Christy Simpson considers what we have learned about solidarity during the COVID-19 pandemic.

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The value of solidarity gained particular prominence during the COVID-19 pandemic. The refrain, “We’re in this together” was frequently repeated, as an appeal to community and to what we need to do in support of one another (such as follow stay at home orders). In many ways, the focus on solidarity was a positive reminder about the need and desire for community, as well as the ways in which we truly are interdependent and interconnected.

It also didn’t take long for a response to this general refrain to rightly argue that there needs to be a more nuanced understanding and application of this value. That is, while we may all be in this together, we definitely did not all experience the pandemic in the same way. This more nuanced understanding of solidarity also meant that there was a need – particularly for those in power, positions of authority, or who are making decisions – to consider more deeply several questions. Who is being most affected by the pandemic and in what ways? What are the possible options for responding to these needs and to the harms caused by specific policies and decisions? And, as the pandemic went on, what needs to change in terms of how decisions are made, and the impacts are addressed?

Photo Credit: Albyn Davis/flickr. Image Description: People clapping and cheering for health care workers in the Upper West Side, New York City, during the initial stages of the COVID-19 pandemic.

We can reflect on these questions in relation to the many changes within the health care system during the pandemic. Changes to the delivery of different health care services during the pandemic, such as the pausing of elective surgeries, have had many repercussions that cannot be underestimated. The impacts on patients, families, providers, staff, and health leaders are still unfolding today.

Stepping back a bit from the immediate effects of the pandemic – how have we traditionally thought about solidarity in the context of the Canadian health care system? Arguably, for many, a sense of solidarity is fundamental to how we think about and why we value a publicly funded health care system – it’s an acknowledgement of need and of suffering and of the “universal human condition.” All of us will need health care at some point and there is a sense in which we come together using our tax dollars in Canada to ensure that health care is available.

But we need to be careful about what we assume, and how we reason from, the perspective of the “universal human condition” and how this applies to health care policy. Who are we picturing in our minds as being affected by a particular policy? Who and what are we missing or essentializing or privileging when rely on this “default” understanding of solidarity?

Solidarity is not a “neutral” term. We need to be attentive to context, history, and culture. We need to be careful about calls to solidarity that serve to undercut and divide, rather than bring together and attend to inequities and structural barriers. According to Rubén A. Gaztambide-Fernández, three critical “aspects” of solidarity ought to be kept in mind:

• Relationships – “We cannot be in solidarity alone. Who are we in solidarity with and what defines that relationship?”
• Commitments/Goals – “What is the aim of our solidarity and where do these commitments come from?”
• Actions – “What am I willing to do and give up in order to ensure the well-being of others…?”

This way of conceiving and talking about solidarity in the context of health care during a pandemic (or otherwise) is helpful. Gaztambide-Fernández challenges us to ensure that appeals to a sense of solidarity as a justification are not taken at face value. For example, what are the goals of policies, such as Visitor/Support Person/Essential Care Partner restriction policies? And what they are asking of each who is impacted (patients, families, health care teams) to achieve these goals? These questions are particularly important if what is “given up” or the harms that may occur, such as patients dying alone or with little family contact, health care team members trying to fill in gaps in care, will be unequally distributed among those affected by a particular policy.

As the pandemic went from days to weeks to months and Visitor/Support Person/Essential Care Partner policies continued to be in place (even with variations), we can further reflect on whether what was asked of people to give up or sacrifice and the harms that accrued due to prolonged isolation and separation was appropriate for the overall goal of safety. The legacies of policies, such as Visitor/Support Person/Essential Care Partner restriction policies, in terms of relationships, commitments, and actions from the perspective of solidarity (among other values) should be examined. Put another way, considering the value of solidarity in relation to these policies encourages us to reflect on what type of community we want to live in and create for each other – including within and across our health care system.

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Christy Simpson is an Associate Professor in the Department of Bioethics at Dalhousie University.

This commentary is based on an address during the public panel event: “No Easy Answers: The complicated and involved practice of ethics in health care during crises”, hosted by the MacEachen Institute for Public Policy and the Faculty of Medicine at Dalhousie University.