Social Ethics

Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 Social Ethics Yesim Isil Ulman* School of Medicine, Department of History of Medicine and Ethics, Acibadem University, Atasehir-Istanbul, Turkey Abstract The ethical values and behaviors are not only abstract terms, but they are refined and conceptualized by real-life experiences. The societal context where the actions of humans can be analyzed by ethical decision-making is entirely relevant to deliberate on what is the right thing to do and what the moral agent should do, since the ethical values and principles response to the actual practices of life and to the needs of humans in the society. This elaboration takes us to the realm of social ethics. This article reviews the definition and contextual meaning of social ethics at a broader level by giving special emphasis to the ethical theories and principles, focusing on the societal and public setting. Ethics will be deliberated with social and community aspects. Based on the principle of justice and public health ethics, the concept of social ethics has been investigated concisely through the relationship between man, as a moral person, and the society in exemplification of the issues of healthcare ethics. It is argued that the tension between individualism and communitarian needs can be reconciled with the perspective of social ethics by respecting the individual autonomy without disregarding the common good and social justice. By promoting the values of social responsibility, solidarity, and social utility, social ethics has been proposed as the basis of a rational, moral, egalitarian, pluralistic, democratic society rising on the pillars of human rights and human dignity. Keywords Ethics; Ethical theories; Ethical principles; Beneficence; Non-maleficence; Autonomy; Justice; Common good; Distributive justice; Equality; Individual freedom; Public health ethics; Public reason; Social rights; Social utility; Solidarity; Social responsibility Introduction Despite the fact that it has not been adequately defined in the contemporary bioethics literature, the concept of social ethics contains manifold denotations. Social ethics is inevitably fraught with the ethical theories and principles, the principle of justice in particular, as well as the moral codes of conduct and ethics of public health. Rather than having a precise definition, the concept of social ethics is in need of being employed with its derivatives such as “social” and “society” (Armstrong 1907). The interaction between human (as a moral person) and society attests the evolution of mankind. In the beginning, man was forced to accept some social obligations in order to remain within a social group or clan which provided survival security, since life outside the clan was not viable. Greek philosophy brought a new understanding of man: it underlined the value of the individual but acknowledged the conflict created between his (her) need to belong to a group and need to be recognized as an individual with specific characteristics. Aristotle, in particular, stated that the essence of a human *Email: yesimul@yahoo.com Page 1 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 being is not only his rationality but also his capability of relating to others, since man is naturally meant to live in a community. Aristotle’s ethical methodology lies on “good action” and defends that we study ethics in order to improve our lives, and therefore its principal concern is the nature of human well-being. Aristotle follows Socrates and Plato in taking the virtues to be central to a well-lived life. Like Plato, he regards the ethical virtues (justice, courage, temperance, and so on) as complex rational, emotional, and social skills. What we need, in order to live well, is a proper appreciation of the way in which such goods as friendship, pleasure, virtue, honor, and wealth fit together as a whole. In order to apply that general understanding to particular cases, we must acquire, through proper upbringing and habits, the ability to see, on each occasion, which course of action is best supported by reasons. Therefore practical wisdom, as he conceives it, cannot be acquired solely by learning general rules. We must also acquire, through practice, those deliberative, emotional, and social skills that enable us to put our general understanding of wellbeing into practice in ways that are suitable to each occasion (Craut 2014). In fact the idea and inspirations of social ethics may be rooted back in the Greek philosophy and Aristotle’s ethics. Thus, Aristotle’s notions of political wisdom (phronesis) and political action (praxis) have been benefited to connect between the Greek ethical thought and the social ethics of Karl Marx, later on. Those elements in Aristotle’s thought include emphasis on the social and political nature of man, the metaphysical relationship between substance and form, potency and act, and finally his distinctions among theoretical, practical, and productive knowledge. Divergent philosophical positions regarding social and economic justice – whether utilitarianism, formalism, liberalism, etc. – stress the distribution of social wealth in terms of individual happiness, social contract, or fairness. However, Marx believes that the essential questions of ethics and politics lie in the analysis of the nature and structure of the economicsocial infrastructure and the organization of the productive