Johanna Ahola-Launonen

This article discusses the suggestion of having the notion of solidarity as the foundational value for welfare scheme reforms. Solidarity is an emerging concept in bioethical deliberations emphasizing the need for value-oriented discussion in revising healthcare structures, and the notion has been contrasted with liberal justice and rights. I suggest that this contrast is unnecessary, flawed, and potentially counterproductive. As necessary as the sense of solidarity is in a society, it is an insufficient concept to secure the goals related to social responsibility. The discussion on solidarity is also based on a questionable sense of nostalgia. Furthermore, solidarity and liberal justice share essential objectives concerning welfare schemes; therefore, the question arises whether the proper comparison should in the first place be within justice and solidarity.

:This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian—or luck egalitarian—tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

There is much discussion about individual responsibility in bioethics, especially in the context of health care distribution. Despite some different views, the majority of literature seems to admit that there are limits to individual responsibility, because of environmental factors, including ecological, physical, social and societal issues and epigenetics that affect a person’s health and well-being and her ability to control her life and make genuine choices. However, when the discussion comes to health care in the future and new genetic technologies, environmental issues seem to be forgotten. The issues concerning health and well-being are reduced to genetics and choices about genetics, as if the present environmental effects through epigenetics and societal issues would be diminished. It appears that a person’s ability to control her life would somehow be remarkably increased. This notion is a fallacy, because - despite new genetic technologies - the environment will continue to affect a person’s life both at a molecular and societal level. The environmental issues should be acknowledged also in scenarios of the future, for -otherwise- the discussion about individual responsibility will lead to a questionable direction and the most efficient means for improving health and well-being will be undermined.