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Bioethics and Deliberative Democracy: Five Warnings from Hobbes
Griffin Trottera a Saint Louis University, Saint Louis, Missouri, USA

To cite this Article Trotter, Griffin(2006) 'Bioethics and Deliberative Democracy: Five Warnings from Hobbes', Journal of

Medicine and Philosophy, 31: 3, 235 — 250 To link to this Article: DOI: 10.1080/03605310600712786 URL:

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MO 63103.Journal of Medicine and Philosophy. No. especially those (such as most bioethicists) advocating for deliberative democracy based on a rational consensus model. USA G. Trotter Bioethics and Deliberative Democracy Downloaded At: 00:33 30 September 2010 Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. I find it about as satisfying as differentiating toads (and frogs) by their digital pads. Hobbes.. coarse-skinned amphibians that use their disproportionately large hind legs to hop and swim. LLC ISSN: 0360-5310 print/1744-5019 online DOI: 10. Vol. Likewise. none of them would focus on rationality when sharing their thoughts about humans. Missouri. toads are better described as slimy.. 2006 Copyright © Taylor & Francis Group. April 2006: pp. Saint Louis. The digital pads are 235 . moral consensus I. In light of these warnings. USA. Grand Blvd. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy. INTRODUCTION Aristotle thought that human beings could be differentiated from other animals by their rationality. Though one could make a case for this particular taxonomy. Ph. his critique of participatory democracy is a potentially valuable source of insight about its liabilities. if toads and other animals could talk. 03. St. but no one thinks of digital pads when they think of toads. For me. Saint Louis University.1080/03605310600712786 Journal 1744-5019 0360-5310 NJMP of Medicine and Philosophy. modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics. no doubt. and use their disproportionately large oral apparatus to say “ribbit” and catch insects. E-mail: trotterc@slu. 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. Keywords: deliberation. democracy. They would Address correspondence to: Griffin Trotter. Center for Health Care Ethics. 0–0 Philosophy Bioethics and Deliberative Democracy: Five Warnings from Hobbes GRIFFIN TROTTER Saint Louis University. Louis. 31. 221 N. modus vivendi. the author suggests an alternative. 31:235–250.

really make much sense as they are laid out by bioethicists. I have no particular disdain for democracy. the bull moose. humans of various stripes exert various forms of power. we enact extravagant dining rituals. eternal vitality. In this article. If we want to fight. on the other hand. they think you want to eat their children or copulate with their latest flame. human rights. and social justice. Apart from its instrumental uses in securing food. In all of this. Of course. they gild and disguise such non-rational motives with the Aristotelian conceit. and security. or subject ourselves to brooding art films that would kill elephants in about five minutes. or to other animals who are capable of achieving it. sex. we experience pleasure in wielding it skillfully. they would talk about our insatiable will to dominate. Thomas Hobbes. Downloaded At: 00:33 30 September 2010 II. But rationality is always mixed with other affections such as anger. Bioethicists are typically human in their ravenous pursuit of dominion and their urgency to achieve arbitrary ends. at least in part. I think. establishing multitudinous and frequently countervailing patterns of dominance. domination has little appeal to the grizzly bear. to serve them. of course. For human beings. in just the way that the venerable grandfather of Enlightenment political philosophy. we crave novelty. pride. Trotter talk. because it diverges so radically from the norm among other animals. lust. If we decide to harvest fish or deer. My intention here is to improve our conception of it. as with our other weapons. I would (but won’t directly) argue. about our bad odor or our death-dealing appendages. This characteristic is bound to elicit notice. Unlike Hobbes. we go for size and volume—even when there is food aplenty in the kitchen back home. Most of all. What I will argue here is that bioethics’ campaign for political influence is founded on a flawed account of democratic deliberation. Yet interestingly. there are no pure instrumentalities. As all outdoor-livers know. I isolate a particular breed of human being—the bioethicist— and examine its characteristic methods of acquiring and wielding political power. trips to Paris. waxing eloquent about cognitively higher-order things like rational consensus.236 G. THE RELEVANCE OF HOBBES It is no mistake that contemporary accounts of the development of liberal political philosophy typically begin with John Locke rather than Thomas Hobbes.1 Contemporary liberalism has wedded itself to two notions that Hobbes . I will employ Hobbesian notions as leading ideas. are always dangerous and always hungry for more than a full stomach. If we want to copulate. greed. we practice every day and then schedule tournaments (or wars) that allow us to fight many opponents in rapid succession. I think. It is flawed. perhaps. and… dominance. and prejudice (to name a few)—and typically it is employed. thought intellectual advocacy for democracy is bound to be flawed. Rationality is certainly an important weapon in our arsenal and. Human beings. wild animals with full bellies are rarely dangerous—unless. To that end. None of these things.

