Meanings of Moralism

The standard distinction is that morality is good and moralism is bad. According to one view, moralism is the exaggerated claim that there are only duties and prohibitions, nothing in between: indifferent choices and actions do not exist, and a moral “you must” or “you must not” applies to everything that we do.^{Footnote 1} The intuitive possibility of merely permissible choices and supererogation challenges this. Most of us think that in most cases we are not morally obliged to have vanilla-flavored ice cream instead of the strawberry-flavored variety. As for supererogatory acts—going beyond the call of duty—J. O. Urmson seems to have a point when he writes:

Some strict formulations of classical utilitarianism, Urmson’s target of criticism in the passage, disagree with his intuition on a theoretical level. G. E. Moore thought that the aim of moral action is to maximize good.^{Footnote 3} We ought to do what maximizes good, and we ought to omit doing what does not. In the case of two different courses of action having the exact impact in terms of promoting good, we are at liberty to choose either one of them.^{Footnote 4} The proviso concerning acts with precisely similar results may or may not make the choice between ice cream flavors neutral,^{Footnote 5} but in the grenade incident, the soldier with the best chances to save the rest of the squad does have the duty to sacrifice himself. Although I will not limit my examination to this kind of case, utilitarianism will loom large in my considerations.

According to another view, moralism, or bad moralism, occurs whenever we extend otherwise legitimate ethical claims to inappropriate contexts, or exaggerate their significance.^{Footnote 6,Footnote 7,Footnote 8} We certainly have a duty to not kill our neighbors for no reason. We probably have a duty to help them out if they are in dire need, if no one else can help them, and we can help them with minimal inconvenience to ourselves. Many philosophers doubt, however, that we have a duty to commit our entire lives to attending to the needs of strangers. Anthony Quinton joined these philosophers by writing:

The discussion on the limits of our obligations has been going on for over two hundred years within the utilitarian tradition alone. On the all-importance of impartiality, and the nonimportance of “ties of affection,” William Godwin considered the case in which the house of Archbishop Fénelon (an influential and well-known benefactor in his time) is on fire, he is inside with his valet (presumably an inconsequential man in terms of the greater good of humanity), and only one can be rescued. Godwin favored the Archbishop, even in the case of family or other special ties being involved:

Since Godwin’s eighteenth-century contribution, the debate has been ongoing,^{Footnote 11} with notable defenders of wide and impartial responsibility in, for instance, Jonathan Glover^{Footnote 12} and Peter Singer.^{Footnote 13,Footnote 14}

Yet another accusation of bad moralism faces people who want to judge others by their own moral standards, either on emotional or intellectual grounds.^{Footnote 15,Footnote 16} The emotional approach means, for its opponents, the elevation of our “Yuck!” reactions into respected moral judgments—a maneuver that they are not themselves willing to condone.^{Footnote 17,Footnote 18,Footnote 19} Its defenders see things in a different light, as evidenced by Leon Kass:

For emotion-based moralists (good or bad, no judgement here), then, something in our immediate reactions is wiser than our considered rational assessments. I will have more to say on this in the section on the Hart-Devlin debate, further on. Purely intellect-based moralists, in their turn, maintain that we should always follow our reason, even at the expense of our dearly held sentiments and harm encountered by innocent people.^{Footnote 21} Immanuel Kant famously argued that since reason tells us that lying is always wrong, we are not to lie even to a murderer who asks whether her intended victim is in our house.^{Footnote 22}

So the three easily detectable uses for the word “moralism” are, claiming that every choice is morally significant; extending valid moral rules into contexts in which they may lose their appeal; and letting our raw feelings or abstract intellect take precedence in ethical evaluations. All these, but particularly the third brand, form the conceptual background of the following considerations.

Conceptual Roots in the Nineteenth Century: Mill and Stephen

The movement against moralism in legislation and morals within the liberal and utilitarian traditions started with John Stuart Mill’s On Liberty.^{Footnote 23} In the seminal passage, he wrote:

Although the paragraph conveys at least half a dozen pretty complex principles instead of the promised one, the message is reasonably clear. Potential harm inflicted on others justifies the use of force and coercion on an individual against the individual’s will. Nothing else does. That the person’s “own good … is not a sufficient warrant” means that Mill does not, as a rule, condone coercive paternalism.^{Footnote 25,Footnote 26} His statement against moralism, the topic of this article, is that an individual “cannot rightfully be compelled to do or forbear because … in the opinions of others, to do so would be wise, or even right.” In other words, society cannot, by laws or moral pressure, legitimately force or coerce us to conform to prevailing attitudes, views, or philosophies. That would go against our freedom, autonomy, and self-chosen way of life, dent our creativity and individuality, and in the end, prevent the flourishing of our state and nation.^{Footnote 27,Footnote 28}

