Public Health Poliy Forum foster and encourage the beneficent instincts of those who work within them is a far more difficult task than changing attitudes or even beliefs. Changing organizational behavior is a harder, more timeconsuming, and slower process and requires more scarcely available skills than changing individual attitudes, even among groups of individuals.To ensure that dying patients are permitted as much infonned self-determination and treated with as much dignity as possible, it is not enough to educate or reeducate entire generations of physicians, nurses, and administrators. We must also figure out how to make hospitals, as complex organizations fulfilling multiple tasks and operating under multiple constraints, operate in a way more consonant with such values. That's a more daunting task, but one no less com-

The field of bioethics arose in the late 1960s in response to the emerging ethical dilemmas of that era. The field for many years focused in general on the dilemmas generated by high-technology medicine rather than on issues of population health and the ethical problems of public health programs and regulations. The time has come to more fully integrate the ethical problems of public health into the field of public health and, at the same time, into the field of bioethics. Public health raises a number of moral problems that extend beyond the earlier boundaries of bioethics and require their own form of ethical analysis.

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When we consider the literature that has been produced exploring approaches to public health ethics, it is rare to fi nd any mention of solidarity. One obvious conclusion is that solidarity is a meaningless or superfl uous consideration. We suggest that this is not the right conclusion to draw, and that we must fi rst understand what solidarity is and then consider what difference it might make to thinking about issues in public health ethics. In this paper we, fi rst, outline some of the existing approaches to public health ethics and suggest that they often involve a set of questionable assumptions about the nature of social relations as well as a clear commitment to particular values. A failure of imagination in relation to solidarity is not, however, an argument against taking the concept seriously. Second, we propose a particular account of solidarity, suggest reasons why it is important for thinking about ethical issues in public health, and suggest how it relates to other relevant values. We argue that it is essential to engage with the issue of where we ought to place solidarity within our debates and frameworks for public health ethics.

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