p. or fleeting whims from those grounded in principles of justice or fundamental needs. politics is rapidly globalizing. pp. counter Hobbes. especially as it is developed in bioethics.” which is the right of each individual to do whatever he or she will to serve his or her own interests). with globalization comes the encounter with ethical and religious pluralism and a stark. 1988. they provide “no opportunity for citizens to try to persuade others of the merits of their views. he says that deliberative democrats sought to mediate countervailing emphases on rights and justice (liberal individualists). which integrates these factors (Kymlicka. 284). presumably it would prove worthwhile to reflect on democracy’s liabilities and shortcomings—a task with which Hobbes is well qualified to help. was an early champion of democracy (Locke. on the other.” and Downloaded At: 00:33 30 September 2010 . nor even primarily. Locke. Yet despite our long tradition of placing Hobbes at the margins of liberal theory. In this article I briefly develop several theses from Hobbes that have bearings on contemporary theories of deliberative democracy. a rational animal. According to Kymlicka. Third. though his version of toleration leaves far more room for ethical pluralism than current versions of tolerance (Khushf. Hobbes stands virtually alone among early Enlightenment political philosophers in insisting that humanity’s natural state is irremediably plural.” I denote accounts of democracy that focus on the legitimizing role of deliberation among citizens. by focusing on the office of citizenship. prejudice. ignorance. 354) and. By “deliberative democracy. there are several good reasons for contemporary political theorists to reengage him. chaotic. p. versus community membership (communitarians).Bioethics and Deliberative Democracy 237 repudiated: democracy and common morality. Second. 2002. As Will Kymlicka observes. In the spirit of useful oversimplification. contemporary theories of deliberative democracy arose in the 1990s as a response to tensions between liberal individualism and communitarianism. Locke was keen to base the principles of government on a common. He understands far better than Locke and Kant that we have passions and that these passions—as much as rationality—constitute our nature. 1997. 16–20). Hobbes aligns with contemporary naturalism in his insistence that homo sapiens is not wholly. If we are serious about honing and improving our conceptions of democracy. This sits better with postmodern thinking than the tradition-bound accounts of Locke. 1994). proponents of deliberative democracy are unsatisfied with “aggregative” or “vote-centric” conceptions of democracy because: 1.” 2. Hobbes is uniquely prominent among Enlightenment philosophers for his critical stance toward democracy. First. and bereft of universal ethical standards (aside from the “Right of Nature. Christian morality (Goldie. and perhaps most importantly. Kant and other prominent Enlightenment theorists. they provide no means for distinguishing between “claims based on selfinterest. postmodern challenge to assumptions about a universal common morality. on one hand.

Conceding that academic bioethics is “not directly concerned with developing a societal response” to ethical issues (Moreno. or of the nature of imposing a comprehensive moral vision upon dissenting subjects). 1995. Jonathan Moreno nevertheless rightly observes that bioethics has from its inception manifested a strong commitment to deliberative processes and the goal of moral consensus. social solidarity. pp. participatory) democracy that directly threaten the welfare. When people are free to express their opinions. For some misgivings about this conception. liberty. seek robust moral consensus (Gutmann & Thompson. 126). Hence. 143–159) based on a particular conception of democracy. the most adroit manipulators of public sentiment will hold power and use this power in the way power is typically used—to serve their individual ends (whether these ends be egoistic. 6). they provide for little if any social dimension to the political process (Kymlicka. FIRST THESIS: PARTICIPATORY DEMOCRACY TENDS TO DEVOLVE INTO ARISTOCRACY For Hobbes there are several features of deliberative (or. 55–72) and as a “social reform movement” (pp. such as Amy Gutmann and Dennis Thompson. enhanced mutual understanding. 6. 290). aimed at enhanced mutual understanding. The particular conception in question is that of deliberative democracy. 2002. p. he regards bioethics not merely as a field of study. 2004. Some theorists. p. Ultimately. 1996. and security of citizens (Flathman. The goals of the political process. there is controversy. and empowered to effect them into law when they recruit devoted followers. He believes. pp. many contenders and public personalities will appear. p. and agreement.4 Bioethicists achieve opportunities for influential public speech both through claims of expertise5 and by establishing political connections. but also as “a set of social practices” (pp. the convergence or consensus-oriented school has held sway for well over a decade. more generally. that participatory democracy is difficult to carry off on a grand scale. on this mainstream account of deliberative democracy. 1962. seek only limited agreement (Young. 2002. such as Iris Marion Young.6 Each of these mutually intertwining pathways is opened by bioethicists’ residence .2 Within the field of bioethics. and a convergence of moral beliefs. are better and more legitimate political decisions. 229–230). 134–142). Some of these contenders will be more adept or politically connected (though not necessarily more wise) than others. as Hobbes frequently presumes. we now turn to Hobbes. and always devolves into rule by an aristocracy of vain-glorious public personalities (Hobbes. 92). As to the likely or desirable level of agreement.3 Downloaded At: 00:33 30 September 2010 III.238 G. p. others. progressive reform. Trotter 3. first of all.

