干旱区生态环境知识资源中心

But he’s a human being, and a terrible thing is happening to him. So attention must be paid. He’s not to be allowed to fall into his grave like an old dog. Attention, attention must be finally paid to such a person. Arthur Miller Work in the fields of bioethics and public health ethics over several decades has been theoretically diverse, but particular styles of theorizing, let alone individual theories, do have distinctive philosophical assumptions and discursive characteristics. For example, in the domain of clinical bioethics a strong emphasis has been given to respect for autonomous will-formation by individuals in medical decisions and behavioral choices directly affecting them. In the domain of public health ethics and policy bioethics, where debates over issues such as health access and financing and over mandatory vaccination policies are ongoing, there is a clash between an individualistic understanding of rights, liberty, and privacy, on the one hand, and a communitarian understanding of the common good and the health and well-being of society as a whole, on the other. Cutting across this spectrum of individualism and holism, there is another discernable array of approaches to theorizing and concept formation in bioethics. Two in particular are pertinent to this article. One may be called an ’applied’ mode of bioethics, which is focused on applying moral principles and rules to specific situations of action and choice. A contrasting ’relational’ mode of bioethics seeks to present normative interpretations of historically embedded patterns of agency, interdependency, and institutional structures of power. To be sure, many specific works of bioethics utilize both an applied and a relational approach, but I believe that this distinction is heuristically useful. It can alert us to the fact that seemingly univocal concepts, such as autonomy, justice, equality, dignity, and personhood, carry a different meaning when they are theorized as principles to be applied from when they are theorized as practices to be interpreted. In this article my aim is to advance the discussion of relational approaches within bioethics by an interpretive analysis of the concept of solidarity and the concept of care when seen as modes of moral and political practice. I single out solidarity for this discussion because the range of moral questions traditionally associated with the concept are normatively integral to many key issues with which health policy and public health must deal-such as just access to healthcare, civic and financial support for social insurance and social welfare policies, and the intergenerational justice issues that bedevil the transition to an aging society and the mitigation of global climate change. In bioethics and public health ethics today, solidarity should be taken seriously and not dismissed as an obsolete idea from a bygone political era, and a recent surge of interest in the concept attests to this. On the other hand, care is an extremely influential normative concept in bioethics and has been for several decades. But the praxis and institutional support for care, no less than those of solidarity, are vulnerable in the current ideological climate and need to be supported discursively and politically. The practices of care are also essential to the core problems with which health policy and public health must grapple.

I believe that solidarity and care offer instructive constitutive contexts within which the moral identity of persons is grounded and articulated in recognition, affirming the moral standing of those oppressed as equal members of a moral community, and in attention, attesting to the moral presence and considerability of those vulnerable and in need. Solidarity constitutes just affirmation of the other as subject, not merely object; care constitutes just attention to the other in a cognate way as subject, not object. This recognition of, and attention paid to, persons as moral subjects, in turn, can politically motivate a society in three respects. The recognition of solidarity and the attention of care can prompt progressive change toward a democratic willingness: (a) to provide for equal respect for rights and dignity; (b) to provide the social resources and services needed for just health and well-being; and (c) to focus its creativity and wealth on the actualization of potential flourishing of each and all. As Carol Gould observes concerning solidarity on this score: ’the proliferation of solidarity relations that establish commonalities across differences, along with the linkages that develop among individuals and groups within solidarity movements, help to construct more universalistic conceptions of our obligations to each other.’ Though much has been written on the protean concepts of solidarity and care, much still remains to be seen and said, for their ethical meaning and political significance change as they develop and manifest themselves in action over time. My discussion explores how persons and groups are recognized within the practices of solidarity and care; what stance or posture persons and groups take toward one another; and how their standing as free and equal members of a moral community is constituted and sustained by these practices. The guiding thread is right recognition of the full ethical standing of other human beings as subjects rather than as objects. Just recognition of moral standing and moral attention in solidarity and care is my explicit focus, finding the moral imagination and political will to sustain them, my background theme. Relational bioethics is a conceptually dynamic and rather eclectic field today, frequently drawing on paradigm-shifting work in moral and political philosophy and on conceptual innovations ongoing in the humanities and the social sciences, including feminist theories, critical theories of various kinds, and orientations informed by philosophical pragmatism and hermeneutics, among others. Inspired by several cognate modes of critical discourse, relational theorizing has turned away from both methodological and ethical individualism. Often, it is more concerned with diachronic (streaming over time) social practices than with synchronic (snapshot in time) individual acts. It favors what Margaret Urban Walker has called the ’expressive-collaborative’ model of morality over the ’theoretical-juridical’ model. It strives to place the agency of individuals within a constitutive context of meaning and interdependence. This context includes both dyadic and small group transactions among persons in direct contact and social, structural interdependencies growing out of institutionalized forms of power. Relational theorizing is a space of historical and cultural embeddedness and embodied living in the natural, material world.

