Bioethics and Deliberative Democracy: Five Warnings from Hobbes

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 (such as most bioethicists) 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.

Keywords:

• deliberation
• democracy
• Hobbes
• modus vivendi
• moral consensus

I. 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, I find it about as satisfying as differentiating toads (and frogs) by their digital pads. For me, toads are better described as slimy, coarse-skinned amphibians that use their disproportionately large hind legs to hop and swim, and use their disproportionately large oral apparatus to say “ribbit” and catch insects. The digital pads are useful, no doubt, but no one thinks of digital pads when they think of toads.

Likewise, if toads and other animals could talk, none of them would focus on rationality when sharing their thoughts about humans. They would talk, perhaps, about our bad odor or our death-dealing appendages. Most of all, I think, they would talk about our insatiable will to dominate. This characteristic is bound to elicit notice, because it diverges so radically from the norm among other animals. As all outdoor-livers know, wild animals with full bellies are rarely dangerous—unless, of course, they think you want to eat their children or copulate with their latest flame. Apart from its instrumental uses in securing food, sex, and security, domination has little appeal to the grizzly bear, the bull moose, or to other animals who are capable of achieving it.

Human beings, on the other hand, are always dangerous and always hungry for more than a full stomach. If we decide to harvest fish or deer, we go for size and volume—even when there is food aplenty in the kitchen back home. If we want to fight, we practice every day and then schedule tournaments (or wars) that allow us to fight many opponents in rapid succession. If we want to copulate, we enact extravagant dining rituals, trips to Paris, or subject ourselves to brooding art films that would kill elephants in about five minutes. In all of this, we crave novelty, eternal vitality, and… dominance.

Of course, humans of various stripes exert various forms of power, establishing multitudinous and frequently countervailing patterns of dominance. Rationality is certainly an important weapon in our arsenal and, as with our other weapons, we experience pleasure in wielding it skillfully. For human beings, there are no pure instrumentalities. But rationality is always mixed with other affections such as anger, greed, pride, lust, and prejudice (to name a few)—and typically it is employed, at least in part, to serve them.

In this article, I isolate a particular breed of human being—the bioethicist—and examine its characteristic methods of acquiring and wielding political power. Bioethicists are typically human in their ravenous pursuit of dominion and their urgency to achieve arbitrary ends. Yet interestingly, they gild and disguise such non-rational motives with the Aristotelian conceit, waxing eloquent about cognitively higher-order things like rational consensus, human rights, and social justice. None of these things, I would (but won’t directly) argue, really make much sense as they are laid out by bioethicists. What I will argue here is that bioethics’ campaign for political influence is founded on a flawed account of democratic deliberation. It is flawed, I think, in just the way that the venerable grandfather of Enlightenment political philosophy, Thomas Hobbes, thought intellectual advocacy for democracy is bound to be flawed. Unlike Hobbes, I have no particular disdain for democracy. My intention here is to improve our conception of it. To that end, I will employ Hobbesian notions as leading ideas.

II 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 repudiated: democracy and common morality. Locke, counter Hobbes, was an early champion of democracy (Locke, 1988, p. 354) and, though his version of toleration leaves far more room for ethical pluralism than current versions of tolerance (Khushf, 1994), Locke was keen to base the principles of government on a common, Christian morality (Goldie, 1997, pp. 16–20).

Yet despite our long tradition of placing Hobbes at the margins of liberal theory, there are several good reasons for contemporary political theorists to reengage him. First, Hobbes is uniquely prominent among Enlightenment philosophers for his critical stance toward democracy. If we are serious about honing and improving our conceptions of democracy, presumably it would prove worthwhile to reflect on democracy’s liabilities and shortcomings—a task with which Hobbes is well qualified to help. Second, politics is rapidly globalizing; with globalization comes the encounter with ethical and religious pluralism and a stark, postmodern challenge to assumptions about a universal common morality. Hobbes stands virtually alone among early Enlightenment political philosophers in insisting that humanity’s natural state is irremediably plural, chaotic, and bereft of universal ethical standards (aside from the “Right of Nature,” which is the right of each individual to do whatever he or she will to serve his or her own interests). This sits better with postmodern thinking than the tradition-bound accounts of Locke, Kant and other prominent Enlightenment theorists. Third, and perhaps most importantly, Hobbes aligns with contemporary naturalism in his insistence that homo sapiens is not wholly, nor even primarily, a rational animal. He understands far better than Locke and Kant that we have passions and that these passions—as much as rationality—constitute our nature.

