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Chapter 6 A PRIMER ON POLITICAL PHILOSOPHY Political philosophy Political philosophy is crucial for understanding and influencing contemporary health policy debates. It helps nurses develop strategies that consider ideological and ideological perspectives, which often drive political de...

Chapter 6 A PRIMER ON POLITICAL PHILOSOPHY Political philosophy Political philosophy is crucial for understanding and influencing contemporary health policy debates. It helps nurses develop strategies that consider ideological and ideological perspectives, which often drive political deliberations. This understanding informs discussions about the role of the state, the evolution of major ideologies, and the influence of issues like race and gender on political thought and action. Nurses should be mindful of these ideologic, philosophic, and political themes to effectively navigate political debates. Political philosophy Political philosophy is a discipline that analyzes and seeks answers to fundamental questions about the state and its moral and ethical responsibilities. It addresses questions such as what constitutes the state, what rights and privileges should the state protect, what laws and regulations should be implemented, and to what extent should government control people's lives. Political philosophy is closely related to legal and moral philosophy, as they all involve discussion of values, distinctions between right and wrong, and the distribution of burdens and benefits. It also addresses two issues: the distribution of material goods, rights, and liberties, and the possession and determination of political power. Political philosophy is a normative discipline that tries to establish how people ought to be expressed through regulations or laws. It is constantly evolving, prompting us to think about how concerns and questions can have different answers over time. For nurses, political philosophy helps analyze and work with situations in practice, policy, organizational, and community settings, such as determining government authorities' regulation of nursing practice and understanding complex ethical situations. The State The state is a crucial concept in political philosophy, as it refers to a social group rather than a single state in the United States. The modern state is a highly organized government entity that influences various aspects of everyday life, such as health policy issues. While national governments are often seen as the modern state, local and geographic state governments also play important roles in protecting individuals, regulating trade, and ensuring individual rights. The political culture of the United States is unique, with a focus on individualism, laissez-faire approach to government and economics, and a strong belief in individual rights. This unique political culture often influences the development of national health insurance programs, as seen in Canada and the United Kingdom. Individual and the state cont... The concept of the state is crucial in preventing chaos and disorder in human behavior, as it serves as a mechanism for imposing order or control. Philosophers like Thomas Hobbes, John Locke, and Jeremy Bentham have contributed significantly to shaping our understanding of this relationship. Hobbes' theory of a "social contract" posits that individuals in a hypothetical state of nature would choose to organize their political affairs through cooperative decisions, setting up a power to dominate them for the common good. Individual and the state cont... Locke's theory emphasizes individual rights over state power, asserting that people should be free from coercive state institutions and possess inherent rights that differ from legal rights established by governmental authority under a Hobbesian contract. Bentham, known as the father of classic utilitarianism, asserts that individuals and governments strive to attain pleasure over pain, with the primary interest of a community being its pleasure, good, or happiness. This principle applies to individual good or pleasure and requires the establishment of legal systems enforced by the sovereign. Individual and the state The tension between individual rights and the role of the state is evident in health policy discussions, such as substance use. While individuals have the right to smoke tobacco and drink alcohol, the state has a legitimate role to intervene, but the challenge lies in finding the right balance between the rights of individuals on both sides and balancing them with the rights of the state. These debates can also raise questions about the nature of the individual, or personhood, which may be invoked in policy discussions related to contraception and embryonic stem cell research. Political ideologies Political ideologies are a set of ideas related to politics that shape and support each other. They provide a framework for analyzing and making decisions on complex political issues and influencing policymakers to convince others that their position will advance the public good. Three major political ideologies, liberalism, socialism, and conservatism, originated in 18th- and 19th-century European philosophers and are the basis of political deliberations and policies worldwide. The terms and definitions of liberalism and conservatism have evolved over time, and they may vary across topics, leading to the use