See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/275654052

Social Ethics

Chapter · May 2015

DOI: 10.1007/978-3-319-05544-2_395-1

CITATION READS

1 37,798

1 author:

Yesim Isil Ulman

Acibadem University School of Medicine
86 PUBLICATIONS   125 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Bioethics & COVID-19 Pandemic View project

Ethical Aspects of the Use of Artificial Systems in Medicine, A Qualitative Study View project

All content following this page was uploaded by Yesim Isil Ulman on 01 May 2015.

The user has requested enhancement of the downloaded file.

Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

Social Ethics
Yesim Isil Ulman*
School of Medicine, Department of History of Medicine and Ethics, Acibadem University, Atasehir-Istanbul, Turkey

Abstract
The ethical values and behaviors are not only abstract terms, but they are refined and conceptualized by
real-life experiences. The societal context where the actions of humans can be analyzed by ethical
decision-making is entirely relevant to deliberate on what is the right thing to do and what the moral
agent should do, since the ethical values and principles response to the actual practices of life and to the
needs of humans in the society. This elaboration takes us to the realm of social ethics.
This article reviews the definition and contextual meaning of social ethics at a broader level by giving
special emphasis to the ethical theories and principles, focusing on the societal and public setting. Ethics
will be deliberated with social and community aspects. Based on the principle of justice and public health
ethics, the concept of social ethics has been investigated concisely through the relationship between man,
as a moral person, and the society in exemplification of the issues of healthcare ethics. It is argued that the
tension between individualism and communitarian needs can be reconciled with the perspective of social
ethics by respecting the individual autonomy without disregarding the common good and social justice.
By promoting the values of social responsibility, solidarity, and social utility, social ethics has been
proposed as the basis of a rational, moral, egalitarian, pluralistic, democratic society rising on the pillars of
human rights and human dignity.

Keywords
Ethics; Ethical theories; Ethical principles; Beneficence; Non-maleficence; Autonomy; Justice; Common
good; Distributive justice; Equality; Individual freedom; Public health ethics; Public reason; Social rights;
Social utility; Solidarity; Social responsibility

Introduction
Despite the fact that it has not been adequately defined in the contemporary bioethics literature, the
concept of social ethics contains manifold denotations. Social ethics is inevitably fraught with the ethical
theories and principles, the principle of justice in particular, as well as the moral codes of conduct and
ethics of public health. Rather than having a precise definition, the concept of social ethics is in need of
being employed with its derivatives such as “social” and “society” (Armstrong 1907).
The interaction between human (as a moral person) and society attests the evolution of mankind. In the
beginning, man was forced to accept some social obligations in order to remain within a social group or
clan which provided survival security, since life outside the clan was not viable.
Greek philosophy brought a new understanding of man: it underlined the value of the individual but
acknowledged the conflict created between his (her) need to belong to a group and need to be recognized
as an individual with specific characteristics. Aristotle, in particular, stated that the essence of a human

*Email: [email protected]

Page 1 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

being is not only his rationality but also his capability of relating to others, since man is naturally meant to
live in a community.
Aristotle’s ethical methodology lies on “good action” and defends that we study ethics in order to
improve our lives, and therefore its principal concern is the nature of human well-being. Aristotle follows
Socrates and Plato in taking the virtues to be central to a well-lived life. Like Plato, he regards the ethical
virtues (justice, courage, temperance, and so on) as complex rational, emotional, and social skills. What
we need, in order to live well, is a proper appreciation of the way in which such goods as friendship,
pleasure, virtue, honor, and wealth fit together as a whole. In order to apply that general understanding to
particular cases, we must acquire, through proper upbringing and habits, the ability to see, on each
occasion, which course of action is best supported by reasons. Therefore practical wisdom, as he
conceives it, cannot be acquired solely by learning general rules. We must also acquire, through practice,
those deliberative, emotional, and social skills that enable us to put our general understanding of well-
being into practice in ways that are suitable to each occasion (Craut 2014). In fact the idea and inspirations
of social ethics may be rooted back in the Greek philosophy and Aristotle’s ethics.
Thus, Aristotle’s notions of political wisdom (phronesis) and political action (praxis) have been
benefited to connect between the Greek ethical thought and the social ethics of Karl Marx, later
on. Those elements in Aristotle’s thought include emphasis on the social and political nature of man,
the metaphysical relationship between substance and form, potency and act, and finally his distinctions
among theoretical, practical, and productive knowledge. Divergent philosophical positions regarding
social and economic justice – whether utilitarianism, formalism, liberalism, etc. – stress the distribution of
social wealth in terms of individual happiness, social contract, or fairness. However, Marx believes that
the essential questions of ethics and politics lie in the analysis of the nature and structure of the economic-
social infrastructure and the organization of the productive relations (McCarthy 1986).
Since then, a balance has been sought between these two characteristics. Unfortunately, history has
shown how this tension has brought about very negative consequences: in the name of the common good,
some atrocities have been committed against individual freedom and dignity; in the name of individual
rights, society has been considered by some individuals as a system that frustrates fulfillment of needs and
expectations causing them to opt out. By considering how both excesses have their limits and their pitfalls,
society is learning to value and respect the dignity of the individual, while the individual is discovering
that society is not just for the reception of benefits but is the right place to fully express and fulfill himself
as a human being in a state of interdependence (Di Mattia 2008).
Based on this brief historical perspective, social ethics can be interpreted through the definition,
methodology, theories, and principles of ethics at a societal context, by giving special emphasis to the
justice principle in ethics.

