Abandonment or overreach: the ethical failures of health and social systems and the need for contributory reciprocity.

Despite rising investment in health and social services, loneliness, mental distress, and social disconnection continue to worsen across high-income countries. This pattern suggests the challenge may not lie solely in insufficient provision, but in how systems conceptualize people and value. Within increasingly individualized and consumption-oriented contexts, people are often positioned as recipients of services rather than contributors to social and civic life, with value reduced to economic or service-based metrics rather than relational and civic contributions. These assumptions shape system design, giving rise to two recurring patterns of failure. In ethical abandonment, systems retreat into markets and transactions, positioning people as consumers without preserving conditions for meaningful agency or contribution. In ethical overreach, systems use prescriptive, behavioral, or medicalised approaches that substitute institutional control for personal authorship, positioning people as objects to be optimized. Although these approaches appear opposed, both deny that people can matter to others beyond their consumption of support, undermining reciprocity, eroding shared life, and driving system expansion.