confidence that the commissions would issue recommendations that cohered rather nicely with the ideology of the Democratic Party officials who appointed them. All this heartbreak aside. The ostensible rationale for these appointments seems to include the dubious supposition that bioethicists’ extensive training in a diversity of philosophical systems was sufficient to ensure an objective. All of this in accordance with Hobbes’s first thesis. While in power. more conservative. Bush II appointing a new. Indeed. . bioethics council). until the latter two were rudely interrupted by the intrusion of Republican administrations (Reagan insisting that some actual conservatives be allowed into the discussion. 1995. Such was also the case with subsequent commissions. academic bioethicists were prominent among the appointees. and also the National Bioethics Advisory Commission (NBAC). SECOND THESIS: PARTICIPATORY DEMOCRACY BEGETS UNPRODUCTIVE DISPUTES According to Hobbes. will rise again. non-partisan approach to the issues at hand—despite the fact that the appointees leaned uniformly leftward towards the Democratic Party. When their influence was cut off (by the aforementioned dislocations and terminations) they responded as all aristocracies do when threatened by the prospect of dwindling power: they lamented publicly about the plight of ordinary citizens. the Democratic Party. academic bioethicists should take solace in the rhythms and oscillations of American politics. The actual rationale was probably exactly the opposite—that is.Bioethics and Deliberative Democracy 239 within the academy. which has structured federal policy on research protections ever since the National Commission served it up. the President’s Commission descended into “partisan politics. p. Jonathan Moreno remarks that with the addition of Reagan appointees.” derailing “a rather explicit elaboration and defense of the idea of a right to health care”—as if the latter were transcendently wise and unstained by the subterfuge of partisan motives (Moreno. these commissions produced influential guidelines such as the Belmont Report. Thus. so suddenly and tragically deprived of needed wisdom and expertise that only they could offer. Their sponsor. Thus. participation in political discourse focuses attention on profitless subjects and thus distracts from more important and satisfying activities (such as attending to family affairs and enjoying the company of friends). 80). including the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (the “President’s Commission”). and with it—them too. Downloaded At: 00:33 30 September 2010 IV. when the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (the “National Commission”) was appointed to address issues related to biomedical research. that is just what the commissions did.

“there may be as many Neros as there are orators who soothe the people” (p. these officials create committees. Each of these mini-demagogues is potentially capable of converting his/her personal concerns into political issues. in a popular democracy. THIRD THESIS: PARTICIPATORY DEMOCRACY BEGETS EXCESSIVE GOVERNMENT POWER AND DOMINION Democratic processes strongly tend to enhance both government’s power (ability to enforce obedience) and its dominion (scope of things enforced). 228–229). pp. the maintenance of life-prolonging treatments in permanently unconscious patients. on his view. In participatory democracy. Trotter Downloaded At: 00:33 30 September 2010 Hobbes’s observation about profitless subjects hinges on his worries about the politicization of ordinary human activities. The morality of abortion or assisted suicide. V. and the application of neurological criteria for death are all issues that hinge on fundamental moral beliefs. desires. there could be no peace” (p. As Hobbes observes. and agencies—filled with political allies and authorized to create or enact more rules . not merely because it cannot succeed in producing a robust moral consensus. The vast diversity of such beliefs. is to carve out a secure area where such activities can be conducted without hostile interference. free from government interference and from each other (Flathman. but more importantly because liberty and individual felicity would be enhanced by allowing opposing individuals and groups to establish their own practices. Hobbes would include moral controversies engendered by needless disputation among those who would be better off to go their own separate ways. Though bioethics may (and to some extent does) succeed in influencing legislation on these issues. each with their own particular interests. the moral controversies persist. the metastasis of public projects eventually produces an unwieldy workload that overwhelms elected officials. and objectives to which political power is an available means. As we have witnessed in recent years. and their incommensurability. public advocacy of this nature is profitless. For Hobbes. their intensity. 1962. Rather than viewing this predicament as a signal to scale down government. 2002. 227). they tend to confuse dominion with liberty (Hobbes. many are involved. for-profit organ donation.240 G. Cooperation with disinterested demagogues is negotiated via a quid pro quo (well illustrated in the United States by our congressional earmarks)—begetting layer upon layer of political accretions. few prohibitions. pp. 228). effective liberty is maximized when there are “few laws.8 Because the citizens of a democracy participate in its rule. The purpose of the state. In actuality.7 Among the inventory of profitless subjects. 101–103). however. and those too such. ensures that subjecting them to public debate will produce only pallid unifying effects. Many of the central issues in bioethics qualify on this point. commissions. that except they were forbidden.