Ethics and Ethical Methodology

Ethics is defined, first of all, as standards of conduct that distinguish between right and wrong, good and
bad, and so on; secondly ethics is an academic discipline that studies standards of conduct, and ethics is
also described as a state of character. As an academic discipline, ethics is a branch of moral philosophy
that is concerned with age-old questions about duty, honor, integrity, virtue, justice, and the good life. The
questions asked by moral philosophy are normative, rather than descriptive, in that they have to do in what
one ought to live or how ought to be structured. Several disciplines in the social and behavioral sciences,
such as psychology, sociology, anthropology, and political sciences, take a descriptive approach to ethical
questions in that they attempt to describe and explain ethical beliefs, attitudes, and behaviors. The study of
ethics can be subdivided into theoretical (or normative) ethics, which studies general theories, concepts,

Page 2 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

and principles of ethics; meta-ethics, which studies the meaning and justification of ethical words,
concepts, and principles; and applied (or practical) ethics, which studies ethical questions that arise in
specific situations or areas of conduct, such as medicine, research, and so on (Shamoo and Resnik 2009).
When ethics is defined as a standard of conduct, it is important to compare ethics with law. Societies
have had laws since ancient times. One of the first legal systems was the 282 rules of the Code of
Hammurabi (1795–1750 BC), established nearly 4,000 years ago. Modern legal systems are based, in
large part, on laws developed in ancient Rome. Laws are like ethical standards in several ways. First, laws,
like ethics, are standards of conduct: they tell people what they ought to and ought not to behave. Second,
ethical and legal standards share many concepts and terms, such as duty, responsibility, negligence, rights,
benefits, and harms. Third, the methods of reasoning used in law and ethics are quite similar: both
disciplines give arguments and counterarguments, analyze concepts and principles, and discuss cases and
examples. However ethics differ from law in several important ways as well. First, the scope of law ethics
is much different from the scope of law. There are many types of conduct that might be considered
unethical but are not illegal. Second, people can appeal to moral or ethical standards to evaluate or judge
legal ones. People may decide there needs to be a law against some type of ethical behavior, or they may
decide that an existing law is unethical. If we decide that a law is unethical, then we are morally obligated
to change it or disobey it. For example, many people who decide that South Africa’s system of apartheid to
be unethical fought to change the system. Herewith, ethics and law can be imagined as circles that overlap
in some areas (Shamoo and Resnik 2009). As the two disciplines fostering each other in terms of
methodology and content, ethics and law can act together to respond to the needs of human welfare,
common good, and social justice. The notion of social ethics is quite relevant and stimulating in this link.
In this context, another distinction is between ethics and religion. Ethical theories and religious
traditions have much in common in that they prescribe standards of human conduct and provide some
account of the meaning and value of life. However ethics is not the same as religion. First, people from
different religious backgrounds can agree on some basic ethical principles and concepts. Christians, Jews,
Muslims, Hindus, and Buddhists can all agree on the importance of honesty, integrity, justice, benevo-
lence, respect for human life, and many other ethical values despite their theological disagreements.
Second, the study of ethics or moral philosophy is a secular discipline that relies on human reasoning to
analyze and interpret ethical concepts and principles (Shamoo and Resnik 2009). Consequently, the
rational decision-making and secular way of thinking methodology can be implemented with the guiding
principles of international human rights law and universal values in order to reach ethical analysis with
social and community aspects.