In this article I briefly develop several theses from Hobbes that have bearings on contemporary theories of deliberative democracy, especially as it is developed in bioethics. By “deliberative democracy,” I denote accounts of democracy that focus on the legitimizing role of deliberation among citizens. As Will Kymlicka observes, contemporary theories of deliberative democracy arose in the 1990s as a response to tensions between liberal individualism and communitarianism. In the spirit of useful oversimplification, he says that deliberative democrats sought to mediate countervailing emphases on rights and justice (liberal individualists), on one hand, versus community membership (communitarians), on the other, by focusing on the office of citizenship, which integrates these factors (Kymlicka, 2002, p. 284). According to Kymlicka, proponents of deliberative democracy are unsatisfied with “aggregative” or “vote-centric” conceptions of democracy because:

1. they provide “no opportunity for citizens to try to persuade others of the merits of their views,”

2. they provide no means for distinguishing between “claims based on self-interest, prejudice, ignorance, or fleeting whims from those grounded in principles of justice or fundamental needs,” and

3. they provide for little if any social dimension to the political process (Kymlicka, 2002, p. 290).

The goals of the political process, on this mainstream account of deliberative democracy, are better and more legitimate political decisions, social solidarity, enhanced mutual understanding, and agreement. As to the likely or desirable level of agreement, there is controversy. Some theorists, such as Iris Marion Young, seek only limited agreement (Young, 1996, p. 126); others, such as Amy Gutmann and Dennis Thompson, seek robust moral consensus (Gutmann & Thompson, 2004, p. 92). ²

Within the field of bioethics, the convergence or consensus-oriented school has held sway for well over a decade. Conceding that academic bioethics is “not directly concerned with developing a societal response” to ethical issues (Moreno, 1995, p. 6), Jonathan Moreno nevertheless rightly observes that bioethics has from its inception manifested a strong commitment to deliberative processes and the goal of moral consensus. Hence, he regards bioethics not merely as a field of study, but also as “a set of social practices” (pp. 6, 55–72) and as a “social reform movement” (pp. 143–159) based on a particular conception of democracy. The particular conception in question is that of deliberative democracy, aimed at enhanced mutual understanding, progressive reform, and a convergence of moral beliefs.

For some misgivings about this conception, we now turn to Hobbes. ³

III FIRST THESIS: PARTICIPATORY DEMOCRACY TENDS TO DEVOLVE INTO ARISTOCRACY

For Hobbes there are several features of deliberative (or, more generally, participatory) democracy that directly threaten the welfare, liberty, and security of citizens (Flathman, 2002, pp. 134–142). He believes, first of all, that participatory democracy is difficult to carry off on a grand scale, and always devolves into rule by an aristocracy of vain-glorious public personalities (Hobbes, 1962, pp. 229–230). When people are free to express their opinions, and empowered to effect them into law when they recruit devoted followers, many contenders and public personalities will appear. Some of these contenders will be more adept or politically connected (though not necessarily more wise) than others. Ultimately, 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, as Hobbes frequently presumes, or of the nature of imposing a comprehensive moral vision upon dissenting subjects). ⁴

Bioethicists achieve opportunities for influential public speech both through claims of expertise ⁵ and by establishing political connections. ⁶ Each of these mutually intertwining pathways is opened by bioethicists’ residence within the academy. Thus, 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, academic bioethicists were prominent among the appointees. Such was also the case with subsequent commissions, including the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (the “President’s Commission”), and also the National Bioethics Advisory Commission (NBAC). 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, non-partisan approach to the issues at hand—despite the fact that the appointees leaned uniformly leftward towards the Democratic Party. The actual rationale was probably exactly the opposite—that is, confidence that the commissions would issue recommendations that cohered rather nicely with the ideology of the Democratic Party officials who appointed them. Indeed, that is just what the commissions did, until the latter two were rudely interrupted by the intrusion of Republican administrations (Reagan insisting that some actual conservatives be allowed into the discussion, Bush II appointing a new, more conservative, bioethics council).