of "neo-" and "post-" to distinguish versions. It is crucial to understand the origins of these ideologies to fully comprehend their rhetoric and role in health policy. Box 6.1 provides major points of each of these ideologies. Liberalism Individuals should be able to develop fully as individuals Emphasizes individual rights and freedom of thought and expression (but not without limits) Individuals have control over own bodies and minds, but not to extent of harming others Democracy as ideal form of government, allowing everyone to participate and express views freely Government protections against abuse of power Conservatism Historically: Those in power have responsibility to help those not in power Contemporary form: Opposes rapid and fundamental change but advocates for decreased federal involvement in all matters, reduced tax burden, traditional social values, and transfer of authority to the geographic states Preference for tradition, stability, and structure Patterns of power that are predictable Socialism Government should protect workers for negative situations and conditions Equality regardless of role or status Economy supports the good of all Concept of a common good Lack of individual ownership Lack of privatization Centralized government in control Liberalism American political thought was greatly influenced by 18th-century European liberalism and the political thinking of Hobbes, Locke, and others. Liberalism relies on the notion that members of a society should be able to “develop their individual capacities to the fullest” (Shively, 2014, p. 29). People also must be responsible for their actions and must not be dependent on others. John Stuart Mill (1806–1873). Mill, a British political philosopher, published an influential essay “On Liberty” (1859) that is foundational to modern liberal thinking. Mill was committed to individual rights and freedom of thought and expression but not unconditionally. He based his work on Locke’s philosophies, tempered by Bentham’s utilitarian philosophy. Mill contended that individuals were sovereign over their own bodies and minds but could not exert such sovereignty if it harmed others. A leading, contemporary political philosopher and political scientist, Ian Shapiro, applied Mill’s balancing of individual rights with his “harm principle” as follows: “... although sanitary regulations, workplace safety rules, and the prevention of fraud coerce people and interfere with their liberty, such policies are acceptable because the legitimacy of the ends they serve is ‘undeniable’” (Shapiro, 2003, p. 60).  Conservatism Conservatism, a political ideology, is rooted in the French Revolution and is often traced back to British Parliamentarian Edmund Burke. Burke argued for a return to pre- revolution ideas and stability, referring to the revolution and instability as the loss of a compass. Despite various variations throughout history, conservatism generally favors tradition and stability in human existence. 19th-century European conservatives, particularly in Great Britain and Germany, developed programs that provided government support to the disadvantaged, such as unemployment assistance and income subsidies. These welfare policies were foundational to Europe's revival after World War II. Conservatism has been a major player in contemporary European politics, particularly in Great Britain, offering a synergy with American conservatism.  Socialism Socialism grew out of dissatisfaction with liberalism by many in the working class. Unable to prosper under liberalism, which relied on individual capacities, socialists looked to the state for policies to protect workers from sickness, unemployment, unsafe working conditions, and other situations. Karl Marx, the German philosopher (1818–1883), is widely considered the originator of socialism. For Marx, individuals could improve their situation only by identifying with their economic class. The 19th-century Industrial Revolution had created the working class, which, according to Marx, was oppressed by capitalists who used workers for their profits. According to Marx, only revolution could relieve workers of their oppression. Socialism arose to equalize access to resources through more centralized control. The collective nature of socialism is in contrast to the primacy of private property that characterizes capitalism. Additional tenets of socialism are provided in Box 6.1. Communism and democratic socialism. Socialism in Europe emerged in the late 19th and early 20th centuries as two ideologies: communism and democratic socialism. In 1917, communists, led by V. I. Lenin, took over the Russian Empire and formed the Soviet Union. They believed in revolution as the only way to advance socialism and improve workers' conditions. Democratic socialists, on the other hand, were more willing to work with government institutions and participate in democracies. Between 1989 and 1991, communist regimes in Eastern Germany, the USSR, and Eastern Europe collapsed, leading to the transition to democracy, democratic socialism, capitalism, and other economic and political models. Currently, only a few countries are under communist rule, while socialists, particularly democratic socialists, have prevailed in Scandinavia and Western Europe, advancing the modern welfare state.  