Bioethics Public Moral
Bioethics Public Moral
Bioethics Public Moral
If it is true that our scientific and medical knowledge have outpaced our ethical
understanding, then even more has our ethical understanding outpaced our ability to
argue effectively about moral or ethical issues. This condition is especially serious
because public argument is the means by which a democratic society comes to
judgment and decision about matters of controversy.
special session following the attack on Fort Sumter: “a government of the people,
by the same people” (Lincoln 1861/1953b)—a phrase that prefigures the Gettysburg
Address. The key idea is that, in a democracy, sovereignty resides with the people.
They delegate power to their leaders, whom they expect to act on their behalf and
whom they hold accountable. For the secular, sovereignty resides in the people by
virtue of natural rights; for the religious, as a gift of God.
If sovereignty resides in the people, three corollaries follow (Zarefsky 2008).
One is political equality. It is not that people in fact are equal in power and influence,
but that decision-making authority is allocated on a per capita basis, not on the basis
of wealth, race, gender, religion, heredity, or intelligence. A second corollary is
majority rule. People will not all think alike, yet decisions must be made in the face
of uncertainty. If each has equal access to decision-making authority, then it follows
that decisions must be made by the weight of greater numbers. And the third corollary
is minority rights. Even though they do not prevail, members of the minority retain
their legitimacy and sovereignty, and they could become the majority another day.
Democracy is like an ongoing conversation; there are no final victories.
A democratic society is grounded in the assumption of human fallibility (Thorson
1962). We commit ourselves to certain beliefs; we think we are right; but we cannot
know for sure. This human imperfection may be the result of unfinished evolution
or of original sin, but the fact is that we could be wrong. For our ideas to be widely
accepted, therefore, we must rely not on their inherent truth but on the free assent of
others. And when their judgment is that our ideas are wrong, society will abandon
those ideas and adopt others. There are no final, absolute victories. The virtue of
democracy is that it permits and encourages the correction of error.
But there is a tradition of discourse that challenges these assumptions; it is the
moral voice. It traces back to the prophets of the Hebrew Bible. They did not seek
the assent of their audiences, or if they did, they went about it in a very strange way.
Excoriation was their mode of operations; they called listeners to account for their
misdeeds and challenged them to repent lest Divine punishment be even more
severe. They had no doubt that they were right. They knew for sure because they
were not expressing their own ideas. They were merely messengers transmitting the
word of God—“thus saith the Lord.” The prophetic voice was not stilled when the
Biblical canon was closed. Even today, some participants in moral controversies
will claim absolute certainty resulting from their access to God’s Word.
Democracy presumes fallibility; prophecy presumes certainty. Yet it is an even
more complicated tension than that. Democracy is not a purely procedural system,
and it is the prophetic voice that enables a democracy to evolve. The abolitionist
movement of the nineteenth century and the civil rights movement of the twentieth
century were inspired by moral appeals. The fundamental evil of slavery was that it
denied the slave the dignity inherent in personhood, and it thereby degraded the
dignity of the master as well. This was not a contingent proposition; the abolition-
ists knew it for sure, and decades of controversy and the circumstances of war
convinced the vast majority of Americans that they were right. The civil rights
movement followed the premise that we are all God’s children—a premise about
which its advocates were certain—and argued to the conclusion that racial
14.1 The Tension Between Democracy and Morality 169
I may value freedom and you may value tyranny, and there is no way to choose
between us. The history of the last century is littered with object lessons suggesting
that we must not settle for these alternatives.
So let us attempt the task of arguing about values, engaging our moral judgments
within the assumptions of a democratic society. We must recognize first that virtually
all arguing about values is case-based. We will not get very far if we try to resolve
our disputes in the abstract. In an essay for the President’s Council on Bioethics,
Adam Schulman notes that human dignity might be grounded in our higher mental
capacities, or in the equality of all persons, or in individual autonomy and choice
(Schulman 2008). In the abstract most of us believe in all of those values, and yet in
a particular situation they can lead to different, even incompatible, outcomes. So we
have to make value judgments by arguing for the applicability of one or another
value to the specific case. This involves the ancient faculty of prudence, or what the
Greeks called phronesis, practical wisdom. It is not conclusive, nor final, nor gener-
alizable. The same methods and materials are available to advocates on both sides
of the dispute.