While in power, these commissions produced influential guidelines such as the Belmont Report, which has structured federal policy on research protections ever since the National Commission served it up. 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, so suddenly and tragically deprived of needed wisdom and expertise that only they could offer. Thus, Jonathan Moreno remarks that with the addition of Reagan appointees, the President’s Commission descended into “partisan politics,” 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, 1995, p. 80).

All this heartbreak aside, academic bioethicists should take solace in the rhythms and oscillations of American politics. Their sponsor, the Democratic Party, will rise again, and with it—them too. All of this in accordance with Hobbes’s first thesis.

IV SECOND THESIS: PARTICIPATORY DEMOCRACY BEGETS UNPRODUCTIVE DISPUTES

According to Hobbes, 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). Hobbes’s observation about profitless subjects hinges on his worries about the politicization of ordinary human activities. The purpose of the state, on his view, is to carve out a secure area where such activities can be conducted without hostile interference. ⁷ Among the inventory of profitless subjects, Hobbes would include moral controversies engendered by needless disputation among those who would be better off to go their own separate ways.

Many of the central issues in bioethics qualify on this point. The morality of abortion or assisted suicide, the maintenance of life-prolonging treatments in permanently unconscious patients, for-profit organ donation, and the application of neurological criteria for death are all issues that hinge on fundamental moral beliefs. The vast diversity of such beliefs, their intensity, and their incommensurability, ensures that subjecting them to public debate will produce only pallid unifying effects. Though bioethics may (and to some extent does) succeed in influencing legislation on these issues, the moral controversies persist. For Hobbes, public advocacy of this nature is profitless, not merely because it cannot succeed in producing a robust moral consensus, but more importantly because liberty and individual felicity would be enhanced by allowing opposing individuals and groups to establish their own practices, free from government interference and from each other (Flathman, 2002, pp. 101–103).

V 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). ⁸ Because the citizens of a democracy participate in its rule, they tend to confuse dominion with liberty (Hobbes, 1962, pp. 228–229). In actuality, however, effective liberty is maximized when there are “few laws, few prohibitions, and those too such, that except they were forbidden, there could be no peace” (p. 228). In participatory democracy, many are involved, each with their own particular interests, desires, and objectives to which political power is an available means. As Hobbes observes, in a popular democracy, “there may be as many Neros as there are orators who soothe the people” (p. 227). Each of these mini-demagogues is potentially capable of converting his/her personal concerns into political issues. 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. As we have witnessed in recent years, the metastasis of public projects eventually produces an unwieldy workload that overwhelms elected officials. Rather than viewing this predicament as a signal to scale down government, these officials create committees, commissions, and agencies—filled with political allies and authorized to create or enact more rules and prohibitions. The end result is more power, more dominion, and less space for the operation of individual liberty.

Bioethics is more than complicit in this hyperplasia of government. It feeds on it and sometimes helps constitute it. The bioethics commissions are an obvious case, but hardly the primary one. To an increasing extent, 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. Grant money flows for “research” projects aimed at:

1. suggesting new research protections (i.e., more regulations constraining possible market arrangements between researchers and subjects),

2. suggesting new guidelines for organ procurement and distribution (i.e., more regulations constraining possible market arrangements between donors and recipients),

3. suggesting ethical remedies for the problem of “health disparities” (i.e., 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),

4. suggesting funding guidelines for federal stem cell research (i.e., more regulations constraining individuals and groups from choosing their own research methods and objectives—said regulations formulated, of course, without altering current constraints on taxpayer decisions concerning what research they will financially support), and so forth.

In other words, bioethics is largely in the business of enhancing the dominion of government, even as it enhances its own. ⁹

VI FOURTH THESIS: PARTICIPATORY DEMOCRACY BREEDS EXCESSIVE COLLECTIVE ASPIRATIONS

Insofar as citizens conflate their political dominion with their liberty or their felicity, they will tend to conjure grand visions of what they can achieve with like-minded political allies (against the will of dissenters). The typical result, on Hobbes’s account, is a suffocating profusion of collective thinking. Collective aspirations can be excessive in several senses. They may be:

1. beyond human capacities (and hence politically unrealistic),

2. beyond effective political control,

3. beyond what is needed for peace (peace being the only cogent rationale for the commonwealth), or

4. based on irrational fears.

