Bioethics, Public Moral Argument, and Social Responsibility

Nancy M.P. King, Michael J Hyde

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136619793
• Topic: Philosophy
• Subtopic: Ethics in Medicine

Bioethics, Public Moral Argument, and Social Responsibility explores the role of democratically oriented argument in promoting public understanding and discussion of the benefits and burdens of biotechnological progress.

The contributors examine moral and policy controversies surrounding biomedical technologies and their place in American society, beginning with an examination of discourse and moral authority in democracy, and addressing a set of issues that include: dignity in health care; the social responsibilities of scientists, journalists, and scholars; and the language of genetics and moral responsibility.

Part I

Public Moral Argument and Social Responsibility

1 Arguing About Values

The Problem of Public Moral Argument

David Zarefsky

I claim expertise neither in medicine nor in ethics, but I do study public argument. And 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.

THE TENSION BETWEEN DEMOCRACY AND MORALITY

An explanation of our predicament must begin with an understanding of the tension between democracy and moral argument. For a working definition of democracy, I’ll use the one Abraham Lincoln put forth when he summoned Congress into 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 19^th century and the civil rights movement of the 20^th 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 abolitionists 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 discrimination, with its assumption of superiority and inferiority, had no place in American life. Racism has not disappeared, but over the past 60 years we have come to accept that officially-sanctioned discrimination is wrong.

One finds the prophetic moral voice in many other controversies—in calls to extend rights and liberties, and in calls to restrict them. It has figured prominently in the movements for women’s rights and, more recently, gay rights; it also has figured prominently in the movements for prohibition and for sexual abstinence before marriage. The paradox is that the prophetic voice is at odds with democracy and yet may be essential in enabling a democracy to advance

It should not be surprising, then, that moral conflicts are particularly difficult. Nor is this anything new. One hundred and fifty years ago, perhaps the greatest champion of democracy (with both an upper-case and a lower-case “d”) was Stephen A. Douglas. Slavery is a complex moral issue, he said, and it is not given to us to know which side is right. So rather than legislate for or against slavery in the territories, let the decision be made by those who go there to live. When a group of Chicago clergymen chastised him for moral obtuseness, he rebuked them, insisting that they had no special authority to speak on the matter (Douglas 1854/1961). On the other hand, John Brown knew for sure that slavery was an evil. It was beyond doubt or argument; his conscience demanded of him existential acts, that he do what he could to purge the nation of its sins. Equally convinced, however, was William Lowndes Yancey, a Southern fire-eater who knew for sure, because it was in the Bible, that slavery was a positive good and therefore that Congress must act affirmatively to protect the property rights of the slaveholders by enacting a slave code for the territories. With hindsight we can say that the genius of Abraham Lincoln was that he fused the prophetic and the pragmatic. He began with the premise that slavery was wrong, just as John Brown and William Lloyd Garrison did, but unlike them he reached the prudent conclusion that it should be contained—a position that enabled “strange, discordant, and even hostile elements” (Lincoln 1858/1953a) to coalesce under the banner of the Republican party.

The moral issues of our own time—issues such as abortion, cloning, stem cell research, gay marriage, and end-of-life decisions—are no less complex than the slavery issue was for our forebears. The experience of the slavery issue also suggests how we need to proceed with our own disputes. We need to argue them out, seeking the assent of our fellow human beings.

Arguing about values is difficult. Even acknowledging value conflicts is hard. We may avoid them because we think they don’t affect us, or because we don’t want to offend others, or because we don’t want to pass judgment and would rather “live and let live.” We don’t want to argue about them because that seems like bickering and fighting, or because we don’t want to risk exposing our beliefs to scrutiny, or because we imagine that there is no way to resolve a dispute: you have your values and I have mine, and that is that.

But if we do not engage our values in argument, we cannot make decisions democratically. We must either rely on some kind of force—the coercion of military power, the weight of authority, or the threat of reprisal—or we must settle for pure relativism, according to which no one value is preferable to any other (Booth 1974). 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 generalizable. The same methods and materials are available to advocates on both sides of the dispute.

HOW WE ARGUE ABOUT VALUES

Levels of Argument

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 audience 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 footprint. 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 established as a claim, and that would require an ancillary argument. Stewardship responsibilities, 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 of the earth for the sake of future generalizations, 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 maximize 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?

Strategies of Argument

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 speculative, 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 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 arguing 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...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgments
• Editors’ Introduction
• PART I. Public Moral Argument and Social Responsibility
• PART II. Moral Relationships and Responsibilities
• PART III. The Media, the Public, and the Person
• Afterword
• About the Editors
• About the Contributors
• Index