Bioethics and Deliberative Democracy 241 and prohibitions.e. . beyond effective political control. 3. more regulations constraining individuals and groups from choosing their own research methods and objectives—said regulations formulated. suggesting new research protections (i.9 Downloaded At: 00:33 30 September 2010 VI. but hardly the primary one. is a suffocating profusion of collective thinking. The typical result. To an increasing extent. more regulations constraining possible market arrangements between researchers and subjects). 2. bioethicists and bioethics departments depend on “external funding”—a term that typically indicates federal grant money divested from taxpayers sans their consultation or consent about its specific uses. more laws or regulations constraining the freedom of individuals to choose their own lifestyles and their prerogative not to be held financially accountable for the health effects of others’ lifestyle choices). without altering current constraints on taxpayer decisions concerning what research they will financially support). It feeds on it and sometimes helps constitute it. suggesting ethical remedies for the problem of “health disparities” (i. The end result is more power. Collective aspirations can be excessive in several senses. The bioethics commissions are an obvious case. of course. Grant money flows for “research” projects aimed at: 1. They may be: 1..e. In other words. even as it enhances its own. beyond what is needed for peace (peace being the only cogent rationale for the commonwealth). FOURTH THESIS: PARTICIPATORY DEMOCRACY BREEDS EXCESSIVE COLLECTIVE ASPIRATIONS Insofar as citizens conflate their political dominion with their liberty or their felicity. more regulations constraining possible market arrangements between donors and recipients). 3. suggesting new guidelines for organ procurement and distribution (i.e. they will tend to conjure grand visions of what they can achieve with like-minded political allies (against the will of dissenters). suggesting funding guidelines for federal stem cell research (i.. and so forth. Bioethics is more than complicit in this hyperplasia of government. and less space for the operation of individual liberty. based on irrational fears.. bioethics is largely in the business of enhancing the dominion of government. more dominion. 2.. on Hobbes’s account. 4. or 4.e. beyond human capacities (and hence politically unrealistic).

and the majority of their colleagues. human rights. Kuczewski. bioethics tends to the assumption— shared by most (liberal or conservative) proponents of majoritarian democracy—that the nation (and ideally the globe) should constitute one big. principles and practices is the proper goal of public deliberation. As I have argued in the past. in Assembly are like many brands. p. 2001. by consistently portraying America’s 45 million uninsured citizens as lower income individuals desperately in need of healthcare11). elimination of health disparities). 4). 1997. for instance. assert that their common morality framework is shared “by all persons in all cultures who are serious about moral conduct” (Beauchamp & Childress. p. 3. this outlook reflects bioethics’ self-interest in sustaining its emerging role in national projects and as a recipient of federal money. 18–38. and the principles of bioethics (Trotter. as the heat of one brand. moral community. 3.10 This thinking reflects a new. it seeks a degree of national moral consensus that is unworkable (Engelhardt. Of course. Hobbes spends quite a bit of time delineating the ways in which public discourse amplifies realistic personal fears into irrational public hysteria. He writes: “For the Passions of men. and eminently achievable (Moreno. Downloaded At: 00:33 30 September 2010 . 2003). In the campaign for collective government action. 13–14. it stokes exaggerated public fears (for instance. Deliberativists like Moreno and Mark Kuczewski are more reserved about the existence of an operational common morality. it champions projects that have little or nothing to do with securing peace (this pertains to most of the political advocacy in bioethics). but think that convergence to common moral beliefs. national political project. happy. 17). it seeks inordinate political influence over matters that cannot be effectively controlled by national governments (for instance. nationalistic anti-federalism (challenging federalism’s deference to state power) which is the contrary of early American forms of anti-federalism (which challenged federalism’s deference to national power). which asunder are moderate. animated by universal convictions about social justice. pp. 1996 [1651]. Beauchamp and Childress. More to the point. (especially when they blow one another with Orations) to the setting of the Common-wealth on fire. 2. Trotter Regarding the latter item. view the construction of a robust public moral philosophy as a collective. pp.242 G. that enflame one another. under pretence of Counselling (sic) it” (Hobbes. 1995. and 4. 2002). bioethics participates in each of the aforementioned forms of Hobbesian excess: 1. 181). The credo seems to be that it is better to do something coercively in large aggregates than to do it by consent in small groups. all of these prominent bioethicists.

Bioethics and Deliberative Democracy 243 VII. Hobbes insists that the distal objective—living well—is a function of individual constitution. 70). that ceaseth only in death. varying widely between persons and moral communities. It is not attainable because peoples’ various and diverging moral beliefs cannot typically be mediated by rational discourse alone (rationality operates on premises that reflect desire. emotion. redistributing property. that most of the twelve claims that Moreno identified in 1995 as objects of Downloaded At: 00:33 30 September 2010 . people act politically to appropriate political power. 2. divergent and at odds. in this sense. for ordinary citizens to respect natural limitations in the accumulation of personal political power. or even a desirable objective. It would be better. peoples’ interests and conceptions of living well are various. do they have a natural moral obligation to avoid doing so). 3. Hobbes thinks. in any robust sense. 1. According to Hobbes. and choice. or other contingencies. then.” arising because power provides the means for living well (Hobbes. as a means to living well. 1996 [1651]. Participatory democracy unfortunately tends to inflate the sense that persons sharing various interests have that they can successfully achieve dominion over competitors (by garnering special privileges. people have a common interest in protecting themselves from one another. of public deliberation. the most primordial case is an appropriation of government power for security against the violence and aggression of other persons. That. on Hobbes’s account. p. human beings are motivated to political activity by their desire for power. according to Hobbes. etc. For ordinary citizens. faith. and is impotent to unseat these foundations except by introducing alternative foundations that are equally contingent). To a much greater degree than other theorists of his era. In sum.12 It is instructive. Of course people have no qualms about appropriating more power than they need for their personal safety and freedom (neither. then. preference. Proximally. Moral consensus. thus enflaming their will for political dominion. we come to understand why Hobbes thinks that rational moral consensus is not the motive.). and 4. political power is useful instrumentally. understanding that the best they can typically do is to limit the ways in which other parties can wield power against them. FIFTH THESIS: RATIONAL CONSENSUS WILL NEVER BE THE PRIMARY MOTIVE IN PUBLIC DELIBERATION By enumerating the dangers of participatory democracy. is not part of this equation because it is neither obtainable nor is it a desirable pursuit. training. human beings are afflicted by a “restless desire of power after power. despite these conflicts. is the primary reason why it is reasonable for them to consent to government.