Regarding the latter item, 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, which asunder are moderate, as the heat of one brand; in Assembly are like many brands, that enflame one another, (especially when they blow one another with Orations) to the setting of the Common-wealth on fire, under pretence of Counselling (sic) it” (Hobbes, 1996 [1651], p. 181).

As I have argued in the past, 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, happy, moral community, animated by universal convictions about social justice, human rights, and the principles of bioethics (Trotter, 2003). Beauchamp and Childress, for instance, assert that their common morality framework is shared “by all persons in all cultures who are serious about moral conduct” (Beauchamp & Childress, 2001, p. 4). Deliberativists like Moreno and Mark Kuczewski are more reserved about the existence of an operational common morality, but think that convergence to common moral beliefs, principles and practices is the proper goal of public deliberation, and eminently achievable (Moreno, 1995, pp. 18–38; Kuczewski, 1997, pp. 3, 13–14, 17). More to the point, all of these prominent bioethicists, and the majority of their colleagues, view the construction of a robust public moral philosophy as a collective, national political project. ¹⁰ This thinking reflects a new, 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). 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. Of course, this outlook reflects bioethics’ self-interest in sustaining its emerging role in national projects and as a recipient of federal money.

In the campaign for collective government action, bioethics participates in each of the aforementioned forms of Hobbesian excess:

1. it seeks a degree of national moral consensus that is unworkable (Engelhardt, 2002);

2. it seeks inordinate political influence over matters that cannot be effectively controlled by national governments (for instance, elimination of health disparities),

3. it champions projects that have little or nothing to do with securing peace (this pertains to most of the political advocacy in bioethics); and

4. it stokes exaggerated public fears (for instance, by consistently portraying America’s 45 million uninsured citizens as lower income individuals desperately in need of healthcare ¹¹ ).

VII FIFTH THESIS: RATIONAL CONSENSUS WILL NEVER BE THE PRIMARY MOTIVE IN PUBLIC DELIBERATION

By enumerating the dangers of participatory democracy, we come to understand why Hobbes thinks that rational moral consensus is not the motive, or even a desirable objective, of public deliberation. According to Hobbes, human beings are afflicted by a “restless desire of power after power, that ceaseth only in death,” arising because power provides the means for living well (Hobbes, 1996 [1651], p. 70). Proximally, then, human beings are motivated to political activity by their desire for power. For ordinary citizens, 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, is the primary reason why it is reasonable for them to consent to government. To a much greater degree than other theorists of his era, Hobbes insists that the distal objective—living well—is a function of individual constitution, preference, and choice, varying widely between persons and moral communities.

Of course people have no qualms about appropriating more power than they need for their personal safety and freedom (neither, according to Hobbes, do they have a natural moral obligation to avoid doing so). 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, redistributing property, etc.), thus enflaming their will for political dominion. It would be better, Hobbes thinks, for ordinary citizens to respect natural limitations in the accumulation of personal political power, understanding that the best they can typically do is to limit the ways in which other parties can wield power against them. In sum, then,

1. people act politically to appropriate political power,

2. political power is useful instrumentally, as a means to living well,

3. peoples’ interests and conceptions of living well are various, divergent and at odds, and

4. despite these conflicts, people have a common interest in protecting themselves from one another.

Moral consensus, in any robust sense, is not part of this equation because it is neither obtainable nor is it a desirable pursuit. 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, faith, training, emotion, or other contingencies, and is impotent to unseat these foundations except by introducing alternative foundations that are equally contingent). ¹² It is instructive, in this sense, that most of the twelve claims that Moreno identified in 1995 as objects of bioethical consensus are still contended within the population at large, which does not widely share the moral presuppositions that structure mainstream bioethical discourse. ¹³ Furthermore, even where rationality has logical traction, it typically possesses insufficient volitional traction to carry the day. In the end, we are not primarily rational animals.

Moral consensus is not a desirable pursuit, at least in the political realm, because political processes aimed at moral consensus exacerbate each of the aforementioned dangers of participatory democracy. Founded, as it is, on the false claim that extensive moral consensus is possible, the quest for consensus requires multiple layers of deception. 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). They must be deceived into believing that their well-being is enhanced by acquiescing to the purported moral consensus. 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).