Ethical Theories and Principles in Relation to Social Ethics

It is worth to examine the ethical theories in the sense of social and communitarian aspects. Beauchamp
defines moral principles as respect for autonomy (the obligation to respect the decision-making capacities
of autonomous persons), non-maleficence (the obligation to avoid causing harm), beneficence
(obligations to provide benefits and to balance benefits against risks), and justice (obligations of fairness
in the distribution of benefits and risks). Method in ethics, firstly, begins with the moral convictions that
inspire the highest confidence and that appear to have the lowest level of bias. They serve as first
principles and conditions of more specific moral conceptions. Ethical principles are taken to be univer-
sally valid norms that warrant us in making intercultural and cross-cultural judgments about moral
depravity, morally misguided beliefs, savage cruelty, and other moral failures. Secondly, these abstract
principles need to be specified to make them suitable for the analysis of a context, case, or policy. It
requires, as does the associated method of reflective equilibrium, that we match and adjust all of our well-

Page 3 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

substantiated moral judgments in order to render them coherent with the full range of our moral
commitments (Beauchamp 2003). This view will be explored more in Rawlsian view of justice and
public reason in terms of social ethics later in the paper.
Kantian ethical theory should be briefly dealt with in this respect. Kantianism is a theory developed by
the German Enlightenment philosopher Immanuel Kant (1724–1804), which has been revised and fine-
tuned by modern day Kantians, such as Christine Korsgaard (1996). The basic insight of Kantianism is
that the ethical conduct is a matter of choosing to live one’s life according to moral principles and rules.
The concept of a moral agent plays a central theory in Kant’s theory. A moral agent is someone who can
distinguish between right and wrong and can legislate and obey moral laws. Moral agents (or persons) are
autonomous (or self-governing) insofar as they can choose to live according to moral rules. For Kant, the
motives of agents (or reasons of actions) matter a great deal. One should do the right action for the right
reason. What is the right thing to do? According to Kant, the right thing to do is embodied in a principle
known as the categorical imperative. One of the categorical imperatives holds that one should act in a way
that one’s conduct could become a universal law for all people. According to another Kantian categorical
imperative, one should treat humanity always as an end, never as a means. The basic insight here is that
human beings have inherent (or intrinsic) moral dignity or worth. We should not abuse, manipulate, harm,
exploit, or deceive people in order to achieve specific goals (Shamoo and Resnik 2009). Thus Kantian
ethical theory is also relevant in deliberating the moral agent’s actions in terms of its societal implications.
Originated from the utilitarian moral philosophy of Jeremy Bentham (1748–1832) and John Stuart Mill
(1806–1873), consequentialism (utilitarianism) bases ethical decision-making on an analysis of the likely
consequences or outcomes of different choices and actions. A consequentialist is somebody who thinks
that what determines the moral quality of an action (i.e., determines whether it is right or wrong) are its
consequences. A contrast is sometimes drawn between theories which determine the moral quality of
actions by their observance or nonobservance of rules and those which determine it by whether they
promote valued consequences. It is, obviously, determined by both, and that any adequate theory will take
both consequences and rules into account. We normally judge rightness or wrongness of actions by their
conformity to rules or principles, and the principles themselves are judged by the consequences of
observing them. If the actions are international, we praise or blame the agent for them (Hare 2012).
Beauchamp and Childress first outlined this contemporary theory of applied ethics in 1983. Their claim
is that a decision is ethically sound provided certain principles are respected and balanced. They proposed
four principles, although proponents have since suggested other candidates. Principlism has become one
of the most popular theories in healthcare ethics, and the principles provide insights into ethical problem-
solving (Schwartz et al. 2002). Ranaan Gillon argues that four principles have moral relevance in the
application to healthcare ethics and predicts that they are going to be acceptable as the basis for a global
bioethics, compatible with and sensitively negotiating the delicate path between moral relativism and
moral imperialism and helping in the pursuit of morally acceptable world peace (Gillon 2003).
The most commonly applied principles are listed below.