Moral consensus is not a desirable pursuit. we are not primarily rational animals. Founded. because political processes aimed at moral consensus exacerbate each of the aforementioned dangers of participatory democracy. CONCLUSION: IS THERE HOPE FOR BIOETHICS AND DELIBERATIVE DEMOCRACY? The intent of this article—to articulate a Hobbesian critique of deliberative democracy as it is interpreted by mainstream academic bioethics—is primarily critical. Bioethics is immersed in a version of deliberative democracy that views deliberation as rational discourse. Yet Hobbes’s critique of democracy-by-rational-consensus. and its bioethical counterpart. Is there hope for deliberative democracy? And bioethics? And if so. which does not widely share the moral presuppositions that structure mainstream bioethical discourse. I conclude. Citizens must be deceived into believing that the opinions of statesmen or moral experts are morally authoritative for the whole group (Hobbes’s sovereign would never pose such a ludicrous claim). or those who have no interest in abiding by it. or should. In Hobbes’s view. VIII. not about why they will. as it is. Trotter Downloaded At: 00:33 30 September 2010 bioethical consensus are still contended within the population at large. In the end. the pronouncement of moral consensus as a political device is similar to other political devices. do it or refrain from doing it (Trotter. to a limited extent at least. the quest for consensus requires multiple layers of deception. we should accept that when people join together in political negotiations. that form of agreement is possible and desirable.13 Furthermore. and rational consensus as its summum bonum. If Hobbes is close to the mark. Contrary to these deceptions. power against those who are not part of the consensus. To avoid such duplicity. what is its source? There is little time even to frame such a discussion here. 2002).244 G. it typically possesses insufficient volitional traction to carry the day. opens the door to a much longer and more difficult discussion. especially in a forthcoming book). even where rationality has logical traction. on the false claim that extensive moral consensus is possible. with a brief pointing-inthe-direction (which summarizes much of the more extensive work I have published or will publish elsewhere. the primary form of agreement they seek is agreement about what they will do or refrain from doing collectively. And they must be deceived into believing that this acquiescence is in important respects autonomous and voluntary (despite the obvious fact that it is coerced). at least in the political realm. It exists as a means of securing power—namely. much less to conduct it. then. They must be deceived into believing that their well-being is enhanced by acquiescing to the purported moral consensus. then this version is unrealistic and . And it has little to do with moral consensus.

its end-in-view is workable compromise. and it is deeply entwined with the notion of public deliberation that would hold sway in such a system. Hobbes prefers monarchy over participatory democracy primarily because he thinks it is less apt to produce tyrannical accretions of government power and dominion. etc. that is.14 This right of giving or withholding assent is the only form of citizen empowerment that the modus vivendi approach allows. All of the normal influences on human cognition (emotive. Liberal. it involves the whole gamut of moral. insofar as property and ownership are themselves social Downloaded At: 00:33 30 September 2010 . democratic versions of the modus vivendi focus on empowering ordinary citizens or citizen groups with some kind of prerogative to grant or. Such assessments hinge. rational or otherwise. would not be out of the question—but they could be established only insofar as they were not barred by the operation of a more fundamental political right: the right of individuals not to be appropriated without their assent. Accepting these Hobbesian challenges. leaving citizens and diverse moral communities at relative liberty to chart their own moral destinies. and it succeeds primarily by producing cooperative activity. A modus vivendi is a provisional arrangement established through the assent of contending parties. argumentative or negotiative) about public action.Bioethics and Deliberative Democracy 245 dangerous. One need not prove that her motives are rational or altruistic. These powers of expression and approval/disapproval are granted without constraining rules of discourse or justification.) pertain. Moral suasion might come into play in some circumstances. on particular moral visions. but also rights to property and ownership—unhindered by untoward takings. and modus vivendi theory is predicated on the thesis that no particular moral vision can be established authoritatively by the state. there are not pretensions about distilling them out. and in the modus vivendi model of public deliberation. Public deliberation. is there anything that can be done to check its vices and tweak deliberative democracy into an effective. These latter are tricky. and amoral human motives. Positive rights. more importantly. There are no pretensions about deep moral consensus. lies in a concept championed by neo-Hobbesian political theorists: modus vivendi. Real political discourse is fractious. I think. but deliberation is in its most fundamental sense the application of human cognition to decisions about action. pending future arrangements that will be more satisfactory for all involved. Of course. not moral consensus. authoritative political tool? The best response. To the contrary. is simply discourse (rational or non-rational. with various forms of veto power against government interference. entitlements to goods and services (including those that enhance the capacity for effective public speech). after all. the right not to be appropriated includes not merely the right not to be conscripted for service unless one assents to the conscription scheme. withhold their assent. especially. This amounts to providing them with possible avenues of public expression and. on this non-rationalistic model. conative. immoral.