Contrary to these deceptions, the pronouncement of moral consensus as a political device is similar to other political devices. It exists as a means of securing power—namely, power against those who are not part of the consensus, or those who have no interest in abiding by it. To avoid such duplicity, we should accept that when people join together in political negotiations, the primary form of agreement they seek is agreement about what they will do or refrain from doing collectively; not about why they will, or should, do it or refrain from doing it (Trotter, 2002). In Hobbes’s view, that form of agreement is possible and desirable, to a limited extent at least. And it has little to do with moral consensus.

VIII 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. Yet Hobbes’s critique of democracy-by-rational-consensus, and its bioethical counterpart, opens the door to a much longer and more difficult discussion. Is there hope for deliberative democracy? And bioethics? And if so, what is its source? There is little time even to frame such a discussion here, much less to conduct it. I conclude, then, with a brief pointing-in-the-direction (which summarizes much of the more extensive work I have published or will publish elsewhere, especially in a forthcoming book).

Bioethics is immersed in a version of deliberative democracy that views deliberation as rational discourse, and rational consensus as its summum bonum. If Hobbes is close to the mark, then this version is unrealistic and dangerous. Real political discourse is fractious; it involves the whole gamut of moral, immoral, and amoral human motives; and it succeeds primarily by producing cooperative activity, not moral consensus. Hobbes prefers monarchy over participatory democracy primarily because he thinks it is less apt to produce tyrannical accretions of government power and dominion, leaving citizens and diverse moral communities at relative liberty to chart their own moral destinies.

Accepting these Hobbesian challenges, is there anything that can be done to check its vices and tweak deliberative democracy into an effective, authoritative political tool? The best response, I think, lies in a concept championed by neo-Hobbesian political theorists: modus vivendi.

A modus vivendi is a provisional arrangement established through the assent of contending parties, pending future arrangements that will be more satisfactory for all involved. There are no pretensions about deep moral consensus, rational or otherwise. To the contrary, its end-in-view is workable compromise. Liberal, democratic versions of the modus vivendi focus on empowering ordinary citizens or citizen groups with some kind of prerogative to grant or, especially, withhold their assent. This amounts to providing them with possible avenues of public expression and, more importantly, with various forms of veto power against government interference. These powers of expression and approval/disapproval are granted without constraining rules of discourse or justification. One need not prove that her motives are rational or altruistic. Such assessments hinge, after all, on particular moral visions, and modus vivendi theory is predicated on the thesis that no particular moral vision can be established authoritatively by the state. ¹⁴

This right of giving or withholding assent is the only form of citizen empowerment that the modus vivendi approach allows, and it is deeply entwined with the notion of public deliberation that would hold sway in such a system. Public deliberation, on this non-rationalistic model, is simply discourse (rational or non-rational; argumentative or negotiative) about public action. Moral suasion might come into play in some circumstances; but deliberation is in its most fundamental sense the application of human cognition to decisions about action. All of the normal influences on human cognition (emotive, conative, etc.) pertain, and in the modus vivendi model of public deliberation, there are not pretensions about distilling them out.

Positive rights, that is, entitlements to goods and services (including those that enhance the capacity for effective public speech), 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. Of course, the right not to be appropriated includes not merely the right not to be conscripted for service unless one assents to the conscription scheme, but also rights to property and ownership—unhindered by untoward takings. These latter are tricky, insofar as property and ownership are themselves social 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.

It is possible (however difficult) to embrace modus vivendi theory without being a libertarian. ¹⁵ It is not possible, however, for the modus vivendi theorist to be a collectivist on fundamental political principles (they can be collectivists, but the envisioned collectivisms are themselves modus vivendi). 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. Deliberative democracy on the modus vivendi model will of necessity be some form of concurrent democracy, championed in the American tradition by John Calhoun (Calhoun, 1992)—that is, a form of government where political sub-units have the right not only to grant or withhold assent to fundamental political arrangements, but also to nullify arrangements when their interpretation becomes a matter of dispute.

