Public deliberation about health policy in the United States often hinges on two untenable basic assumptions about political legitimacy. The first assumption, common in public debate throughout the United States, is that federal oversight of health care is justified under a federal compact binding all citizens. This assumption is false because the federal compact precludes such oversight. Indeed, the ascendancy of national government (and demise of federalism) over the past 70 years was engineered through the subversion of the federal compact, (...) creating an expansive legitimation gap. The second assumption—that political legitimacy can be established through appeals to expert consensus about fundamental conceptions of justice or human rights—is prevalent among bioethicists. I argue that this assumption is illicit because it hinges on a weak, rationalistic form of majoritarian democracy that conflates public acquiescence with public approval. If the public mission of academic bioethics involves protecting the integrity of public deliberation, then these two basic assumptions should be challenged. (shrink)

This essay contrasts the notions of charity employed by Traditional Christianity and by liberal cosmopolitan bioethics, arguing that: (1) bioethics attempts to reconstruct the notion of charity in a manner that is caustic to the Traditional Christian moral vision, (2) Christians are, on the whole, more charitable than proponents of bioethics' reconstructed view (even given the standards of the latter), and (3) the theistically oriented conception of charity employed by Traditional Christianity cannot be expressed in bioethics' purportedly neutral public vocabulary. (...) The upshot is that, in the name of neutrality and pluralism, liberal cosmopolitan bioethicists seek to impose an impoverished moral vocabulary that reflects liberal cosmopolitan ideology while excluding input from Traditional Christianity and other non-liberal-humanistic moral visions. (shrink)

Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. Though Hobbes 's alternative to participatory democracy - assent by subjects to rule by an absolute sovereign - no longer constitutes a viable political alternative for Westerners, his critique of participatory democracy is a potentially valuable source of insight about its liabilities. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy, especially those advocating (...) for deliberative democracy based on a rational consensus model. In light of these warnings, the author suggests an alternative, modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics. (shrink)

The organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and thus reap the potential benefits of (...) such collaboration, despite having different moral beliefs or values. A first way is the pragmatic way in which the different health care institutions avoid ethical reflection and focus on solutions. A second possible route is that of consensus where health care institutions base their collaboration on values that they all share. The third, and final, approach is that of compromise. Although moral compromise is often seen in a negative light, we argue that in many cases compromise might be necessary and ethically justified. In a final section, we will shift our focus from discussing various theoretical methods to allow collaboration to the potential content of consensus or compromise. (shrink)

Moral pluralism is a reality. It is grounded, in part, in the intractable pluralism of secular morality and bioethics. There is a wide gulf that separates secular bioethics from Christian bioethics. Christian bioethics, unlike secular bioethics, understand that morality is about coming into a relationship with God. Orthodox Christian bioethics, moreover, understands that the impersonal set of moral principles and goals in secular morality gives a distorted account of the moral life. Therefore, Traditional Christian bioethics is separated from bioethics by (...) a radical difference in paradigms. (shrink)

The substantive center of Christian ethics is Jesus’s ministry of the kingdom or reign of God, and its preferential inclusion of the poor, the outcast, and the sinner. What defines a gospel-based bioethics is a hopeful, practical commitment to improve the health of those who are most vulnerable to illness and early death because they lack basic needs. This commitment is distinctive of Christian bioethics, if not “unique” in the sense that no other bioethical approaches or traditions share it. To (...) succeed in reducing disparities in access to health care requires cooperative social action with members of multiple moral and political communities, meaning that there is no strict boundary between secular and Christian bioethics at the practical, political level, the level of applied Christian social ethics. (shrink)

According to G. E. Moore, moral expertise requires abilities of several kinds: the ability to factor judgments of right and wrong into (a) judgments of good and bad and (b) judgments of cause and effect, (2) the ability to use intuition to make the requisite judgments of good and bad, and (3) the ability to use empirical investigation to make the requisite judgments of cause and effect. Moore’s conception of moral expertise is thus extremely demanding, but he supplements it with (...) some very simple practical guidance. (shrink)