a form of government where political sub-units have the right not only to grant or withhold assent to fundamental political arrangements. and likewise 2. based for instance on common moral commitments. This version of participatory democracy is shielded. persuasion. and description. would still arise. to a much greater extent than one based on rational consensus theory. Trotter constructs—not eternally sketched in conceptual stone as Locke and many mainstream libertarian descendents tend to hold—but themselves the objects of a modus vivendi. but they would be manifold and at cross purposes. Were bioethics to adopt a modus vivendi model. Rational analysis would still constitute an important domain in which bioethicists could contribute. against the dangers enumerated by Hobbes. substantive moral vision. rational analysis. would be occupied Downloaded At: 00:33 30 September 2010 . Were modus vivendi theory to hold sway. While majoritarian democracy always devolves into a two-party. championed in the American tradition by John Calhoun (Calhoun. recognizing that: 1. rational argumentation always hinges on premises that cannot be established by reason alone. concurrent democracy breeds a multiplicity of parties and aristocracies that work better at holding one another in check. However. but also to nullify arrangements when their interpretation becomes a matter of dispute. It is possible (however difficult) to embrace modus vivendi theory without being a libertarian. such contributions would be offered in a spirit of humility. the office of the bioethicist would change radically – especially regarding bioethics’ overlapping activities of theorization. but they would be addressed to citizens and citizen groups capable of giving or withholding assent. and as such would often be marketed towards those already sympathetic to said traditions. alone never sufficient to constitute a comprehensive. however. two-aristocracy fight for dominance (where the upper hand means immense power). the descriptive office of bioethics would be enhanced. Massive accretions of government power become far less likely. Theorization would transpire primarily and self-consciously within the context of particular moral and political traditions. rather than to political authorities who are expected to enact the systems coercively. Attempts to persuade others of the superiority of one tradition-based political system. rationality is only one tool in the human arsenal. but the envisioned collectivisms are themselves modus vivendi).15 It is not possible. Many bioethicists. Aristocracies would certainly emerge.246 G. Deliberative democracy on the modus vivendi model will of necessity be some form of concurrent democracy. for the modus vivendi theorist to be a collectivist on fundamental political principles (they can be collectivists. 1992)—that is. that is. Nor can modus vivendi theory sanction majoritarian democracy of the kind that increasingly holds sway (especially in the power structures of the two major parties) in the United States.