This version of participatory democracy is shielded, to a much greater extent than one based on rational consensus theory, against the dangers enumerated by Hobbes. Aristocracies would certainly emerge, but they would be manifold and at cross purposes. While majoritarian democracy always devolves into a two-party, two-aristocracy fight for dominance (where the upper hand means immense power), concurrent democracy breeds a multiplicity of parties and aristocracies that work better at holding one another in check. Massive accretions of government power become far less likely.

Were bioethics to adopt a modus vivendi model, the office of the bioethicist would change radically – especially regarding bioethics’ overlapping activities of theorization, persuasion, rational analysis, and description. Theorization would transpire primarily and self-consciously within the context of particular moral and political traditions, and as such would often be marketed towards those already sympathetic to said traditions. Attempts to persuade others of the superiority of one tradition-based political system, based for instance on common moral commitments, would still arise, but they would be addressed to citizens and citizen groups capable of giving or withholding assent, rather than to political authorities who are expected to enact the systems coercively. Rational analysis would still constitute an important domain in which bioethicists could contribute. However, such contributions would be offered in a spirit of humility, recognizing that:

1. rational argumentation always hinges on premises that cannot be established by reason alone, and likewise

2. rationality is only one tool in the human arsenal, alone never sufficient to constitute a comprehensive, substantive moral vision.

Were modus vivendi theory to hold sway, the descriptive office of bioethics would be enhanced. Many bioethicists, that is, would be occupied with interpreting particular moral traditions to the polity at large—clarifying points of contention and agreement, and thus facilitating the processes of political negotiation.

There are, of course, many difficult issues facing any attempt at transition to forms of deliberative democracy, or the practice of bioethics, that embrace modus vivendi political theory. 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. Though I have elsewhere suggested strategies for addressing these and related problems (Trotter, 2001), much more needs to be said. Perhaps bioethics would do well to recognize the cogency of Hobbes’s critique, and embrace this challenge.

Notes

1. Rawls, for instance, takes the works of Locke, Rousseau, and Kant as “definitive of the social contract tradition,” writing that Hobbes “raises special problems” (Rawls, 1971, p. 11n). In his seminal political treatise, Nozick elaborates an essentially Lockean theory, never even mentioning Hobbes (Nozick, 1974). There are, on the other hand, a few prominent contemporary political theorists who attend seriously to Hobbes. The short list includes Patrick Neal (1997), Richard Flathman (1992), John Gray (1995), and David Gauthier (1986).

2. Young never subscribed to the term “deliberative democracy,” preferring “communicative democracy” instead. Recently, as the upper hand in theorization about deliberative democracy has shifted to those who seek robust moral consensus, Young has issued strong criticisms of the movement (Young, 2003). To her credit, Young staunchly insists that political communication involves more than exercising our mutual capacities for rationality. She also purposes to make more room for moral pluralism, but her efforts here are weak—insisting, as she does, 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, but as centrally important ends-in-themselves. 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. Such programs preclude the genuinely morally pluralistic state, which remains sanguine when citizens mutually abhor the opposing views they nevertheless must tolerate.

3. My account of Hobbes in this essay is deeply influenced by Richard Flathman (2002).

4. 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. But that only holds in the unlikely event that an entire populace has been persuaded. With regard to genuine public controversies, there is always a dissenting minority. In a simple democracy this dissenting minority is subject to moral systems and rules imposed by the majority.

5. Merely listing oneself as a faculty member on the website of a bioethics department currently positions the bioethicist to make an exaggerated expertise claim. Like many bioethicists, 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, but also sometimes for opinions on legislative matters). Often, my name has been acquired through a quick Google search. Almost invariably, 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. A similar assumption typically pertains when I am asked to speak at churches, hospitals, government meetings, and so on. Not to correct these mistaken assumptions is tantamount to making an exaggerated expertise claim.

6. Often political connections come passively, as in appointments to bioethics commissions and requests for consultation (though these appointments and requests presumably often reflect prior maneuvering). In recent years, 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.

