Johanna Ahola-Launonen

Ryan and Savulescu recently offered an ethical analysis of the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, we continue the discussion and argue that their framework insufficiently addresses structural inequalities and the broader political context of obesity treatment. Positioning pharmaceutical drugs as a solution to socially produced health problems narrows moral decision-making, causing structural approaches to appear less urgent and less important. We criticise the individualistic conception of autonomy commonly invoked to justify pharmaceutical choice, arguing that a proper definition of autonomy requires attention to social contexts—stigma, discrimination and economic inequality—that shape treatment decisions. We call for a broader ethical framework—one that interrogates structural injustices and reimagines health interventions beyond individual treatment—asking: is the problem our bodies or unregulated markets and environments that produce ill health in them?

In this paper, I discuss the idea of having solidarity as the fundamental principle for welfare structures, and the call for a strengthened principle of solidarity as a guideline in applied ethics. More precisely, I focus on analysing the motivation and argumentation behind solidarity. What normative and conceptual roles is solidarity supposed to play? For the most part, solidarity has been suggested as a contrast, alternative, or supplement to accounts that are seen to overemphasise individualism, proceduralism, and autonomy. However, I argue that what this criticism requires is not a thick theory of solidarity, but merely a thin account recognising the social contexts human beings live in. In fact, I claim that any thicker views on solidarity, applied to policy-oriented theory, create contradictory outcomes to the original aims for highlighting solidarity. Solidarity is a concept oriented towards the individual, and thick concepts of solidarity easily incorporate asymmetrical, exclusionist, and moralistic tendencies into the discussion. The proponents of solidarity should be careful to keep the “thick” and “thin” levels of solidarity separate.

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.

: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.

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.