such solicitations are accompanied by the assumption that my status as an academic bioethicist qualifies me to identify “what is ethical” and “what is not” in medical and health policy matters. for instance. Nozick elaborates an essentially Lockean theory. 1974). and so on. there is always a dissenting minority. NOTES 1. and embrace this challenge. In a simple democracy this dissenting minority is subject to moral systems and rules imposed by the majority. that morally divergent parties appreciate others’ moral practices and regard mutual participation and moral diversity as positive goods that the state ought to promote not merely for their instrumental political benefits. Rousseau. Young staunchly insists that political communication involves more than exercising our mutual capacities for rationality. and David Gauthier (1986). 3. Such programs preclude the genuinely morally pluralistic state. many difficult issues facing any attempt at transition to forms of deliberative democracy. To her credit. 5. and Kant as “definitive of the social contract tradition. a few prominent contemporary political theorists who attend seriously to Hobbes. Though I have elsewhere suggested strategies for addressing these and related problems (Trotter. There are. My account of Hobbes in this essay is deeply influenced by Richard Flathman (2002). takes the works of Locke. In his seminal political treatise. Almost invariably. She also purposes to make more room for moral pluralism.” preferring “communicative democracy” instead. as she does. There are. Young’s political vision is one of many current versions where “diversity” becomes a linchpin of state-enforced conceptions of the good and of substantial justice. but also sometimes for opinions on legislative matters). my name has been acquired through a quick Google search. as the upper hand in theorization about deliberative democracy has shifted to those who seek robust moral consensus. Richard Flathman (1992). of course. Not the least of these is the problem of delineating practical boundaries between moral communities and an acceptable inventory of particular individual or group political rights to grant or withhold assent—without derailing public projects that clearly improve the lives of virtually all citizens. never even mentioning Hobbes (Nozick. A similar assumption typically pertains when I am asked to speak at churches. Merely listing oneself as a faculty member on the website of a bioethics department currently positions the bioethicist to make an exaggerated expertise claim. 4. Young has issued strong criticisms of the movement (Young. or the practice of bioethics. as in appointments to bioethics commissions and requests for consultation (though these appointments and requests presumably often reflect prior Downloaded At: 00:33 30 September 2010 . But that only holds in the unlikely event that an entire populace has been persuaded. Like many bioethicists. but as centrally important ends-inthemselves. 2001). 2003). 6.Bioethics and Deliberative Democracy 247 with interpreting particular moral traditions to the polity at large—clarifying points of contention and agreement. but her efforts here are weak—insisting. The short list includes Patrick Neal (1997). 11n). Recently. Not to correct these mistaken assumptions is tantamount to making an exaggerated expertise claim. which remains sanguine when citizens mutually abhor the opposing views they nevertheless must tolerate.” writing that Hobbes “raises special problems” (Rawls. Perhaps bioethics would do well to recognize the cogency of Hobbes’s critique. Young never subscribed to the term “deliberative democracy. and thus facilitating the processes of political negotiation. government meetings. p. that embrace modus vivendi political theory. 2. John Gray (1995). Rawls. Often. Often political connections come passively. 1971. I receive a steady stream of requests for media interviews and legal consultation (the latter most frequently for advice or expert testimony on tort cases. Perhaps some readers will object that the necessity within democracy of garnering public support for proposed reforms precludes the liability of imposing a moral vision on dissenting subjects. hospitals. With regard to genuine public controversies. much more needs to be said. on the other hand.

Aside from the nit-picky rejoinder that such projections of harm are never certain. The negative synergy is well illustrated in the aftermath of Hurricane Katrina. 2002. 1995. The most central reason for Hobbes’s favoritism of monarchy is that he thinks it tends to be much less intrusive than democracy. To wit: 1.248 G. pp. Take. 9. Even the moral rationale for establishing such access was not clearly delineated or agreed upon. either through public programs that they choose not to utilize. 47). dominion is always unlimited (Flathman. To the contrary. 10. To buttress their collectivist ideology. more than 18 million uninsured persons are young (18–34 y/o). subjects relate to the commonwealth in a cool. 1996. or because of a combination of these factors or considerations” (Flathman. H. 7. He writes: “Hobbesian subjects enter and undertake obligations to political associations exclusively in order to satisfy their desire for peace. public discourse in this instance is better characterized as political negotiation between those with diverging moral visions about how best to achieve a common goal of access to a basic package of healthcare benefits (Trotter. still maintain traditional convictions that sick . A subject’s obligations end if her life or bodily well-being is jeopardized by the Sovereign or by others against whom the Sovereign should protect the subject… In these respects. Of course. and 3. There is another sense of “dominion” sometimes used by Hobbes—denoting the scope of authority. Bioethicists also tend to the misleading implication that the rising number of healthcare-uninsured persons reflects an increasing percentage of uninsured persons rather than merely an increasingly large population in residence. however. the first of these claims: “competent adult patients should be informed of their diagnosis unless it is certain that immediate and severe harm will result” (Moreno. 11. 1999. a prominent bioethicist squarely outside the mainstream as I have characterized it here. In actuality. defense. 2. In this second sense. Flathman’s analysis is particularly compelling on this point. This limited practical scope preserves important liberties. for instance. p. 13). Jr. In monarchy. 2004). for instance. Tristram Engelhardt. 32–101). offers the definitive account of why rational moral consensus is unobtainable through discursive means (Engelhardt. 12.. this claim is repudiated by a number of prominent moral and cultural groups in the United States. Trotter Downloaded At: 00:33 30 September 2010 maneuvering). many of the uninsured are financially well off (25% have yearly incomes in excess of $50. rather distant manner. and the possibility of commodious living to which peace and defense are necessary. and lower in 2003 than in 1997 or 1998. bioethicists often misinterpret ordinary political negotiation as public deliberation about the deep nature of morality.000). 2006). mostly healthy adults who are encouraged not to purchase health insurance by “guaranteed issue” laws enacted in several states (Editors. Laurie Zoloth characterizes the Oregon Medicaid Experiment as an inclusive communal discourse about the nature of social justice (Zoloth. p. where bioethical commentary about how to prevent similar future debacles consists mostly of advice to increase deliberation (especially among bioethicists) about refractory issues (such as “social justice”) rather than on strategies that would funnel federal money into immediately-helpful projects such as construction of a fleet of mobile medical hospitals (Trotter. or through their own income (this fact stands even apart from consideration that any American citizen who chooses to serve in the armed forces will receive medical benefits for life). it will do so because the Sovereign takes care not to provoke disobedience or rebellion by arousing fears greater than fear of her. p. 8. the majority of healthcare uninsured persons have access to insurance. All of this relates to the tendency among bioethicists to insist on a rich canon of collective ethical standards—a tendency that will be discussed in the treatment of the fourth thesis from Hobbes. democracy. and so on—is absolute. calculated. Many Chinese Americans (and many others of Asian cultural heritage). 2002. oligarchy. there has been considerable enthusiasm among many members of the American Society of Bioethics and Humanities to “take stands” on political issues—often justified by claims that bioethicists are well situated to advise the public about what is right and wrong in the clinic and the legislature. because the subjects fear one another more than they fear the Sovereign. however. analysis of Census Bureau data indicates that the percentage of healthcare uninsured persons was the same in 2003 as it was in 1996. absolute authority is less apt to be applied in unproductive ways. In this vein. the aforementioned tendency to engender profitless disputes is organically related to the tendency to enhance government power and dominion. p. 136). The portrayal of healthcare-uninsured Americans as a class of uniformly low income individuals who are desperately in need of health care is misleading on all fronts. 2001). 130). It seems that the relationship has little depth and an uncertain durability. If it persists. In recent years. Hobbes thinks that all political authority—in monarchy. 13.