relations (McCarthy 1986). Since then, a balance has been sought between these two characteristics. Unfortunately, history has shown how this tension has brought about very negative consequences: in the name of the common good, some atrocities have been committed against individual freedom and dignity; in the name of individual rights, society has been considered by some individuals as a system that frustrates fulfillment of needs and expectations causing them to opt out. By considering how both excesses have their limits and their pitfalls, society is learning to value and respect the dignity of the individual, while the individual is discovering that society is not just for the reception of benefits but is the right place to fully express and fulfill himself as a human being in a state of interdependence (Di Mattia 2008). Based on this brief historical perspective, social ethics can be interpreted through the definition, methodology, theories, and principles of ethics at a societal context, by giving special emphasis to the justice principle in ethics. Ethics and Ethical Methodology Ethics is defined, first of all, as standards of conduct that distinguish between right and wrong, good and bad, and so on; secondly ethics is an academic discipline that studies standards of conduct, and ethics is also described as a state of character. As an academic discipline, ethics is a branch of moral philosophy that is concerned with age-old questions about duty, honor, integrity, virtue, justice, and the good life. The questions asked by moral philosophy are normative, rather than descriptive, in that they have to do in what one ought to live or how ought to be structured. Several disciplines in the social and behavioral sciences, such as psychology, sociology, anthropology, and political sciences, take a descriptive approach to ethical questions in that they attempt to describe and explain ethical beliefs, attitudes, and behaviors. The study of ethics can be subdivided into theoretical (or normative) ethics, which studies general theories, concepts, Page 2 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 and principles of ethics; meta-ethics, which studies the meaning and justification of ethical words, concepts, and principles; and applied (or practical) ethics, which studies ethical questions that arise in specific situations or areas of conduct, such as medicine, research, and so on (Shamoo and Resnik 2009). When ethics is defined as a standard of conduct, it is important to compare ethics with law. Societies have had laws since ancient times. One of the first legal systems was the 282 rules of the Code of Hammurabi (1795–1750 BC), established nearly 4,000 years ago. Modern legal systems are based, in large part, on laws developed in ancient Rome. Laws are like ethical standards in several ways. First, laws, like ethics, are standards of conduct: they tell people what they ought to and ought not to behave. Second, ethical and legal standards share many concepts and terms, such as duty, responsibility, negligence, rights, benefits, and harms. Third, the methods of reasoning used in law and ethics are quite similar: both disciplines give arguments and counterarguments, analyze concepts and principles, and discuss cases and examples. However ethics differ from law in several important ways as well. First, the scope of law ethics is much different from the scope of law. There are many types of conduct that might be considered unethical but are not illegal. Second, people can appeal to moral or ethical standards to evaluate or judge legal ones. People may decide there needs to be a law against some type of ethical behavior, or they may decide that an existing law is unethical. If we decide that a law is unethical, then we are morally obligated to change it or disobey it. For example, many people who decide that South Africa’s system of apartheid to be unethical fought to change the system. Herewith, ethics and law can be imagined as circles that overlap in some areas (Shamoo and Resnik 2009). As the two disciplines fostering each other in terms of methodology and content, ethics and law can act together to respond to the needs of human welfare, common good, and social justice. The notion of social ethics is quite relevant and stimulating in this link. In this context, another distinction is between ethics and religion. Ethical theories and religious traditions have much in common in that they prescribe standards of human conduct and provide some account of the meaning and value of life. However ethics is not the same as religion. First, people from different religious backgrounds can agree on some basic ethical principles and concepts. Christians, Jews, Muslims, Hindus, and Buddhists can all agree on the importance of honesty, integrity, justice, benevolence, respect for human life, and many other ethical values despite their theological disagreements. Second, the study of ethics or moral philosophy is a secular discipline that relies on human reasoning to analyze and interpret ethical concepts and principles (Shamoo and Resnik 2009). Consequently, the rational decision-making and secular way of thinking methodology can be implemented with the guiding principles of international human rights law and universal values in order to reach ethical analysis with social and community aspects. Ethical Theories and Principles in Relation to Social Ethics It is worth to examine the ethical