Autonomy
The ability of a person to be self-determining and self-governing; the capacity of a person to make
reasoned choices on the basis of information. It implies a duty on the part of caregivers to do what is
necessary to promote or at least not hinder their patient’s autonomy. This requires respect for persons,
by not interfering with their plans, ambitions, and choices (recall Kant’s categorical imperative
regarding ends and means). Autonomy is the primary consideration in patient-centered treatment.
Beneficence/non-maleficence
These are related concepts. Beneficence requires the caregiver to do good and help people;
non-maleficence is the Hippocratic requirement on the caregiver to do no harm. If only beneficence

Page 4 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

was required of a medical practitioner, it would be impossible to maintain because it entails no limits.
Thus the requirement is balanced, so at the very least caregiver ought to do no harm. However, even this
principle is not satisfactory on its own, as practitioners do occasionally have to cause some harm, such
as the sting of a needle or a noxious treatment like chemotherapy. Thus we rely on beneficence to ensure
that the harm is performed for a greater end.
Justice
In some of the literature justice means to treat people fairly. This might entail treating equals equally
whenever possible. However, it might also mean treating some people differently when their differ-
ences are relevant. For instance, we might choose to provide more healthcare to low-income areas
where health problems are often greater and healthcare is traditionally less accessible. Some philoso-
phers believe justice means equality of distribution of resources, while others claim it requires only
equality of access (Schwartz et al. 2002).
Every civilized society is a cooperative venture structured by moral, legal, and cultural principles
that define the terms of social cooperation. Beneficence and respect for autonomy are principles in this
fabric of social order, but justice has been the subject of more treatises on the terms of social
cooperation than any other principle. A person has been treated justly if treated according to what is
fair, due, or owed. For example, if equal political rights are due to all citizens, then justice is done when
those rights are accorded (Beauchamp 2008). The terms fairness, desert (what is deserved), and
entitlement have been used by various philosophers, in attempts to explicate justice. These accounts
interpret justice (in medical setting) as fair, equitable, and appropriate treatment in light of what is due
or owed to persons. Standards of justice are needed whenever persons are due benefits or burdens
because of their particular properties and circumstances, such as being productive or having been
harmed by another person’s acts. An injustice involves a wrongful act or omission that denies people
resources or protections to which they have a right (Beauchamp and Childress 2009).
Distributive justice and social ethics
The term distributive justice refers to fair, equitable, and appropriate distribution in society deter-
mined by justified norms of distribution that structure part of the terms of social cooperation. Usually
this term refers to the distribution of primary social goods, such as economic goods and fundamental
political rights. But burdens are so within its scope. Paying for forms of national health insurance is a
distributed burden.
Recent literature on distributive justice has tended to focus on consideration of fair economic
distribution, especially unjust distributions in the form of inequalities of income between different
classes of persons and unfair tax burdens on certain classes. But many problems of distributive justice
exist besides issues about income and wealth, including the issues raised in prominent contemporary
debates over healthcare distribution (Beauchamp 2008).

Shift from Individualism Toward Rights and Duties in the Community

Robert Veatch comments that when modern ethics began to shift from a Hippocratic ethics of benefit to a
more deontological ethics of rights and duties, drawing on the notion of respect for persons and the
underlying principles of fidelity, autonomy, veracity, and avoiding killing, the new ethics was still
addressing problems of the individual patient/physician relation – problems of confidentiality, informed
consent, disclosure of diagnosis, and the care of dying patient. It was as if in all the world there were only
one physician and one patient. The moral problem was figuring out how the patient ought to be treated.
The dispute between the consequentialist Hippocratic ethics and non-consequentialist ethics of respect for
persons was one within the tradition of individualism. Veatch argues that the moral problems in medicine
of the future moved from individual to a more social model. This shift required confronting the problems
of ethical individualism. Both Hippocratic beneficence and respect for persons ignore duties to third

Page 5 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

parties. In the modern world, ignoring society increasingly becomes impossible. Medicine must confront
issues of allocating scarce medical resources, including organ transplant, and conducting research on
human subjects where the goal is not improving the welfare of the individual patient but producing
knowledge for the benefit of the society.
Veatch examines the concepts of social utility, resource allocation, equity, and justice to draw attention
to the need of a social ethics. Social utility is defined as a principle that an action or rule is morally right
insofar as it produces as much or more net good consequences as any alternative, taking into account the
benefits and harms for all parties affected. To achieve this goal and to balance social utility and justice,
egalitarian justice principle is implemented in the sense of allocating scarce resources justly on the basis of
need and equity (Veatch 2003).
At this point, the ethics of public health is particularly relevant to improve the individualistic approach
of ethics in favor of common good and to endorse the perspective of social ethics.

