In his press briefing on the outbreak of COVID-19 held 18 March 2020, the Director-General of the World Health Organization (WHO) stated that ‘[the] spirit of solidarity must be at the centre of our efforts to defeat COVID-19’.

Underscoring the WHO message, Australian authorities have since repeatedly reminded us that ‘We are all in this together’ and have consistently pleaded with people to respond collectively to the current public health crisis.

In keeping with the WHO stance, the public health messaging from Australian authorities has been clear: combating the spread and impact of COVID-19 requires solidarity with our neighbours and fellow citizens.

This requires all us to follow recommended and legally mandated safety precautions such as maintaining physical distancing, wearing masks, participating in testing and tracing programs and complying with ‘stay at home’ and lockdown rules.

A question of nursing ethics
Despite the near desperate urgings by authorities for us all to respond collectively to the current public health crisis, there have been notable examples of individuals and even governments (eg. USA, Brazil) who have simply refused to engage in solidarity behaviours. For many, the careless disregard some entities have shown towards the health, wellbeing and lives of others and their refusal to accept that their behaviours are potentially harmful even to themselves not just to others, is bewildering, frustrating and distressing.

Here several questions arise: What is solidarity? Are people morally bound by solidarity considerations? Should those who fail to act reasonably, ie., commit ‘solidarity derelictions’ (refuse to comply with legitimate COVID-19 safety precautions) be penalised? And are healthcare providers obligated to treat those who, because of their solidarity derelictions, become ill with COVID-19 and require hospital care?

Solidarity ethics
The notion of solidarity and its role as a foundational idea in ethics has long been the subject of critical debate. Despite being a contested notion, there is nonetheless general agreement that it encompasses a ‘We-thinking’ versus ‘I-thinking’ focus that requires people to ‘play their part’ in fulfilling certain reciprocal obligations to uphold solidarity systems and institutions (Davies & Savulescu 2019).

It has also been clarified that solidarity is not just a ‘feeling’, but a fundamental moral requirement that commits people to action –ie. to change their behaviour in the interests of promoting and protecting the greater public good. In short, solidarity is a ‘moral practice that is fundamental to a social and cultural structure of right relationship’ (Jennings & Dawson 2015, p.32).

Solidarity derelictions
Not all see themselves as being in a relationship with solidarity and, for a complexity of reasons, fail to show reciprocal moral concern for their fellow beings. Examples of their ‘solidarity derelictions’ (after West-Oram 2020) include those who, for dubious reasons, wilfully flout public health recommendations, engage in public protests against the public health safety measures mandated by governments (falsely claiming such requirements are a violation of democratic principles), and abuse those who are ‘doing the right thing’ by complying with COVID-19 restrictions.

Some argue that those ‘who choose to impose unreasonable burdens on others’– or who refuse, unreasonably, to consider the burdens their solidarity derelictions impose on others– deserve to be penalised, including being denied treatment if they get sick (Davies & Savulescu 2019, p.136).

One reason for this is that their actions fail to show reciprocal concern and respect for their fellow beings, which in turn violates the minimal standards of justice (a pre-requisite for solidarity). Just as penalties apply for drink driving, it might be argued, so too should penalties apply to those who, in the context of a pandemic, behave in a reckless, disregarding and careless manner thereby endangering the lives of others.

Whether such persons forfeit their right to healthcare if they get sick from COVID-19 is another matter. The commentary by Davies and Savulescu (2019) would suggest such persons could be reasonably denied healthcare, especially in cases where they had ‘Golden Opportunities’ to engage in realistically adoptable ‘right’ behaviours. Health professional codes of ethics, however, prescribe otherwise: just as healthcare providers are obliged to treat and care for drunk drivers and others who become injured or ill due to their own reckless behaviour, likewise they are obliged to care for those who have recklessly contracted COVID-19.

Fostering solidarity
Some argue that ‘most people will not comply perfectly with responsible behaviour even if they are motivated by solidarity’ (Davies and Savulescu 2019, p.139). Nonetheless, this does not mean that ‘anything goes’ and that the behaviours of those who wilfully flout restrictions aimed at protecting the health, safety and lives of the public are justified.

How best to motivate those unwilling to engage in solidarity – how to motivate them to be willing to help others, to make sacrifices for the greater good – remains an open question and one that has no easy answer.

Thus, it remains the work not just of governments but of us all to develop a firm commitment to the requirements of justice and to foster in ourselves and others a sense of our shared vulnerability and interdependence. This, in turn, might help to foster (even in the COVID-reckless) a meaningful sense of collective identity, mutual respect, reciprocity, and trust, and the desire to care about and help others.

Meanwhile, so long as individuals cannot be relied upon to voluntarily do the right thing, people will continue to die, and legal enforcement will remain the only option to help contain the spread of the disease.

References
Davies B & Savulescu J. 2019 Solidarity and responsibility in health care. Public Health Ethics, 12(2): 133-144

Jennings B & Dawson A. 2015 Solidarity in the moral imagination of bioethics. Hastings Center Report, 45(5): 31-38

West-Oram P 2020. Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19. Journal of Medical Ethics; Epub ahead of print doi:10.1136/medethics-2020-106522

Dr Megan-Jane Johnstone AO is a retired professor of nursing who writes as an independent scholar. She is the author of the landmark book Bioethics: a nursing perspective (Elsevier, Sydney).