theories in the sense of social and communitarian aspects. Beauchamp defines moral principles as respect for autonomy (the obligation to respect the decision-making capacities of autonomous persons), non-maleficence (the obligation to avoid causing harm), beneficence (obligations to provide benefits and to balance benefits against risks), and justice (obligations of fairness in the distribution of benefits and risks). Method in ethics, firstly, begins with the moral convictions that inspire the highest confidence and that appear to have the lowest level of bias. They serve as first principles and conditions of more specific moral conceptions. Ethical principles are taken to be universally valid norms that warrant us in making intercultural and cross-cultural judgments about moral depravity, morally misguided beliefs, savage cruelty, and other moral failures. Secondly, these abstract principles need to be specified to make them suitable for the analysis of a context, case, or policy. It requires, as does the associated method of reflective equilibrium, that we match and adjust all of our wellPage 3 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 substantiated moral judgments in order to render them coherent with the full range of our moral commitments (Beauchamp 2003). This view will be explored more in Rawlsian view of justice and public reason in terms of social ethics later in the paper. Kantian ethical theory should be briefly dealt with in this respect. Kantianism is a theory developed by the German Enlightenment philosopher Immanuel Kant (1724–1804), which has been revised and finetuned by modern day Kantians, such as Christine Korsgaard (1996). The basic insight of Kantianism is that the ethical conduct is a matter of choosing to live one’s life according to moral principles and rules. The concept of a moral agent plays a central theory in Kant’s theory. A moral agent is someone who can distinguish between right and wrong and can legislate and obey moral laws. Moral agents (or persons) are autonomous (or self-governing) insofar as they can choose to live according to moral rules. For Kant, the motives of agents (or reasons of actions) matter a great deal. One should do the right action for the right reason. What is the right thing to do? According to Kant, the right thing to do is embodied in a principle known as the categorical imperative. One of the categorical imperatives holds that one should act in a way that one’s conduct could become a universal law for all people. According to another Kantian categorical imperative, one should treat humanity always as an end, never as a means. The basic insight here is that human beings have inherent (or intrinsic) moral dignity or worth. We should not abuse, manipulate, harm, exploit, or deceive people in order to achieve specific goals (Shamoo and Resnik 2009). Thus Kantian ethical theory is also relevant in deliberating the moral agent’s actions in terms of its societal implications. Originated from the utilitarian moral philosophy of Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873), consequentialism (utilitarianism) bases ethical decision-making on an analysis of the likely consequences or outcomes of different choices and actions. A consequentialist is somebody who thinks that what determines the moral quality of an action (i.e., determines whether it is right or wrong) are its consequences. A contrast is sometimes drawn between theories which determine the moral quality of actions by their observance or nonobservance of rules and those which determine it by whether they promote valued consequences. It is, obviously, determined by both, and that any adequate theory will take both consequences and rules into account. We normally judge rightness or wrongness of actions by their conformity to rules or principles, and the principles themselves are judged by the consequences of observing them. If the actions are international, we praise or blame the agent for them (Hare 2012). Beauchamp and Childress first outlined this contemporary theory of applied ethics in 1983. Their claim is that a decision is ethically sound provided certain principles are respected and balanced. They proposed four principles, although proponents have since suggested other candidates. Principlism has become one of the most popular theories in healthcare ethics, and the principles provide insights into ethical problemsolving (Schwartz et al. 2002). Ranaan Gillon argues that four principles have moral relevance in the application to healthcare ethics and predicts that they are going to be acceptable as the basis for a global bioethics, compatible with and sensitively negotiating the delicate path between moral relativism and moral imperialism and helping in the pursuit of morally acceptable world peace (Gillon 2003). The most commonly applied principles are listed below. Autonomy The ability of a person to be self-determining and self-governing; the capacity of a person to make reasoned choices on the basis of information. It implies a duty on the part of caregivers to do what is necessary to promote or at least not hinder their patient’s autonomy. This requires respect for persons, by not interfering with their plans, ambitions, and choices (recall Kant’s categorical imperative regarding ends and means). Autonomy is the primary consideration in patient-centered treatment. Beneficence/non-maleficence These are related concepts. Beneficence