relationship among each other. Three types of reasons are used to justify the obligations of mutual aid imposed by the NHI. These reasons are embedded within divergent conceptions of solidarity. The research also finds that government’s performance, the stability of decision-making and users’ personal experiences engaging with the system are important conditions for the users’ supportive attitude toward the system. Solidarity is a plausible concept in sustaining a non-Western social health insurance such as Taiwan’s NHI. (shrink)

The recent and ongoing refugee crisis in Europe highlights conflicting attitudes about the rights of migrants and refugees to health care in transition and destination countries. Some European and Scandinavian states, such as Germany and Sweden, have welcomed large numbers of migrants, while others, such as the U.K., have been significantly less open. In part, this is because of reluctance by certain national governments to incur what are seen as the high costs of delivering aid and care to migrants. In (...) response to these assumptions, some theorists have argued that the appropriate way to view the health needs of migrants is not in terms of rights, but in terms of the interests of destination and transition countries—and have argued that providing care to migrants and refugees will generate benefits for their host countries. However, self‐interest alone is less effective at motivating the provision of care for health deprivations that do not pose a threat to third parties, or to migrants and refugees in poor or distant countries. In this paper, I argue that while self‐interest is unlikely in itself to motivate the provision of all necessary health care to all migrants and refugees, and may risk stigmatizing already vulnerable persons, it can provide the foundation upon which such motivations can be built. My goal is therefore to show how and why a more just approach to the provision of health care to migrants can and should be derived from narrower, self‐interested commitments to preserving citizen health. (shrink)

"This is a most timely, intelligent, well-written, and absorbing essay on a central and painful social and political problem of out time."--Sir Isaiah Berlin"The major achievement of this remarkable book is a critical theory of nationalism, worked through historical and contemporary examples, explaining the value of national commitments and defining their moral limits. Tamir explores a set of problems that philosophers have been notably reluctant to take on, and leaves us all in her debt."--Michael WalzerIn this provocative work, Yael Tamir (...) urges liberals not to surrender the concept of nationalism to conservative, chauvinist, or racist ideologies. In her view, liberalism, with its respect for personal autonomy, reflection, and choice, and nationalism, with its emphasis on belonging, loyalty, and solidarity are not irreconcilable. Here she offers a new theory, "liberal nationalism," which allows each set of values to accommodate the other. Tamir sees nationalism as an affirmation of communal and cultural memberships and as a quest for recognition and self-respect. Persuasively she argues that national groups can enjoy these benefits through political arrangements other than the nation-state. While acknowledging that nationalism places members of national minorities at a disadvantage, the author offers guidelines for alleviating the problems involved using examples from currents conflicts in the Middle East and in Eastern Europe.Liberal Nationalismis an impressive attempt to tie together a wide range of issues often kept apart: personal autonomy, cultural membership, political obligations, particularity versus impartiality in moral duties, and global justice. Drawing on material from disparate fields--including political philosophy, ethics, law, and sociology--Tamir brings out important and previously unnoticed interconnections between them, offering a new perspective on the influence of nationalism on modern political philosophy. (shrink)

The demand for social justice, especially in the context of the welfare state, is often framed as a demand of solidarity. But it is not clear why: in what sense, if any, is social justice best understood as a demand of solidarity? This article explores that question. There are two reasons to do so. First, very little has been written on the concept of solidarity, and almost nothing on why and how solidarity can both give rise to and be the (...) target of a moral obligation. The first aim of the article is to fill this gap. The second aim of the article is to explore the normative implications of this account of solidarity for the commitment to social justice at the heart of the welfare state, and in so doing, to put into question the idea that shared experience or shared identity are either necessary or sufficient bases for social justice qua solidarity. (shrink)

Nationalism is often dismissed today as an irrational political creed with disastrous consequences. Yet most people regard their national identity as a significant aspect of themselves, see themselves as having special obligations to their compatriots, and value their nation's political independence. This book defends these beliefs, and shows that nationality, defined in these terms, serves valuable goals, including social justice, democracy, and the protection of culture. National identities need not be illiberal, and they do not exclude other sources of personal (...) identity, such as ethnicity or religion. An ethics that gives weight to special relationships is more effective in motivating people to pursue justice and other values because it connects peoples’ duties to their identity; but this is consistent with recognizing some universal values, such as human rights. There are strong reasons for making the boundaries of states and nations coincide wherever possible, but in other cases, nations can achieve forms of self‐determination that fall short of full sovereignty. Multicultural arguments in favour of identity politics and special rights for minority groups ignore the benefits that such groups derive from participating in a shared national identity and the kind of democratic politics that such an identity makes possible. Although national identities are often said to be in decline in an increasingly globalized world, they serve such important purposes that our aim should be to rebuild them in a form that makes them more accessible to excluded cultural minorities. (shrink)

In times of global economic and political crises, the notion of solidarity is gaining new currency. This book argues that a solidarity-based perspective can help us to find new ways to address pressing problems. Exemplified by three case studies from the field of biomedicine: databases for health and disease research, personalised healthcare, and organ donation, it explores how solidarity can make a difference in how we frame problems, and in the policy solutions that we can offer.

n this paper, I argue that political solidarity is important to justice. At its core, political solidarity is a relational concept. To be in a relation of political solidarity, is to be in a relation of connection or unity with one’s fellow citizens. I argue that fellow citizens can be said to stand in such a relation when they have attitudes of collective identification, mutual respect, mutual trust, and mutual support and loyalty toward one another. I argue that political solidarity, (...) so conceived, is an integral element of a theory of justice. I argue that there are distinctly social bases for political solidarity and that justice requires that we promote these. Furthermore, as an example of the sort of social and political arrangements that might encourage political solidarity, I discuss Canada’s response to the recent H1N1 pandemic and the failings of this response with respect to members of the Aboriginal community within Canada. I argue that ensuring that members of the Aboriginal community had equal access to the goods they needed to protect themselves against H1N1 infection would have promoted relations of political solidarity and, in turn, would have promoted justice more effectively. (shrink)

The further development of public health ethics will be assisted by a more direct engagement with political theory. In this way, the moral vocabulary of the liberal tradition should be supplemented—but not supplanted—by different conceptual and normative resources available from other traditions of political and social thought. This article discusses four lines of further development that the normative conceptual discourse of public health ethics might take. The relational turn. The implications for public health ethics of the new ‘ecological’ or ‘relational’ (...) interpretation that is emerging for concepts such as agency, self-identity, autonomy, liberty and justice. Governing the health commons. The framework of collective action problems is giving way to notions of democratic governance and management of common resources. The concept of membership. Membership is specified by the notions of equal respect and parity of voice and agency. The concept of mutuality. Mutuality is specified by the notions of interdependent concern and care. (shrink)

The dominant language of politics in the United States has been political individualism, with minimal restrictions on property and personal, voluntary conduct. But there are second languages of community that stress cooperation and group action. These second languages include the constitutional tradition for public health. Public health offers a community justification for paternalistic measures that, for example, discourage smoking or require seatbelts.

Using an innovative blend of political theory, international law, and studies on the sociological and geo-political foundations of minority rights, this landmark publication will set the debate on the likely future of the international politics of diversity.