Moreover, due to this contextual perspective, relational theorizing and its discourse are reflexive in questioning their own philosophical grounding and epistemic legitimacy, and they are willing to move away from once solid convictions concerning objectivity, impartiality, and rational authority. All theory and praxis, on this view-including bioethics-inevitably reflects some positional perspective, especially when it most strenuously claims not to, and the best that can be done is to sustain a continuing engagement with different values and viewpoints over time. Closure of conflicting interpretations in the public space of question and answer is apt to be provisional and contingent. While chastening, this need not be an epistemological loss. Within such a critical reflexivity, possibilities open up for new ways of thinking about the basic object of study of ethics and for an emphasis on substantive aspects of ethical agency and value that have been relatively neglected heretofore. The object of study in bioethics (or in ethics generally) or in social science is not intuitively given or logically or methodologically determined. Settling on what should be taken as the unit of ethics analysis is the result of an on-going, contested process of interpretation, partly derived from available theoretical concepts, partly from the exercise of experience-based practical judgment. As social theorist Craig Calhoun argues, concerning this contest, we should ’see the process as basic and never ending, and [subject] it to our continuing attention, rather than [imagine] that it is settled once and for all’. When bioethics focuses on relational practices, its designated object of study becomes those patterns and structures of interrelated activity, choice, and the exercise of power in time. These patterns are understood dynamically, as well as diachronically, with emergent properties and functions taking shape contingently rather than deterministically. Dynamic patterns in social life and human action may at times be spontaneous or random. However, when these patterns endure they comprise ’practices’, which may be defined as rule-based, value-laden forms of agency and activity in which diverse human capabilities or potentialities are actualized in the social and material worlds. Let us consider the elements of this definition more fully. First, social practices are structured sociologically by roles and relationships involving authority, power, distribution, and exchange. Governments, corporations, and hospitals are examples of institutionalized structures where social practices of various kinds take place. Social practices are also structured normatively by various conceptions of rightness, goodness, and value. Finally, social practices are experienced within lifeworlds of social-cultural meanings, where action-guiding reasons and motivations are formed, culturally mediated self- and group-identities are shaped, and ongoing reinterpretation of roles and relationships takes place. How are social practices so conceived possible and sustainable? Here the theoretical mediation between individualistic and communitarian orientations takes place. Diachronic social practices are made possible by moral agents who possess the ability to interpretively apprehend what other human beings are thinking in and through their agency, and to read the meaning such expressive agency conveys among agents as they interact together.

