Jean-Jacques Rousseau, born in Geneva in 1712, had an important influence on political philosophy in the 18th century and since, in particular through his book The social contract, published in 1762. (1,2) This monumental work is part of the family of older, major writings on social contract theory by Thomas Hobbes (1588-1679) and John Locke (1632-1704).
The relationships between individuals, the state and government form the key components of Rousseau's "social contract". A first principle to govern these relationships is that man has no natural authority over other human beings and sheer force exercised by one individual over another does not justify authority. Rather, legitimate authority must find its rationale in so-called social pacts or contracts. (2) Secondly, competition among men will stimulate the need for a social pact, so that each can preserve oneself and be protected by the "general will" enacted by the people. (3)
The social contract purports to provide a proper alternative to the "state of nature". For Rousseau, the state of nature was initially peaceful, with this harmony attributable--among other things--to the small size of the population, the abundance of nature and the absence of competition. (3) Gradually society became more complex, introduced private property and created new forms of dependence among men, resulting in economic and social inequalities. The state of greed and competition that came into being led Rousseau to propose a new social pact, in broad agreement with Hobbes. Hobbes proclaimed men to be rational and interested in such a social pact, as it would bring them a better life compared with the state of nature. (3) In addition, for Locke, a particularly strong reason to abandon the state of nature and for men to contract with civil government was the emergence of war.
Rousseau compares the social contract to an "act of association" whereby there is reciprocal commitment between the state and the individual. The individuals as citizens share sovereign power, but as subjects put themselves under the laws of the state. Rousseau also defines government as one of the principal actors: it is an intermediary body between the subjects and the state with the main tasks of executing the laws and preserving civil and political freedom. (2)
Interestingly, Rousseau uses economic reasoning in the evaluation of the social contract, by comparing losses and gains: "What man loses by the social contract is his natural liberty and an unlimited right to everything he tries to get and succeeds in getting; what he gains is civil liberty and the proprietorship of all he possesses". (2) (Note here that "natural liberty" is constrained by the physical power of the individual, whereas it is the general will that defines the contents of "civil liberty". In addition, "property" is based on a legal tide whereas "possession" is the result of man exercising force.) According to Rousseau, the result of this kind of cost-benefit analysis is clearly positive: individuals will get net benefits, as the social contract will preserve them and protect them through the general will which is shaped by the same individuals. Furthermore, the adoption of a social contract is rational, as without it the state of nature (which is also referred to by Roussean as a "primitive condition") is put under such pressure that it would collapse.
How can we now assess Rousseau's social contract within the context of the development of contractual arrangements, such as in the health sector? (4) The social contract is focusing on principles of political organization and cooperation at the highest levels of society, and its usefulness for practical approaches at the micro- or meso-levels is scant. In particular, the process of seeking agreement for specific contracts does not find ready and practical advice in Rousseau's book, but its principles help in understanding the rationale for cooperation in the health sector. …