Public Health Ethics, as a Link Between Healthcare and Social Ethics

Public health is primarily concerned with the health of the entire population, rather than the health of
individuals. Its features include an emphasis on the promotion of health and the prevention of disease and
disability; the collection and use of epidemiological data, population surveillance, and other forms of
empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of
health; and a focus on the complex interactions of many factors – biological, behavioral, social, and
environmental – in developing effective interventions. Public health ethics, like the field of public health it
addresses, traditionally has focused more on practice and particular cases than on theory. We can establish
the relevance of a set of these considerations in part by looking at the kinds of moral appeals that public
health agents make in deliberating about and justifying their actions as well as at debates about moral
issues in public health. The relevant general moral considerations include:

• Producing benefits
• Avoiding, preventing, and removing harms
• Producing the maximal balance of benefits over harms and other costs (often called utility)
• Distributing benefits and burdens fairly (distributive justice) and ensuring public participation includ-
ing the participation of affected parties (procedural justice)
• Respecting autonomous choices and actions, including liberty of action
• Protecting privacy and confidentiality
• Keeping promises and commitments
• Disclosing information as well as speaking honestly and truthfully (often grouped under transparency)
• Building and maintaining trust

Several of these general moral considerations – especially benefiting others, preventing and removing
harms, and utility – provide a prima facie warrant for many activities in pursuit of the goal of public health.
It is sufficient for our purposes to note that public health activities have their grounding in general moral
considerations and that public health identifies one major broad benefit that societies and governments
ought to pursue (Childress et al. 2002).
Public health ethics, as a field of study, also, seeks to understand and clarify principles and values which
influence decision-making in public health practice. Whereas public health ethics, as a field of practice,
applies principles and values to public health activities, it helps to deal with ethical dilemmas, in order to
come up with the best possible solution for a specific case. Public health ethics is also concerned with the
ethical dimensions of public health as a specific profession (professional ethics).

Page 6 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

Public health ethical issues were minimal when the paternalistic approach to public health measures
was accepted (paternalism is the attempt to impose limitations upon someone or to require actions by
someone for his or her own good; such impositions usually are justified with children because it is
assumed that they are incapable of deciding on their own behalf and with those who, because of cognitive
limitations, cannot choose on their own behalf). As from the second half of the twentieth century, the
authority of medicine and the paternalistic approach of physicians and public health officials started to be
questioned due to certain factors:

• The discovery of new treatments and new technologies has enormously increased the chances of cure
along with the risk of causing harm.
• Patients’ knowledge in general and on medical issues in particular has grown out of all proportion.
• The place of the individual has gained more ground in society, as have government policies and laws
which have developed toward protecting the individual, being informed by autonomy and human rights
issues.

Medical ethics has proportionally increased its body of study and research, in an effort to update its
code to the new reality, which now includes problems like medicine and palliative medicine (palliative
care and hospice). As a result, the more inclusive term for ethics in clinical medicine is “bioethics.”
Bioethics has found a strong point of reference in the patient-centered approach. As a result, clinicians
have clear guidelines for their interaction with patients, based on four principles: beneficence (doing
good), non‐maleficence (not doing harm), autonomy (respect for personal rights and the individual), and
justice (distributing benefits, risks, and costs fairly).
Those four principles have also strongly influenced public health decisions in the last few decades,
based on the argument that, while directed to the whole population, public health activities interact with
individuals. Although public health practice should not overlook the rights, interests, and freedom of the
individual, it has to look at the well-being of the entire population; therefore, the ethical principles and
values (ethical values) applied in bioethics, which follow the individualistic orientation, cannot be used as
a point of reference when dealing with the entire population.
Let us take the principle of non‐maleficence (not doing harm). If the point of reference is an individual,
it can be (somehow) easy to identify a possible harm and, as a consequence, be easy to avoid that harm.
However, if the case is of a necessary intervention targeted at a whole population, there may well be
individuals likely to be harmed by the intervention who are difficult (if not impossible) to identify, and the
harm, therefore, cannot be avoided. As a conclusion, in public health practice the principle of non‐
maleficence can be understood as doing the least harm possible to the least possible number of people
(Di Mattia 2008).
Interdependence is the complement of autonomy; an individual has a social role which, if carried out,
prevents the development of an extreme individualistic perspective that is inconsistent with the true nature
of human beings. We all understand that a society where individuals are free to do whatever they want
would not last long. Many of the collective goals in society that benefit the whole community are achieved
by sacrificing some degree of independence and freedom; maybe not every individual agrees with this
social contract, but we all experience the collective benefits (Di Mattia 2008).