A moral philosophy that took human beings to be radically solipsistic and opaque to one another would be unable to account for, let alone justify, its own discourse. A theory of practices presupposes the possibility of social communication and cultural hermeneutics. A practice is a form of activity that is valued in a society and governed by ethical norms. By engaging in these orderly, yet living, flexible activities, individuals pursue the attainment of excellence and seek to actualize potential capabilities. In this way, cultures and societies provide pathways for the development of flourishing lives well lived. It is through practices that virtues of character are developed, rights are respected and duties fulfilled, and beneficial collective consequences are pursued and obtained. To be sure, practices are conceptually constructed or ’theorized’, as are notions like autonomous reason, but they are grounded in ongoing cultural traditions and experimental or innovative new modes of social cooperation. Practices are both embodied and enacted. In the embodiment of practices, they are informed by tacit knowing or habitus-Pierre Bourdieu stresses their phenomenological and pre-reflective aspects. In the enactment of practices, evaluative deliberations take place and reflective judgments are arrived at that shape future activity and the structure of subsequent lives-Alasdair MacIntyre stresses their aspects that mirror Aristotle’s notion of phronesis or practical judgment. Drawing explicitly on the work of Simone Weil and implicitly on Emmanuel Levinas, David Wiggins suggestively and rather effusively locates solidarity at ’the root of the ethical’. His essay can be read as a strong reinterpretation of the object of ethical analysis or the moral point of view. He is not interested in offering a stipulative definition of solidarity or a classification of its various types. Solidarity names a fundamental awareness, arbitrary and uncalculating, and an ability to respond to a call to ethical action in the presence of another in peril-another who is a moral subject, a being with a visage, a gaze, an ontological claim to stake, a political inheritance to claim, a place of membership rightfully to occupy. In tune with considerations of this sort, I posit right recognition and attention at the center of my analysis of solidarity and care as moral practices. My approach is a modification of what has been called ’interpretive phenomenology’ and has been well developed in the literature of nursing and nursing ethics. While it is clearly well designed for the study of care, I believe it can also throw important light on solidarity. Like philosophical phenomenology more broadly, interpretive phenomenology seeks to offer a deeper understanding of intentional activity and its aim than agents themselves may explicitly possess; an understanding that may be more perspicacious than their own sense of what they are doing or bringing about. The following characterization of the general approach by Patricia Benner informs my discussion of solidarity and care: The understanding sought in interpretive phenomenology considers historical change, transformations, gains, losses, temporality, and context horizontal ellipsis The ethos embedded in [interpretive] phenomenology is respect for the social and cultural nature of being human. Human practices, skills, habits, meanings, and, in particular, recognition practices allow for the other to be encountered and made visible.

When unarticulated, taken-for-granted practices and meanings fade from our social ecology and the social fabric of our lives, and we lose what they enable us to see, create, and represent. As I seek to develop it, this interpretive approach involves seeing human beings and doings in and through relationships of recognition, mutuality, respect and concern, need and vulnerability. In this relational dynamic, the watchword is the variety, not uniformity, of transactional agency and interdependent positions and projects. The context for the importance of right recognition and attention in solidarity and care is pluralism, reflexive perspectivalism, and a restructuring of economic and social institutions that would open society to new forms of inclusive, discursive engagement. Solidarity promotes these conditions and values as a future demand and promise; care honors them as a precondition for the possibility of the healing and meaning it facilitates. Perhaps I can clear the way for my account of solidarity offered below by briefly mentioning some contrasting and complementary approaches. In recent studies of solidarity, two overlapping concerns have been salient. One is to counter interpretations of solidarity that make it unduly insular and defined by exclusive, closed bonds of shared experience or loyalty. The other is to counter interpretations of solidarity that render it unduly political in the sense of being instrumental and strategic rather than viewing it as a form of life that can give expression to a normative moral or political ideal. The first problem of overly thick solidarity in which certain beliefs and values are so deeply shared that they are beyond debate, is addressed by Jodi Dean. She presents a critique of what she calls ’conventional solidarity’, and defines a counter-notion of ’reflective solidarity’-a space of mutuality in which in which genuine difference, discursive conflict, and pluralism would be at home and neither uncritical consensus nor the predominance of only one group of voices would prevail. Focusing on the second problem, Carol Gould and Craig Calhoun both seek ways of introjecting a cosmopolitan orientation into the practice of solidarity. Gould does so by aligning it with justice and human rights in the formation of global networks of political activity. And Calhoun, whose emphasis is more on discursive agency, does so by exploring how a more universal kind of solidarity can emerge from the ongoing discourse within the public sphere. In contrast to these concerns that the bonds of solidarity will be overly tight and narrowly nationalistic, ethnic or localized, Avery Kolers is concerned that bonds of solidarity will not be thick enough to override the primacy of individual judgment and conscience. Then the practice of solidarity will be too weak and will ultimately break down into something irresolute and individualistically self-serving, whether in the authentic form of Quaker witness inspired by inner light or the inauthentic moral narcissism of radical chic. ’Conscience just isn’t enough to enable us to comprehend the nature of grave evils or our role in them,’ he writes. ’Ultimately we must overcome conscience in favor of solidarity horizontal ellipsis Conscience is directed at ensuring one’s own moral integrity rather than at fostering the political movement that could secure moral results that challenge one’s standing.