Arguments about values occur on two different levels. Sometimes the point of the
argument is to determine that something is a value in its own right. In these cases the
value is the claim to be established. The claim is defended by reasons that an audi-
ence would take to be justification for it, as well as by warrants derived from other
values that the audience accepts. For example, one might defend the claim that
reducing our carbon footprint is a moral obligation. Reasons might include evidence
that we are depleting the world’s natural resources and a warrant derived from other
values might be that we have a stewardship responsibility to care for the earth. If the
audience accepted the warrant and was convinced by the evidence, the combination
of warrant and evidence would establish the obligation to reduce our carbon foot-
print. The advocate for this claim will want to use warrants that the audience is
known to accept. If the warrant is not accepted, then it too will need to be estab-
lished as a claim, and that would require an ancillary argument. Stewardship respon-
sibilities, for example, could be warranted both by an appeal to justice and by their
acknowledgment in the Bible. In theory, the search for warrants acceptable to the
audience could produce an infinite regress, but it is highly unlikely that there will be
no commonly accepted values. Abandoning the effort to find common values that
can warrant other values should be the arguer’s last resort.
A variation on this approach to arguing about values is the argument a fortiori.
This is an argument about more and less. It suggests that the greater implies the
lesser (or vice versa, as the case may be). If we have the responsibility to take care
14.2 How We Argue About Values 171
of the earth for the sake of future generations, then even more do we have the
(subsidiary) responsibility to reduce harmful pollution from carbon emissions,
which is one of the threats to the future of the earth. Acceptance of the greater value
should imply acceptance of the lesser value which it subsumes.
More common, however, is the second kind of value argumentation: defending a
choice between or among competing values. For example, in the abstract we may
value both telling the truth and showing empathy and concern for others. But we are
confronted with a practical situation in which we must choose between these values.
In a conversation with a friend, should we tell the person what we honestly think
about his or her spouse, thereby being faithful to the value of truth-telling, or should
we tell a “white lie” in order to show empathy and concern for the friend and the
relationship? The answer will vary with the specific circumstances, but in any given
case we must be able to argue that one value should be preferred over the other. Like
this example, conflicts typically involve two values that are good in themselves but
may be incompatible in a specific case, such as the conflict between liberty and
equality. In principle we support both of these values, yet each recedes as we maxi-
mize the other. Sometimes there is a compromise tradeoff, but sometimes we want
to argue directly for the prominence of one over the other. When that is our goal,
how do we pursue it?
First, we can argue that one value subsumes the other. By choosing one we actually
could enhance both. For instance, the controversy over whether to undertake heroic
measures to resuscitate patients believed to be terminally ill can be understood as a
conflict between the values of life and the quality of life. Advocates on one side may
say that valuing life is to be preferred because life is a necessary condition for the
quality of life; there is no point in considering the quality of life after the patient has
died. Conversely, however, one might maintain that the quality of life is precisely
what makes life meaningful and distinguishes it from mere existence.
Second, we might try to establish that pursuing one value yields a comparative
benefit over pursuing the other. In considering priorities for public spending, one
advocate might contend that spending on education will be an investment in the
future; another might reply that spending on prisons will assure our security in
the present. Funds are limited and it is not possible to direct significant resources
to both. Then the dispute will turn on the question of whether greater benefit is
achieved by focusing on the needs of the future or of the present.
Third, we might argue for one value over another on the basis that it has a greater
likelihood of attainment. If we can achieve one value while the other remains specu-
lative, then it would seem reasonable to pursue the one that could be obtained rather
than risking the loss of both. An example might be the vexing philosophical
problem of whether justice should be preferred over happiness, or vice versa.
One might prefer the value of justice on the grounds that it can be achieved in this
172 14 Arguing About Values: The Problem of Public Moral Argument
world whereas true happiness can be achieved only in the next. Alternatively, one
might maintain that one should pursue happiness because it is a state of mind,
subject to our own control, whereas achieving justice depends upon the actions of
others as well.
Fourth, we could argue that one value is preferred over another because it is a
better means to a shared goal. In this case there is agreement on the terminal value
to be sought but disagreement over the instrumental values that promote it. Virtually
all parents, for example, want their children to grow into mature adults, but there is
considerable disagreement about the values that will lead to that goal. One advocate
might defend the value of autonomy, saying that giving children latitude to make
many of their own decisions will provide experience in responsible decision making
that is a hallmark of maturity. Another might maintain that close supervision and
direction is a better path to the goal, because the child who practices desirable
behavior under parental supervision will develop a habit of it and hence will be
more likely to behave appropriately on his or her own. The advocates would
exchange reasons for believing that the instrumental values they support will be
more likely to achieve the commonly-held terminal value.
Fifth, we might propose that one value is better supported by authoritative
sources than is the other. This approach presumes that both advocates accept the
authority of the source. For example, we might imagine two religious people argu-
ing about the extent of human responsibility for the environment. The advocate who
believes that this is a low priority might maintain that the world exists for human
use, citing the Biblical admonition that humankind fill up the earth and subdue it.