Rawls’s Contributions, a Path Paving Way to Social Ethics

Herein, it is particularly worth mentioning the ideas of John Rawls. In his A Theory of Justice, Rawls
developed the theory of justice by describing the role of justice in social cooperation and by defining

Page 7 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

justice as fairness, and he dealt with the traditional conception of social contract (Rawls 1971, 1999). His
elaboration of justice in the context of social cooperation and social contract paves the way to the idea of
social ethics.
John Rawls (1921–2002), one of the most important political philosophers of the twentieth century,
wrote highly influential articles in the 1950s and 1960s focusing on substantive problems of moral and
political philosophy about what we ought to do. Rawls revitalized the social-contract tradition, using it to
articulate and defend a detailed vision of egalitarian liberalism in his first book, A Theory of Justice (TJ)
(1971). He recast the role of political philosophy, accommodating it to the effectively permanent
“reasonable pluralism” of religious, philosophical, and other comprehensive doctrines or worldviews
that characterize modern societies in Political Liberalism (1993). He explains how philosophers can
characterize public justification and the legitimate, democratic use of collective coercive power while
accepting that pluralism. TJ sets out and defends the principles of justice as fairness. Rawls takes the basic
structure of society as his subject matter and utilitarianism as his principal opponent. Part 1 of TJ designs a
social-contract-type thought experiment, the original position, and argues that parties in the original
position will prefer justice as fairness to utilitarianism and various other views. In order to understand the
argument from the original position, one must pay special attention to the motivation of the parties to the
original position, which is philosophically stipulated and provided with a Kantian interpretation. Part 2 of
TJ checks the fit between the principles of justice as fairness and our more concrete considered views
about just institutions, thereby helping move us toward a reflective equilibrium that supports those
principles. Part 3 of TJ addresses the stability of a society organized around justice as fairness, arguing
that there will be an important congruence in such a society between people’s views about justice and what
they value (Richardson 2015).
In this context, Rawls developed the idea of public reason, as a conception of a well-ordered
constitutional democratic society. To him, the form and content of this reason – the way it is understood
by citizens and how it interprets their political relationship – is part of the idea of democracy itself. This is
because a basic feature of democracy is the fact of reasonable pluralism; the fact that a plurality of
conflicting reasonable comprehensive doctrines, religious, philosophical, and moral is the normal result of
its culture of free institutions. Citizens realize that they cannot reach agreement or even approach mutual
understanding on the basis of their irreconcilable comprehensive doctrines. In view of this, they need to
consider what kinds of reasons they may reasonably give one another when fundamental political
questions are at stake. Rawls argues that in public reason comprehensive doctrines of truth or right are
replaced by an idea of the politically reasonable addressed to citizens as citizen. The well-ordered
constitutional democratic society of Political Liberalism is one in which the dominant and controlling
citizens affirm and act from irreconcilable yet reasonable comprehensive doctrines. These doctrines in
turn support reasonable political conceptions although not necessarily the most reasonable which specify
the basic rights, liberties, and opportunities of citizens in society’s basic structure (Rawls 1997).
Rawls’s conception of political liberalism provides valuable information about how a democratic
society should deal with bioethical questions. The public use of reason consists, therefore, also of the
development of procedures and criteria in order to apply the principles of justice and the political values
they reflect (political and civic freedoms, equal opportunities, social equality, economic reciprocity, and
general well-being) in a generally acceptable manner. The core of Rawls’s political liberalism is this: we
can reach an overlapping consensus on those political values that are part of a political notion of justice
connected with a democratic basic order (Pauer-Studer 2006). Rawls’ contributions to moral philosophy
have fertilized the new analyses on the ethical principle of justice and equality that is worth considering
social ethics based on social contract and political liberalism.

