By Avery Kolers.

Think of a time when you were trying to flex a rarely used muscle: say, learning to raise one eyebrow. In the moment, the action isn’t hard to do in the sense of being costly or requiring strength you don’t have, it’s hard to do because you don’t know how to isolate that muscle and send it the required electrical impulse.

In other words, in the moment, working a rarely used muscle is not so much about physical exertion as it is a feat of proprioception – attending to how we perceive ourselves from the inside.

Both scholars and activists discussing solidarity – whether on Covid-19 restrictions, Black Lives Matter, or other issues – focus a lot on the kinds of demands solidarity can make: from simply wearing a mask, to accepting the loss of your business; from donating money, to calling elected officials, to risking arrest. I am interested here in a different kind of demand that solidarity can make, namely, this demand for proprioception. Solidarity requires those of us who are privileged to perceive ourselves, and our broader ‘comfort zone’ of institutions and acquaintances, in unfamiliar and often unwelcome ways.

In their ground-breaking work on the subject, Barbara Prainsack and Alena Buyx characterize solidarity in biomedical contexts as “an enacted commitment to carry ‘costs’ … to assist others with whom a person or persons recognise similarity in a relevant respect.”

I agree that solidarity is about action; it’s about doing things, not just believing or supporting or sympathizing. But I question Prainsack and Buyx’s requirement of similarity.

Solidarity does not respond to similarity, but creates it. That is, the similarity is not antecedent, but rather, an achievement or commitment: deciding to throw our lot in with someone. Just as saying “I promise” does not describe a moral relation but establishes one, so the solidary agent’s statement “we are in this together” does not observe a reality but makes one. Instances of solidarity should therefore be morally evaluated less based on what we do than that on who we’ve decided to throw our lot in with, and why.

This is how solidarity becomes proprioceptively demanding.

Professionals who ascend the career ladder tend to inhabit – for lack of a better term – a comfort zone where we can see others and be seen as individuals, because antecedent similarities are taken for granted. Outside this comfort zone our interactions are much more transactional; there, we engage with others as avatars of social roles – people we know by job or location rather than by name. It is our everyday behaviour that sets, and polices, the boundaries of this comfort zone. Those who inhabit positions of power and prestige can normally expect others to accept the boundaries of their comfort zone and to defer to them rather than pull them out of it.

Those in positions of power and prestige need to learn to see themselves and their comfort zones as built on unjust structures and located within social and political struggles. They need to learn to throw their lot in with those who seek to break down the boundaries of comfort zones that are built on injustice. The actions required to do this need not demand much by way of physical exertion or cost. But they are often proprioceptively demanding because they require attending to how we perceive ourselves, and instead seeing ourselves ‘from below’; recognizing that, to others who lack our privileges, we are avatars of social roles. Consequently, actions that seem, from the inside, like perfectly reasonable responses to highly individual contexts, may be revealed as structurally determined and politically retrograde when viewed from below.

So what does all this have to do with biomedicine? The power and prestige of the medical profession, buttressed by physicians’ associations, make it easy for physicians to recognize similarities with other physicians, especially when faced with demanding patients, desperate families, or political pressure. In turn, the social structures that support physicians’ power and prestige ensure that most patients approach physicians in a deferential manner, accommodating physicians’ manners and schedules rather than demanding to be accommodated in these ways, and most politicians approach physicians’ associations in ways that seek consensus rather than lay down the law.

In this context, the ‘solidarity’ of physicians – their willingness to carry costs for one another on the basis of perceived similarity – too often spurs physicians to morally dubious or politically retrograde action, such as microaggressions, larger-scale prejudice, or at a political level, opposition to expanded rights to health care.

If solidarity is to be of any use for bioethics, it should help physicians and health system administrators build the proprioceptive capacities that enable them to see themselves from below, and to break out of patterns of action that reinforce their power and privilege relative to patients, support staff, and those without access to adequate care.

Paper title: What Can Solidarity Do for Bioethics?

Author(s): Avery Kolers

Affiliations: Department of Philosophy, University of Louisville

Competing interests: none

Social media accounts of post author(s): twitter: @avery_kolers