The other, who thinks that we must preserve the earth for future generations and that
attending to this responsibility is a high priority, might cite the Biblical admonition
to take care of the earth, claiming that we are stewards but that the earth does not
belong to us. This can be a productive argument because both advocates accept the
authority of the Bible. The question then is which of the competing Biblical texts
more clearly applies to the case at hand. On the other hand, if one advocate regarded
the Bible as a guide to conduct and the other regarded it only as an interesting
narrative, then a prior argument would be needed about whether the Bible should be
regarded as an authoritative source, and if not, what other source should be consid-
ered authoritative. Or if the arguers rely on different sources, each of which could
lay claim to authority (based on experience, training, or previous judgment, for
example), then it will be necessary to determine in the given case which source can
lay the greater claim.
Sixth, we might appeal to what in rhetoric is referred to as the locus of the irrepa-
rable (Perelman and Olbrechts-Tyteca 1958/1969). This is an argument suggesting
that if one choice is made (or not made, as the case may be), the consequences will
be irreversible; we will be past the point of no return. The underlying assumption
ordinarily is that preserving options is better than losing them. For example, an
advocate might prioritize the value of energy conservation over energy use by
noting that if we exhaust the earth’s fossil fuels, we cannot replace them. Since we
cannot know how quickly alternative fuels can be made available, it makes sense to
slow the rate at which we deplete fossil fuels. On the other hand, an opposing
14.2 How We Argue About Values 173
advocate might argue that the current use of fossil fuels is essential to sustain
economic growth, and without continued economic growth we not only will be
unable to meet current social needs but also will lack the capital investment
necessary to develop alternative fuel technologies. For one advocate, then, the locus
of the irreparable is grounds for conserving fossil fuels while for another advocate
it is grounds for continuing to use them.
These six broad patterns hardly exhaust the ways in which we argue about values,
but they illustrate ways for getting beyond the stalemate that results from the mere
assertion of opposing value claims. They are what the ancients called topoi, places
in the mind where one might find arguments. Since each pattern can be used on both
sides of a dispute, as the examples indicate, invoking a pattern does not by itself
resolve the dispute either. Rather, it opens a space for argument, in which each of
the disputants attempts to convince a relevant audience that his or her value should
be preferred over that of the antagonist.
would do); since he said that the country must become “all one thing or all the
other,” he must really be an extreme abolitionist (Zarefsky 1990).
What these six general patterns (strategies) and two specific types of support
(tactics) suggest is that, notwithstanding the difficulty, people do in fact argue about
values and can do so productively, It follows, then, that the moral issues posed by
bioethics should not be regarded as beyond the pale of public moral argument.
From the examples, it is evident that many arguments about values are not conclu-
sive. The very same sorts of warrants are available to advocates on any side of a
dispute, and their task is to gain others’ agreement that their value best fits the case.
The outcome is unknown and may not be the same in each case.
In these explanations, democracy has been privileged over morality. Even the
prophet, who claims to know for sure, ultimately must make a case that will be
acceptable by others. This point of view may be readily accepted by secularists who
see that the alternative is tyranny. It may be readily accepted by those whose faith
traditions, like mine, hold that prophecy ceased many centuries ago, with the prophet
Malachi being the last. On this view, the word of God is found not in the human
voice but in sacred texts that we must struggle, with all our imperfections, to interpret.
And since it is not given to us to know what they mean, for sure, we must recognize
and respect the views of others as well as our own. This is nowhere better captured
than in the Talmud, which is argumentative through and through. Human beings
must decide, they cannot know for sure, so they must submit their claims and rea-
sons to the judgment of their fellows.
But this resolution will not sit well with those of other faith traditions who
believe that God continues to speak directly to us, telling us how to behave in the
world. Suppose that we really did know, for sure, when human life begins, or what
is our responsibility to the planet, or whether a particular war is a moral obligation.
If we really knew for sure, would we be tolerant of ignorant people who did not see
the light but who nevertheless challenged our judgment? Would we spare any effort
to be sure that we prevailed? Would we be patient with the niceties of democratic
decision making? If we knew the truth and others decided in error, would we not
also be implicated in the sin of the whole?
This is the position of the prophet. Others might call him or her a fanatic, deluded
perhaps, most likely presumptuous and arrogant, but most prophets have been
similarly reviled. How can we maintain that even one who claims to know for sure
should be constrained by the proceduralism of democratic society? The answer
might be to observe that it is democracy that creates the conditions in which one
can espouse what he or she claims to know for sure. Otherwise, the tyranny of the
ignorant could silence the true believer, confining him or her to ineffectual martyr-
dom. How religious freedom came to the United States is an interesting case in
point. It did not grow out of Enlightenment political philosophy so much as out of
176 14 Arguing About Values: The Problem of Public Moral Argument
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