Contemporary conservatism and liberalism Contemporary political conservatism emerged in the late 20th century in the United States, opposing a strong government role in assisting the disadvantaged and rapid change. Conservatives advocate for devolution of responsibility for health and social issues from the federal government to state authorities, reduced government involvement in policy, reduced tax burden, and the importance of traditional social values. The 1980 election of President Ronald Reagan is often seen as a turning point for the rise of contemporary American conservatism. Liberals, on the other hand, support an expanded government role in social policy, including income support, healthcare coverage, child care assistance, vocational guidance, and tuition. The Great Society programs of Presidents John F. Kennedy and Lyndon B. Johnson boosted American liberal policies, including Medicare, Medicaid, and Head Start. Decision-making may benefit from collective discussion for optimal outcomes rather than a win-or-lose approach to policy.  Gender and race in political philosophy In the postmodern era, traditional political philosophy has been criticized for failing to represent the voices of various groups, particularly those based on gender and race. The perspective of class has emerged, leading to the evolution of political ideologies of division along various lines. Gender is a particular policy viewpoint and an emphasis on the treatment of people of different genders. Feminist political philosophy emphasizes politics as a social contract, rejecting it as necessarily male- centered. Democratic feminism, a variant of democratic theory, argues for an egalitarian foundation with "norms of equality and symmetry" and open debate. However, it can divide people based on gender, as identity is connected to various factors such as ethnicity, socioeconomic status, work role, family structure, and sexual orientation. This focus on gender fails to recognize the intersectionality of identity, contributing to fractured identities and polarization. The "Racial Contract" is another example of how traditional approaches to political philosophy overlooked the realities of most of the world's population of people of color, including Black people, Native Americans, people of Asian origin, and millions of others non-White in ancestry.  The welfare state The welfare state refers to the percentage of the economy devoted to government social expenditures. The United States ranks below the midpoint in social expenditures compared to other developed countries, but consistently ranks higher in health expenditures. The 1935 U.S. Social Security Act established the Social Security program, welfare, and federal maternal and child health programs to help alleviate the Great Depression. Social security is sometimes referred to as an "entitlement," potentially leading to faulty inflation of funding towards "welfare."  Types of welfare states Welfare states are diverse across the US and internationally, based on the division of social service responsibilities between public and private sectors and the central government's role. Esping-Andersen's categorization of welfare states into social-democratic, corporatist, and liberal states is the most well-known. Social-democratic states promote equality, while corporatist states provide state interventions when family capacities fail. Liberal welfare states, like the US, Canada, and Australia, primarily use privately sponsored benefits, with the US being unique for its high percentage of social spending.  Political philosophy and implications for nurses Nurses can apply political philosophy concepts to their involvement in health politics and policy. They need to be aware of the context, trends, and policies that affect their lives and those in their community. Nurses bring a unique perspective to policy discussions, with expertise in social issues, community well-being, and health care. Regardless of partisan preference, nurses can participate in ideologic and political debates that shape health policy and the lives of others. Understanding one's own perspective is essential for engaging in conversation with others who may hold similar or disparate views. Nurses should listen to rhetoric, identify underlying political and philosophical threads, use similar language, and use written texts to advance their positions. The relationship between nursing and the state is underexplored, with many aspects of nursing's political history unexplored. Political philosophy is crucial in nursing's strategic thinking, as it helps bridge the gap between policy, politics, and practice, working with public officials and studying the state's role in nursing policies.  Ideology and Policy Options: Case Examples The ideology and policy options for uninsured Americans can be divided into two main categories: conservatism, which emphasizes minimal government role, and socialism, which supports government-run programs like Medicare, Medicaid, and CHIP. Conservatism advocates for individual accountability through health savings accounts and tax credits, while socialism supports the creation or support of government-run programs like Medicare and Medicaid. Liberals believe in the importance of promoting a peaceful society and controlling personal actions for the common good, while conservatism advocates for the right of motorcyclists to decide whether or not to wear helmets, with some policy options favoring no helmet law and promoting individual choice.