requires the caregiver to do good and help people; non-maleficence is the Hippocratic requirement on the caregiver to do no harm. If only beneficence Page 4 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 was required of a medical practitioner, it would be impossible to maintain because it entails no limits. Thus the requirement is balanced, so at the very least caregiver ought to do no harm. However, even this principle is not satisfactory on its own, as practitioners do occasionally have to cause some harm, such as the sting of a needle or a noxious treatment like chemotherapy. Thus we rely on beneficence to ensure that the harm is performed for a greater end. Justice In some of the literature justice means to treat people fairly. This might entail treating equals equally whenever possible. However, it might also mean treating some people differently when their differences are relevant. For instance, we might choose to provide more healthcare to low-income areas where health problems are often greater and healthcare is traditionally less accessible. Some philosophers believe justice means equality of distribution of resources, while others claim it requires only equality of access (Schwartz et al. 2002). Every civilized society is a cooperative venture structured by moral, legal, and cultural principles that define the terms of social cooperation. Beneficence and respect for autonomy are principles in this fabric of social order, but justice has been the subject of more treatises on the terms of social cooperation than any other principle. A person has been treated justly if treated according to what is fair, due, or owed. For example, if equal political rights are due to all citizens, then justice is done when those rights are accorded (Beauchamp 2008). The terms fairness, desert (what is deserved), and entitlement have been used by various philosophers, in attempts to explicate justice. These accounts interpret justice (in medical setting) as fair, equitable, and appropriate treatment in light of what is due or owed to persons. Standards of justice are needed whenever persons are due benefits or burdens because of their particular properties and circumstances, such as being productive or having been harmed by another person’s acts. An injustice involves a wrongful act or omission that denies people resources or protections to which they have a right (Beauchamp and Childress 2009). Distributive justice and social ethics The term distributive justice refers to fair, equitable, and appropriate distribution in society determined by justified norms of distribution that structure part of the terms of social cooperation. Usually this term refers to the distribution of primary social goods, such as economic goods and fundamental political rights. But burdens are so within its scope. Paying for forms of national health insurance is a distributed burden. Recent literature on distributive justice has tended to focus on consideration of fair economic distribution, especially unjust distributions in the form of inequalities of income between different classes of persons and unfair tax burdens on certain classes. But many problems of distributive justice exist besides issues about income and wealth, including the issues raised in prominent contemporary debates over healthcare distribution (Beauchamp 2008). Shift from Individualism Toward Rights and Duties in the Community Robert Veatch comments that when modern ethics began to shift from a Hippocratic ethics of benefit to a more deontological ethics of rights and duties, drawing on the notion of respect for persons and the underlying principles of fidelity, autonomy, veracity, and avoiding killing, the new ethics was still addressing problems of the individual patient/physician relation – problems of confidentiality, informed consent, disclosure of diagnosis, and the care of dying patient. It was as if in all the world there were only one physician and one patient. The moral problem was figuring out how the patient ought to be treated. The dispute between the consequentialist Hippocratic ethics and non-consequentialist ethics of respect for persons was one within the tradition of individualism. Veatch argues that the moral problems in medicine of the future moved from individual to a more social model. This shift required confronting the problems of ethical individualism. Both Hippocratic beneficence and respect for persons ignore duties to third Page 5 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 parties. In the modern world, ignoring society increasingly becomes impossible. Medicine must confront issues of allocating scarce medical resources, including organ transplant, and conducting research on human subjects where the goal is not improving the welfare of the individual patient but producing knowledge for the benefit of the society. Veatch examines the concepts of social utility, resource allocation, equity, and justice to draw attention to the need of a social ethics. Social utility is defined as a principle that an action or rule is morally right insofar as it produces as much or more net good consequences as any alternative, taking into account the benefits and harms for all parties affected. To achieve this goal and to balance social utility and justice, egalitarian justice principle is implemented in the sense of allocating scarce resources justly on the basis of need and equity (Veatch 2003). At this point, the ethics of public health is particularly relevant to improve the individualistic approach of ethics in favor of common good and to endorse the perspective of social ethics. Public Health Ethics, as a Link Between Healthcare and Social Ethics Public health is primarily concerned with the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors – biological, behavioral, social, and environmental – in developing effective interventions. Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory. We can establish the relevance of a set of these considerations in part by looking at the kinds of moral appeals that public health agents make in deliberating about and justifying their actions as well as at debates about moral issues in public health. The relevant general moral considerations include: • • • • • • • • • Producing benefits Avoiding, preventing, and removing harms Producing the maximal balance of benefits over harms and other costs (often called utility) Distributing benefits and burdens fairly (distributive justice) and ensuring public participation including the participation of affected parties (procedural justice) Respecting autonomous choices and actions, including liberty of action Protecting privacy and confidentiality Keeping promises and commitments Disclosing information as well as speaking honestly and truthfully (often grouped under transparency) Building and maintaining trust Several of these general moral considerations – especially benefiting others, preventing and removing harms, and utility – provide a prima facie warrant for many activities in pursuit of the goal of public health. It is sufficient for our purposes to note that public health activities have their grounding in general moral considerations and that public health identifies one major broad benefit that societies and governments ought to pursue (Childress et al. 2002). Public health ethics, as a field of study, also, seeks to understand and clarify principles and values which influence decision-making in public health practice. Whereas public health ethics, as a field of practice, applies principles and values to public health activities, it helps to deal with ethical dilemmas, in order to come up with the best possible solution for a specific case. Public health ethics is also concerned with the ethical dimensions of public health as a specific profession (professional ethics). Page 6 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 Public health ethical issues were minimal when the paternalistic approach to public health measures was accepted (paternalism is the attempt to impose limitations upon someone or to require actions by someone for his or her own good; such impositions usually are justified with children because it is assumed that they are incapable of deciding on their own behalf and with those who, because of cognitive limitations, cannot choose on their own behalf). As from the second half of the twentieth century, the authority of medicine and the paternalistic approach of physicians and public health officials started to be questioned due to certain factors: • The discovery of new treatments and new technologies has enormously increased the chances of cure along with the risk of causing harm. • Patients’ knowledge in general and on medical issues in particular has grown out of all proportion. • The place of the individual has gained more ground in society, as have government policies and laws which have developed toward protecting the individual, being informed by autonomy and human rights issues. Medical ethics has proportionally increased its body of study and research, in an effort to update its code to the new reality, which now includes problems like medicine and palliative medicine (palliative care and hospice). As a result, the more inclusive term for ethics in clinical medicine is “bioethics.” Bioethics has found a strong point of reference in the patient-centered approach. As a result, clinicians have clear guidelines for their interaction with patients, based on four principles: beneficence (doing good), non‐maleficence (not doing harm), autonomy (respect for personal rights and the individual), and justice (distributing benefits, risks, and costs fairly). Those four principles have also strongly influenced public health decisions in the last few decades, based on the argument that, while directed to the whole population, public health activities interact with individuals. Although public health practice should not overlook the rights, interests, and freedom of the individual, it has to look at the well-being of the entire population; therefore, the ethical principles and values (ethical values) applied in bioethics, which follow the individualistic orientation, cannot be used as a point of reference when dealing with the entire population. Let us take the principle of non‐maleficence (not doing harm). If the point of reference is an individual, it can be (somehow) easy to identify a possible harm and, as a consequence, be easy to avoid that harm. However, if the case is of a necessary intervention targeted at a whole population, there may well be individuals likely to be harmed by the intervention who are difficult (if not impossible) to identify, and the harm, therefore, cannot be avoided. As a conclusion, in public health practice the principle of non‐ maleficence can be understood as doing the least harm possible to the least possible number of people (Di Mattia 