’ Solidarity on Kolers’s view is about taking sides and deferring to the views of others concerning why and how their rights and interests should prevail. It is a political practice that attempts to achieve moral outcomes, rather than one that is constitutive of moral norms. It gives voice primarily to those for whom solidarity is enacted, rather than containing within its own practice the standard of parity of voice and agency toward which it aims as an achieved political condition for all. Thus Kolers defines solidarity as ’reason-driven political action on other’s terms’. This appeal to deference sets him apart from the more dialogic and egalitarian interaction envisioned by Dean, Gould, and Calhoun in their various ways. He is taken by the danger that both reflective or dialogic communication and the self-correcting function of networks of solidarity will subtly reinforce forms of domination and power instead of overcoming them. By integrating the notion of right recognition of the moral standing of others, I am trying to understand thick relationships of community and more abstract and principled commitments to justice and respect for persons as orientations that can mutually inform and refine one another. My strategy is to conceptualize the practice of solidarity in developmental and transformational ways so that the practice of solidarity contains within itself a shaping of moral psychology and moral learning, from relatively thin commitments at first, to increasingly strong commitments over time, as a deeper understanding of the other fuels a kind of political and ethical maturity in oneself. Important groundwork for the perspective on solidarity that I offer here has been laid by Barbara Prainsack and Alena Buyx, whose work provides an institutional and structural analysis of solidarity, distinguishing among various levels of social organization within which it can be practiced. I agree that in understanding solidarity as a practice one cannot ignore the interaction between agency and the institutional structures within which agency takes place. Nor should one take solidarity as an abstract regulative idea rather than a concept whose philosophical and motivational force develops in and through active social practices. Nonetheless, my own approach tends to be more moral psychological, stressing the cognitive and motivational bases for a growth of understanding and cooperation among self and other in the practice of solidarity. Among those actively working on the concept, my thinking about solidarity is perhaps closest to that of Andrew Mason, who is primarily interested in the concept and practices of community, but who crucially brings community and solidarity into close theoretical proximity. He offers a study of what might be called ’comparative relationalities’, and I am attempting to follow along these lines here with a comparative discussion of solidarity and care. For his part, Mason deploys solidarity and community together not so much by characterizing solidarity as more intense and intimate than it is often taken to be, nor by making community less so, but by circumventing a dichotomous view (the legacy, one might say, of Aristotle and Kant alike) altogether. He builds solidarity into a normative conception of community, and his formulation is worth considering at length: A community is not just a group of people who share a range of values and a way of life, identify with the group and its practices, and recognize each other as fellow members.