Page 8 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

Social Contract, Solidarity, Responsibility, and Social Ethics

The social contract tradition contends that society is established through a collective, mutually binding
agreement or contract. Moral expectations and duties are shaped by the contract and its implications.
Ethics is, therefore, primarily socially constructed and regulated. In a pre-political state, referred to as the
state of nature, rational individuals accept to enter a reciprocal agreement because it is mutually beneficial.
The contract is hypothetical in that its existence cannot be validated historically; however, its moral
legitimacy derives from the assumption that rational, self-interested individuals would likely forge this
agreement because they have more to gain from joining in a mutually beneficial association than from
staying out of it. In the Hobbesian version of the social contract, morality, rooted in social reality, is a
pragmatic, self-interested response to sustain survival. Other social contract theorists, such as Locke,
Rousseau, and Rawls, do not adopt such a self-interested and pessimistic stance. Kantian contractarianism
(or contractualism), for instance, values people as ends-in-themselves and assumes preexisting moral
duties embedded in the human ability to reason (Rozuel 2013).

Conclusion
The idea of social ethics has been proposed to develop the themes of global governance, civil society,
sustainable human development to point to the need of a partnership, and a long-term vision of our
collective needs, a “sine qua non” condition for an equitable, hence, sustainable development process
(Levy 1997). The ethical values and behaviors are not only abstract terms, but they are refined and
conceptualized by the real-life experiences. The societal context where the actions of humans can be
analyzed by ethical decision-making is entirely relevant to deliberate on what is the right thing to do, since
the ethical values and principles response to the actual practices of life and to the needs of humans in the
society. Furthermore the tension between individualism and communitarian needs can be reconciled with
the perspective of social ethics by respecting the individual autonomy without disregarding the common
good. Provided with basis of the ethical principles of non-maleficence, beneficence, autonomy, and
justice, the idea of social ethics paves the way to a communitarian and social contractarian alternative
to restore the injustices and inequalities in a democratic society fostered with the idea of public reason. By
promoting the values of social responsibility, solidarity, and social utility, social ethics stands as the
fulcrum of a rational, moral, egalitarian, pluralistic, democratic society rising on the pillars of human
rights and human dignity.

Acknowledgment
I would like to thank my colleagues, Nadi Bakirci, MD, PhD, professor of Public Health and Pinar
Topsever, MD, PhD, associate professor of Family Medicine for their inspirations.

Cross-References
▶ Access to Health Care
▶ Applied Ethics
▶ Benefit-sharing
▶ Bioethics and Politics

Page 9 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

▶ Bioethics: Global
▶ Biopolitics
▶ Citizenship
▶ Codes of Conduct
▶ Common Good
▶ Communitarian Bioethics
▶ Egalitarianism
▶ Equality and Equity
▶ Ethics
▶ Health Education and Promotion
▶ Health: Social Determinants of
▶ Health Insurance
▶ Health Policy
▶ Human Dignity
▶ Human Rights
▶ Moral Theories
▶ Natural Law
▶ Poverty
▶ Professionalism
▶ Public Debate
▶ Public Health
▶ Resource Allocation
▶ Right to Health
▶ Social Work
▶ Solidarity
▶ Welfare
▶ Workplace Ethics

References
Armstrong, A. C. (1907). Individual and social ethics. The Journal of Philosophy, Psychology and
Scientific Methods, 4(5), 119–122. http://www.jstor.org/stable/2010586. Accessed 21 Sept 2014.
Beauchamp, T. L. (2003). Methods and principles in biomedical ethics. Journal of Medical Ethics, 29,
269–274.
Beauchamp, T. L. (2008). Ethical theory and bioethics. In T. L. Beauchamp, L. R. Walters, J. P. Kahn, &
A. C. Mastroianni (Eds.), Contemporary issues in bioethics (7th ed., pp. 25–26). Belmont, USA:
Wadsworth Cengage.
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford
University Press.
Childress, J. E., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E.,
Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain.
Journal of Law, Medicine and Ethics, 30, 170–178.