2008). Interdependence is the complement of autonomy; an individual has a social role which, if carried out, prevents the development of an extreme individualistic perspective that is inconsistent with the true nature of human beings. We all understand that a society where individuals are free to do whatever they want would not last long. Many of the collective goals in society that benefit the whole community are achieved by sacrificing some degree of independence and freedom; maybe not every individual agrees with this social contract, but we all experience the collective benefits (Di Mattia 2008). Rawls’s Contributions, a Path Paving Way to Social Ethics Herein, it is particularly worth mentioning the ideas of John Rawls. In his A Theory of Justice, Rawls developed the theory of justice by describing the role of justice in social cooperation and by defining Page 7 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 justice as fairness, and he dealt with the traditional conception of social contract (Rawls 1971, 1999). His elaboration of justice in the context of social cooperation and social contract paves the way to the idea of social ethics. John Rawls (1921–2002), one of the most important political philosophers of the twentieth century, wrote highly influential articles in the 1950s and 1960s focusing on substantive problems of moral and political philosophy about what we ought to do. Rawls revitalized the social-contract tradition, using it to articulate and defend a detailed vision of egalitarian liberalism in his first book, A Theory of Justice (TJ) (1971). He recast the role of political philosophy, accommodating it to the effectively permanent “reasonable pluralism” of religious, philosophical, and other comprehensive doctrines or worldviews that characterize modern societies in Political Liberalism (1993). He explains how philosophers can characterize public justification and the legitimate, democratic use of collective coercive power while accepting that pluralism. TJ sets out and defends the principles of justice as fairness. Rawls takes the basic structure of society as his subject matter and utilitarianism as his principal opponent. Part 1 of TJ designs a social-contract-type thought experiment, the original position, and argues that parties in the original position will prefer justice as fairness to utilitarianism and various other views. In order to understand the argument from the original position, one must pay special attention to the motivation of the parties to the original position, which is philosophically stipulated and provided with a Kantian interpretation. Part 2 of TJ checks the fit between the principles of justice as fairness and our more concrete considered views about just institutions, thereby helping move us toward a reflective equilibrium that supports those principles. Part 3 of TJ addresses the stability of a society organized around justice as fairness, arguing that there will be an important congruence in such a society between people’s views about justice and what they value (Richardson 2015). In this context, Rawls developed the idea of public reason, as a conception of a well-ordered constitutional democratic society. To him, the form and content of this reason – the way it is understood by citizens and how it interprets their political relationship – is part of the idea of democracy itself. This is because a basic feature of democracy is the fact of reasonable pluralism; the fact that a plurality of conflicting reasonable comprehensive doctrines, religious, philosophical, and moral is the normal result of its culture of free institutions. Citizens realize that they cannot reach agreement or even approach mutual understanding on the basis of their irreconcilable comprehensive doctrines. In view of this, they need to consider what kinds of reasons they may reasonably give one another when fundamental political questions are at stake. Rawls argues that in public reason comprehensive doctrines of truth or right are replaced by an idea of the politically reasonable addressed to citizens as citizen. The well-ordered constitutional democratic society of Political Liberalism is one in which the dominant and controlling citizens affirm and act from irreconcilable yet reasonable comprehensive doctrines. These doctrines in turn support reasonable political conceptions although not necessarily the most reasonable which specify the basic rights, liberties, and opportunities of citizens in society’s basic structure (Rawls 1997). Rawls’s conception of political liberalism provides valuable information about how a democratic society should deal with bioethical questions. The public use of reason consists, therefore, also of the development of procedures and criteria in order to apply the principles of justice and the political values they reflect (political and civic freedoms, equal opportunities, social equality, economic reciprocity, and general well-being) in a generally acceptable manner. The core of Rawls’s political liberalism is this: we can reach an overlapping consensus on those political values that are part of a political notion of justice connected with a democratic basic order (Pauer-Studer 2006). Rawls’ contributions to moral philosophy have fertilized the new analyses on the ethical principle of justice and equality that is worth considering social ethics based on social contract and political liberalism. Page 8 