Calhoun. T. for all men equally. 2000. (1996). ‘Consensus formation: The creation of an ideology. 2002. 1996 [1651]. Hampshire. and Chastened Politics (New Edition). that citizens always maintain a right of violent opposition against encroachments of liberty effected without their assent.’ Cambridge Quarterly of Healthcare Ethics. but also from traditional conservatives and contemporary neoconservatives.. John Gray and Stuart Hampshire are prominent examples (Gray. NY: Cornell University Press. . Hampshire.. 11(1).’ in R. Calhoun (pp. Morals by Agreement. modus vivendi theorists deny the existence of such a principle—agreeing on only a negative principle. 424–425). Principles of Biomedical Ethics (5th edition). (2002). it merely precludes the claim that it can be codified as a political principle. D. 5–78). (1986). (2000). there is “no Obligation on any man. F. Gutmann. 2002. 15. ‘A disquisition on government. Enlightenment’s Wake. Goldie. (2002). M. Flathman calls this “the core claim of Hobbes’s contractarianism” (Flathman. A. (1997). New York: Oxford University Press. ‘Health and poverty. Jr. J. Individuality. Two Faces of Liberalism. Jr. (2000). New York: Rowman & Littlefield. Gauthier. Why Deliberative Democracy? Princeton. (1995). (2001). p. As Hobbes writes. so far as it is obtainable (Hobbes. Oxford: Clarendon Press. Union and Liberty: The Political Philosophy of John C. and indeed it is the only sense in which I believe that Hobbes can properly be called a contractarian. Indianapolis: Liberty Fund. The Foundations of Bioethics (2nd edition). This is one point where Hobbes differs radically not only from the contemporary liberal cosmopolitans who dominate bioethics. Thomas Hobbes: Skepticism. This austere limitation of political foundations to a negative principle does not preclude the modus vivendi theorist from recognizing a supreme. one must show that there is some universal principle that tends to unite men even across national frontiers. (2004). unifying principle or spirit operating in the world. T. H.’ Wall Street Journal. and one that can be codified into a fundamental political principle. p. NJ: Princeton University Press.. J. The principle to which Babbitt refers is of needs a substantive. which ariseth not from some Act of his own. D. J. Willful liberalism: Voluntarism and Individuality in Political Theory and Practice. pp. R. M. Russell Kirk quotes conservative Irving Babbitt as follows: “If one is to refute Machiavelli or Hobbes. p. The modus vivendi socialist is one who envisions an agreement among citizens to rules of property acquisition and ownership that accord with a socialist program. Engelhardt. Gray. 14.. Princeton. T. Flathman. a principle that continues to act even when their egoistic impulses are no longer controlled by the laws of some particular state supported by its organized force” (Kirk. August 27). L. In his classic treatise on conservative thinking. & Thompson.). But this is a dictum of prudence. Justice Is Conflict. Lence (Ed.). 2000). Editors (2004. J. In distinction to conservatives. Gray. New York: New Press. 60– 61) rather than the ideal contracts of rational deliberators. (Ed. New York: Cambridge University Press. (1992). Locke: Political Essays. 150). 71). 1996 [1651]. New York: Oxford University Press. REFERENCES Beauchamp. R. 7–16.. Ithaca. Engelhardt. & Childress. positive moral principle. (1992). H. 92). Flathman. and that these should be handled by a family member in charge (Hern et al. pp. A12.Bioethics and Deliberative Democracy 249 Downloaded At: 00:33 30 September 2010 individuals should be spared the details of their medical management. p. NJ: Princeton University Press. C. his laws of nature being subordinate to and contingent upon actual acts of assent (Flathman. The closest Hobbes comes to a fundamental positive political principle is his dictum that we ought to seek peace. 1998). are by nature Free” (Hobbes. 1985. New York: Routledge. S.

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