Page 10 of 11
Encyclopedia of Global Bioethics
DOI 10.1007/978-3-319-05544-2_395-1
# Springer Science+Business Media Dordrecht 2015

Craut, R. (2014). Aristotle’s ethics. Stanford Encyclopedia of Philosophy. In E. N. Zalta (Principal Editor),
First published Tue 1 May 2001; substantive revision Mon 21 Apr 2014, ISSN 1095–5054. http://plato.
stanford.edu/entries/aristotle-ethics/. Accessed 26 Feb 2015
Di Mattia, P. (2008). Ethics. In W. Kirch (Ed.), Encyclopedia of public health. Springer Reference. www.
springerreference.com. Berlin Heidelberg: Springer, 2011-01-31 23:00:00 UTC.
Gillon, R. (2003). Ethics needs principles – four can encompass the rest – and respect for autonomy
should be “first among equals”. Journal of Medical Ethics, 29, 307–312.
Hare, R. M. (2012). A utilitarian approach. In H. Kuhse & P. Singer (Eds.), A companion to bioethics
(2nd ed., pp. 85–90). Chichester, West Sussex, UK: Wiley-Blackwell.
Lévy, B. (1997). Globalisation et développement: à la recherche d’une éthique sociale. Canadian Journal
of Development Studies/Revue canadienne d’études du développement, 18(3), 519–534, Published
online: 14 Jun 2013.
McCarthy, G. (1986). German social ethics and return to Greek Philosophy Aristotle and Marx. Studies in
Soviet Thought, 31, 1–24.
Pauer-Studer, H. (2006). Public reason and bioethics. MedGenMed, 8(4), 13.
Rawls, J. (1971). A theory of justice (rev. ed.). Copyright 1999 by the President and Fellows of Harvard
College, Printed in the United States of America. This book is a revised version of A Theory of Justice
published in 1971 by Harvard University Press, Sixth Printing 2003.
Rawls, J. (1997). The idea of public reason revisited. The University of Chicago Law Review, 64(3),
765–807.
Rawls, J. (1999). A theory of justice, Revised edition. Cambridge, MA: Belknap Press of Harvard
University Press.
Richardson, H. S. (2015). John Rawls (1921–2002). The Internet Encyclopedia of Philosophy (A peer-
reviewed academic resource). In J. Fieser, B. Dawson (Eds.), ISSN 2161–0002. http://www.iep.utm.
edu/. Accessed 24 Feb 2015.
Rozuel, C. (2013). Social contract. In S. Idowu, N. Capaldi, L. Zu, & A. Gupta (Eds.), Encyclopedia of
corporate social responsibility. Springer Reference. www.springerreference.com. Berlin\Heidelberg:
Springer, 2013-03-13 15:49:25 UTC
Schwartz, L., Preece, P. E., & Hendry, R. A. (2002). Medical ethics, a case-based approach. Edinburgh,
UK: Saunders Elsevier.
Shamoo, A. E., & Resnik, D. B. (2009). Responsible conduct of research (2nd ed.). New York: Oxford
University Press.
Veatch, R. M. (2003). The basics of bioethics (2nd ed.). New Jersey: Prentice Hall.

Further Readings
Anand, S., Peter, F., & Sen, A. (Eds.). (2009). Public health, ethics, and equity. New York: Oxford
University Press (Reprinted).
Buchanan, A. (2010). Health-care delivery and resource allocation. In R. M. Veatch (Ed.), Medical ethics
(2nd ed.) (pp. 321–361). Mississagua, Canada: Jones and Bartlett Publishers.
Guttman, W. (2008). Ethics of health promotion. In K. Heggenhougen (editor-in-chief), & S. Quah
(Associate editor-in-chief), International encyclopedia of public health: Vol. 2. (pp. 477–482).
Academic Press is an imprint of Elsevier, Oxford, UK
Pogge, T. (2005). Human rights and global health: A research program. Metaphilosophy, 36(1–2), 2005.
Wikler, D., & Marchand, S. (2012). Society’s allocation of resources for health. In H. Kuhse & P. Singer
(Eds.), A companion to bioethics (Blackwell companions to philosophy 2nd ed., Vol. VIII,
pp. 351–361). Chichester, West Sussex, UK: Wiley-Blackwell.

Page 11 of 11

View publication stats