7. Flathman’s analysis is particularly compelling on this point. He writes: “Hobbesian subjects enter and undertake obligations to political associations exclusively in order to satisfy their desire for peace, defense, and the possibility of commodious living to which peace and defense are necessary. 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, subjects relate to the commonwealth in a cool, calculated, rather distant manner. It seems that the relationship has little depth and an uncertain durability. If it persists, it will do so because the Sovereign takes care not to provoke disobedience or rebellion by arousing fears greater than fear of her, because the subjects fear one another more than they fear the Sovereign, or because of a combination of these factors or considerations” (Flathman, 2002, p. 130). The most central reason for Hobbes’s favoritism of monarchy is that he thinks it tends to be much less intrusive than democracy. This limited practical scope preserves important liberties. Hobbes thinks that all political authority—in monarchy, democracy, oligarchy, and so on—is absolute. In monarchy, however, absolute authority is less apt to be applied in unproductive ways.

8. There is another sense of “dominion” sometimes used by Hobbes—denoting the scope of authority. In this second sense, dominion is always unlimited (Flathman, 2002, p. 136).

9. Of course, the aforementioned tendency to engender profitless disputes is organically related to the tendency to enhance government power and dominion. The negative synergy is well illustrated in the aftermath of Hurricane Katrina, 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, 2006). 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.

10. To buttress their collectivist ideology, bioethicists often misinterpret ordinary political negotiation as public deliberation about the deep nature of morality. In this vein, Laurie Zoloth characterizes the Oregon Medicaid Experiment as an inclusive communal discourse about the nature of social justice (Zoloth, 1999, p. 47). To the contrary, however, 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, 2001). Even the moral rationale for establishing such access was not clearly delineated or agreed upon.

11. 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. To wit:

1. many of the uninsured are financially well off (25% have yearly incomes in excess of $50,000),

2. the majority of healthcare uninsured persons have access to insurance, either through public programs that they choose not to utilize, 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), and

3. more than 18 million uninsured persons are young (18–34 y/o), mostly healthy adults who are encouraged not to purchase health insurance by “guaranteed issue” laws enacted in several states (Editors, 2004). 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. In actuality, analysis of Census Bureau data indicates that the percentage of healthcare uninsured persons was the same in 2003 as it was in 1996, and lower in 2003 than in 1997 or 1998.

12. H. Tristram Engelhardt, Jr., a prominent bioethicist squarely outside the mainstream as I have characterized it here, offers the definitive account of why rational moral consensus is unobtainable through discursive means (Engelhardt, 1996, pp. 32–101).

13. Take, for instance, 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, 1995, p. 13). Aside from the nit-picky rejoinder that such projections of harm are never certain, this claim is repudiated by a number of prominent moral and cultural groups in the United States. Many Chinese Americans (and many others of Asian cultural heritage), for instance, still maintain traditional convictions that sick individuals should be spared the details of their medical management, and that these should be handled by a family member in charge (Hern et al., 1998).

14. This is one point where Hobbes differs radically not only from the contemporary liberal cosmopolitans who dominate bioethics, but also from traditional conservatives and contemporary neoconservatives. In his classic treatise on conservative thinking, Russell Kirk quotes conservative Irving Babbitt as follows: “If one is to refute Machiavelli or Hobbes, one must show that there is some universal principle that tends to unite men even across national frontiers, 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, 1985, pp. 424–425). The principle to which Babbitt refers is of needs a substantive, positive moral principle, and one that can be codified into a fundamental political principle. In distinction to conservatives, modus vivendi theorists deny the existence of such a principle—agreeing on only a negative principle, that citizens always maintain a right of violent opposition against encroachments of liberty effected without their assent. As Hobbes writes, there is “no Obligation on any man, which ariseth not from some Act of his own; for all men equally, are by nature Free” (Hobbes, 1996 [1651], p. 150). Flathman calls this “the core claim of Hobbes’s contractarianism” (Flathman, 2002, p. 71), and indeed it is the only sense in which I believe that Hobbes can properly be called a contractarian, his laws of nature being subordinate to and contingent upon actual acts of assent (Flathman, 2002, pp. 60–61) rather than the ideal contracts of rational deliberators. This austere limitation of political foundations to a negative principle does not preclude the modus vivendi theorist from recognizing a supreme, unifying principle or spirit operating in the world; it merely precludes the claim that it can be codified as a political principle. The closest Hobbes comes to a fundamental positive political principle is his dictum that we ought to seek peace, so far as it is obtainable (Hobbes, 1996 [1651], p. 92). But this is a dictum of prudence.

15. John Gray and Stuart Hampshire are prominent examples (Gray, 2000; Hampshire, 2000). 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.