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 Social Contract, Solidarity, Responsibility, and Social Ethics The social contract tradition contends that society is established through a collective, mutually binding agreement or contract. Moral expectations and duties are shaped by the contract and its implications. Ethics is, therefore, primarily socially constructed and regulated. In a pre-political state, referred to as the state of nature, rational individuals accept to enter a reciprocal agreement because it is mutually beneficial. The contract is hypothetical in that its existence cannot be validated historically; however, its moral legitimacy derives from the assumption that rational, self-interested individuals would likely forge this agreement because they have more to gain from joining in a mutually beneficial association than from staying out of it. In the Hobbesian version of the social contract, morality, rooted in social reality, is a pragmatic, self-interested response to sustain survival. Other social contract theorists, such as Locke, Rousseau, and Rawls, do not adopt such a self-interested and pessimistic stance. Kantian contractarianism (or contractualism), for instance, values people as ends-in-themselves and assumes preexisting moral duties embedded in the human ability to reason (Rozuel 2013). Conclusion The idea of social ethics has been proposed to develop the themes of global governance, civil society, sustainable human development to point to the need of a partnership, and a long-term vision of our collective needs, a “sine qua non” condition for an equitable, hence, sustainable development process (Levy 1997). The ethical values and behaviors are not only abstract terms, but they are refined and conceptualized by the real-life experiences. The societal context where the actions of humans can be analyzed by ethical decision-making is entirely relevant to deliberate on what is the right thing to do, since the ethical values and principles response to the actual practices of life and to the needs of humans in the society. Furthermore the tension between individualism and communitarian needs can be reconciled with the perspective of social ethics by respecting the individual autonomy without disregarding the common good. Provided with basis of the ethical principles of non-maleficence, beneficence, autonomy, and justice, the idea of social ethics paves the way to a communitarian and social contractarian alternative to restore the injustices and inequalities in a democratic society fostered with the idea of public reason. By promoting the values of social responsibility, solidarity, and social utility, social ethics stands as the fulcrum of a rational, moral, egalitarian, pluralistic, democratic society rising on the pillars of human rights and human dignity. Acknowledgment I would like to thank my colleagues, Nadi Bakirci, MD, PhD, professor of Public Health and Pinar Topsever, MD, PhD, associate professor of Family Medicine for their inspirations. Cross-References ▶ Access to Health Care ▶ Applied Ethics ▶ Benefit-sharing ▶ Bioethics and Politics Page 9 of 11 Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_395-1 # Springer Science+Business Media Dordrecht 2015 ▶ Bioethics: Global ▶ Biopolitics ▶ Citizenship ▶ Codes of Conduct ▶ Common Good ▶ Communitarian Bioethics ▶ Egalitarianism ▶ Equality and Equity ▶ Ethics ▶ Health Education and Promotion ▶ Health: Social Determinants of ▶ Health Insurance ▶ Health Policy ▶ Human Dignity ▶ Human Rights ▶ Moral Theories ▶ Natural Law ▶ Poverty ▶ Professionalism ▶ Public Debate ▶ Public Health ▶ Resource Allocation ▶ Right to Health ▶ Social Work ▶ Solidarity ▶ Welfare ▶ Workplace Ethics References Armstrong, A. C. (1907). Individual and social ethics. The Journal of Philosophy, Psychology and Scientific Methods, 4(5), 119–122. http://www.jstor.org/stable/2010586. Accessed 21 Sept 2014. Beauchamp, T. L. (2003). Methods and principles in biomedical ethics. 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Gupta (Eds.), Encyclopedia of corporate social responsibility. Springer Reference. www.springerreference.com. Berlin\Heidelberg: Springer, 2013-03-13 15:49:25 UTC Schwartz, L., Preece, P. E., & Hendry, R. A. (2002). Medical ethics, a case-based approach. Edinburgh, UK: Saunders Elsevier. Shamoo, A. E., & Resnik, D. B. (2009). Responsible conduct of research (2nd ed.). New York: Oxford University Press. Veatch, R. M. (2003). The basics of bioethics (2nd ed.). New Jersey: Prentice Hall. Further Readings Anand, S., Peter, F., & Sen, A. (Eds.). (2009). Public health, ethics, and equity. New York: Oxford University Press (Reprinted). Buchanan, A. (2010). Health-care delivery and resource allocation. In R. M. Veatch (Ed.), Medical ethics (2nd ed.) (pp. 321–361). Mississagua, Canada: Jones and Bartlett Publishers. Guttman, W. (2008). Ethics of health promotion. In K. Heggenhougen (editor-in-chief), & S. Quah (Associate editor-in-chief), International encyclopedia of public health: Vol. 2. (pp. 477–482). Academic Press is an imprint of Elsevier, Oxford, UK Pogge, T. (2005). Human rights and global health: A research program. Metaphilosophy, 36(1–2), 2005. Wikler, D., & Marchand, S. (2012). Society’s allocation of resources for health. In H. Kuhse & P. Singer (Eds.), A companion to bioethics (Blackwell companions to philosophy 2nd ed., Vol. VIII, pp. 351–361). Chichester, West Sussex, UK: Wiley-Blackwell. Page 11 of 11