In order for a group to constitute a community in the moralized sense, two further conditions need to be met. First, there must be solidarity between its members. ’solidarity’ is a multiply ambiguous notion, but in the sense I intend it consists in mutual concern: minimally this means that members must give each other’s interests some non-instrumental weight in their practical reasoning. horizontal ellipsis Second, there must be no systematic exploitation or (on some versions) no systematic injustice. My own specific concern is to accentuate the normative aspects of this type of interpretation of the practices of solidarity and care: how persons and groups are recognized within these practices; what stance or posture persons and groups take toward one another; and how their standing as free and equal members of a moral community is constituted and sustained by these practices. The practice of solidarity begins with the latent possibilities of a given place at a given time. It builds on senses of historical memory and tradition, and it feeds on the gratitude felt when one remembers the service and contributions that others have made to one’s way of life in the past, or when one has the moral imagination to foresee the contributions that newcomers can make in the future. Solidarity begins with the recognition of reciprocal and symbiotic interdependence among members of a moral community and then intervenes in-interrupts-an ongoing community when it is unjustly exclusionary and refuses to recognize the moral standing of some within it. Solidarity inherently leads us to view our own lives and agency as bound together with the rights, well-being, health, and dignity of others here and now. I take the fundamental gesture and stance of solidarity to be standing up beside another, thereby signaling publicly one’s recognition of that person’s (or group’s) moral standing. In addition, there are three distinct postures agents assume toward others whose moral standing is in need of defense. These may be called standing up for, standing up with, and standing up as.Standing up for. This mode of solidarity assumes the stance of advocacy. It involves assisting, defending, and pleading the cause of the other. It stands up against exclusion and oppression. In general discussions of solidarity, the other is often taken to be a stranger, but that is not necessary; it makes perfect sense to talk about being in solidarity with friends and acquaintances. Moreover, the other need not be a human individual: one can stand up for other species, an ecosystem, or a cultural way of life. What is crucial is that there is some kind of power or knowledge differential between self and other in a relationship of solidarity and some kind of injustice or danger impinging upon the life of the other. This kind of solidarity can advocate for improved treatment or benefits for an oppressed or vulnerable group, but does not necessarily challenge the underlying basis for their subordinate social status. Yet, if it does not undermine structural inequalities, standing up for solidarity can perpetuate subordination rather than achieve equality.Standing up with. Solidarity as standing up with takes another step in the recognition of moral standing. Moving from the standpoint for to the standpoint with requires deeper engagement with the experience and lifeworld of the other.

The difference created by the specificity of lifeworlds nonetheless resides within an overarching interpretive commonality, namely, the ability to understand lifeworlds other than one’s own. Without such understanding, others cannot truly be treated with respect, they can only be tolerated, benignly neglected, not interfered with. This closer understanding can tend to humanize and personalize the relationship further, and the potential benefit becomes more reciprocal. Those who stand with others may find their own initial prejudgments concerning others transformed by the encounter. Those who practice solidarity must open themselves to the opportunity-and risk-it poses. Relating to other people or groups in the specificity of their values and vocabularies of self-interpretation can simultaneously develop respect for the specific standpoints of others. It can also enable a greater capacity for intercultural and transpersonal interpretive understanding broadly within a democratic political culture and way of life.Standing up as. The third standpoint is solidarity as standing up as. Obviously this suggests a yet stronger degree of identification between the providers of solidaristic support and the recipients of such support. The solidarity of standing up as involves finding a kind of covering connection that does not negate diversity among individuals at all, but rather establishes the grounds of its respect, protection, and perpetuation. To move through the trajectory of solidarity is to move in the direction of greater imaginative creativity and range in the moral life. Standing up for depends upon a kind of abstract moral commitment to support the application of general norms to the life situation of the other as a being with a certain inherent moral status. It thereby embraces shared moral norms (equal protection of the law, universal human rights), but without necessarily embracing the lived reality and distinct perspectives of the other. Standing up with involves adopting a perspective that is more internal to the lifeworld and the contextually meaningful agency of the other. Standing up as returns to generality, in the sense of a recognition of common humanity, a global or planetary membership, but also moves one imaginatively more deeply into a comprehension of difference and the distinctive individuality of the other. As the moral recognition of the other is altered by this interpretive journey, so is the moral imagination of the self. Arguably a growth in one’s capacity to project oneself imaginatively into the perspective and viewpoint of the other person, and a growth in moral awareness or the ability to see connections previously unseen are plausible outcomes of the interpretive transformation effected by the trajectory of solidarity. The practices of solidarity mainly arise in the face of morally aberrant and unjust situations that are stifling human potential and where those being oppressed or suppressed need mobilized support and recognition. What the recipients of solidarity need, and the agents of solidarity provide, is affirmation and tangible support. In contrast, what the recipients of care need, and the agents of care provide, is attention. Though closely related and mutually reinforcing in many ways, solidarity and care are not the same, as affirmation and attention are different stances with different moral significance and developmental potentials. The practices of care are premised on situations that are neither aberrant nor unjust per se but are an inherent part of human species-being.

Like solidarity, care also deepens the moral imagination of both those who care for others and those who are cared for by others. If focusing on solidarity shifts away from individualism and independence toward mutuality and interdependence, focusing on care shifts away from the individualism of self-reliance to an individuality validated by reliance on others. The practices of care are called forth where a common background condition of potential fragility, vulnerability, insufficiency, and mortality take center stage in the lives of persons in need or trouble and in the lives of those around them. Care offers a universalism that is concrete and thick. It is quite possible to imagine (and to find close empirical approximations of) societies where solidarity is absent. Not so with care. Even the subjugated and impoverished society of the Ik so strikingly (and controversially) described by Colin Turnbull, retained ways of caring for their very young, if not for their very old. They almost, but not quite, lost their cultural concept of care. Care theorists, such as Eva Feder Kittay, point out that universalism is biologically grounded on the necessity of maternal care. Every living human being has in common the fact that once they were cared for by someone (female or male) who took on a mothering role and relationship with them. This commonality extends backward in time. All persons who cared as a mother for a child were able to do so only because mothering had been extended to them by a previous generation. Human society fundamentally depends on the production and reproduction of this structure of care-giving roles and relationships. Equality, Kittay argues, is not based on properties that an individual possesses by virtue of who that individual is, but instead on properties that one possesses by virtue of properties that another person has or once had. In keeping with this, care theorist Joan Tronto also views care as a concrete universal, or a ’species activity’ and has proposed that caring: includes everything that we do to maintain, continue, and repair our ’world’ so that we can live in it as well as possible. That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web. This provides yet another reason to distinguish between solidarity and care. Solidarity is based on who the other is as an individual human being and on ’properties’ they possess, if by properties we mean something like their moral standing and considerability, their entitlement to dignity and to respect for their human rights. When it comes to care, however, we are dealing not so much with recognition due to persons as with the ongoing, intergenerational, evolutionary web of living that all practices of care at any given moment are a part of. Solidarity is a response that unjustly denied recognition and moral standing calls for. Caring is a response that need calls forth, drawing on cognitive commitments and emotional capabilities that previous practices of caring have made possible. Care, like all the practices that relational bioethics examines and evaluates, should not be defined as good or just in all circumstances and in all its forms. The important work of ethical specification and judgment is skipped over when we equate care with virtues such as agape (selfless love of the other) and caritas (charity), or with social emotions such as other-regarding altruism or sympathy.

Thus it is important to ask what substantive values should inform caring as a moral practice and its effects. How best to describe the stance and intentionality of caring, its transformative moral psychological effects on agents of care and recipients, and its role in governing structural and institutional power so as to mitigate the tension between social order and social diversity? With these questions in mind, I turn again to construct a developmental moral phenomenology of the practice of care. Before presenting my own account, I should note that Tronto has already offered something akin to what I have in mind. She distinguishes among caring about, taking care of, care giving, and care receiving. Caring about denotes the initial recognition of another’s need for care. Taking care of involves assuming responsibility for the determined need of the other and undertaking steps to meet that need. Care giving involves assuming a more direct, physical, and intimate role in the practices of care. Need can be recognized and attended to in many distanced and indirect ways, but giving care is hands-on, physical work. It signifies a new level of commitment and engagement than the other forms the activity of care can take. Finally, car