Mill’s liberal view did not go uncriticized even within the utilitarian tradition. James Fitzjames Stephen took issue with it in his book Liberty, Equality, Fraternity, published at the time of Mill’s death.^{Footnote 29} Stephen perceived himself as defending the classical, original formulation of utilitarianism that Jeremy Bentham had presented^{Footnote 30} and Mill adhered to in his earlier work,^{Footnote 31,Footnote 32} just to modify it later.^{Footnote 33,Footnote 34,Footnote 35,Footnote 36} Stephen’s main concern was what he saw as Mill’s overconfidence in the wisdom of the “members of a civilized community.” He began by noting that, according to Mill,

Stephen questioned Mills assertion that citizens of even “civilized countries” are the best decision makers for themselves:

Stephen himself was convinced that some people are wiser, and that Mill agreed with him, although their normative conclusions were different:

The legitimation Stephen used was on the surface straightforwardly utilitarian. Since good lawgivers and captains of industry know what makes citizens and workers happy in a good way, they are rightfully the ones to make important decisions even when these decisions go against the views of the citizens and workers themselves.^{Footnote 40,Footnote 41}

The refutation of Mill so far seems to be paternalistic (the rulers know best how to achieve everybody’s happiness) rather than moralistic (the rulers have a superior morality to back up their commands and prohibitions). In the definition of “good happiness,” however, Stephen deviates from the simple calculation of pleasure and pain, which is the hallmark of most secular utilitarianism, and brings in the idea of an afterlife, best known to the wisest in the population. He does not embrace traditional Christian teachings on life after death, but comes close when he writes:

The idea that our permanent core is our mind is then linked with the ideas of morality and character:

A wise person would not, according to Stephen, practice vices or neglect duties, because conscience is our constituent element as spiritual creatures:

By postulating a nontraditional, nonreligious, personal heaven-and-hell scenario, Stephen could then justify the rule of the wisest in terms of our ultimate moral well-being:

The conclusion, then, is that a competent adult citizen of a civilized country can

In Mill’s framework, this makes Stephen’s view both paternalistic and moralistic. Notably, the theory also creates a link between theological utilitarianism, one of the original formulations of the British creed that Mill adhered to in its secular form,^{Footnote 47,Footnote 48,Footnote 49} and modern legal moralism, that makes social stability the cornerstone of legislation.

Conceptual Roots in the Twentieth Century: Devlin and Hart

Modern legal moralism came to the fore in the twentieth-century discussion known as the Hart-Devlin debate.^{Footnote 50,Footnote 51,Footnote 52} In 1957, a Committee chaired by John Wolfenden published their report on the need to review laws concerning prostitution and homosexuality in England.^{Footnote 53} The normative starting point for the Committee’s work was Mill’s distinction^{Footnote 54} between private and public spheres of morality, or “self-regarding” and “other-regarding” actions. The Wolfenden Committee reported:

For the sake of “public order and decency,”^{Footnote 56} the Committee proposed that law should not allow prostitution out in the streets. In the other cases they reviewed, however, they assumed a more lenient view. Since “private immorality should not be the concern of the criminal law,”^{Footnote 57} it is not, according to the Committee,

In practical terms, then, the Wolfenden Committee concluded that it was not the law’s business to interfere with unobtrusive, nonexploitative forms of prostitution, nor with secluded sexual dealings between consenting adult men (English law did not regulate sexual dealings between women to begin with).^{Footnote 59}

Patrick Devlin, a renowned English jurisprudent of the time, strongly objected to the Wolfenden Committee’s conclusions.^{Footnote 60} He believed that the law can legitimately intervene with some acts of “private immorality,” and he held that the idea of crime should remain connected to the idea of sin, or to “transgression against divine law or the principles of morality.”^{Footnote 61} He wrote:

To show that the English legal system was on his side, he cited several matters that were “private” yet strictly controlled: voluntary euthanasia, suicide, attempted suicide, suicide pacts, duelling, abortion, and incest between brother and sister.^{Footnote 63} If the only point of criminal legislation were to protect individuals, Devlin argued, these laws would not have existed. The only way to justify them is by reference to a moral principle.

Devlin’s appeal to the idea of sin was not religious but social and cultural. In secularized nations, we can find “transgressions against … the principles of morality” by observing outraged feelings and by studying their significance in our particular social and historical setting. Devlin argued that we are at liberty to ethically condemn and even legally ban controversial practices that provoke strong negative feelings. He did not claim that any immediate reaction by the person in the street would justify legal restrictions. His argument was that feelings can guide legislation, but only when certain conditions are met. The feelings in questions must (also) be felt by individuals who are calm and understand the demands of reason and common sense; and even then only if these feelings reflect the true basis of social life in a nation. Devlin’s analysis proceeded in three stages.

First, Devlin opined:

In this widely cited passage Devlin does not necessarily say, as many commentators have thought, that if a practice is disgusting to a certain percentage of self-righteous citizens, they should feel free to ban it. The message here can be, more moderately, that “intolerance, indignation, and disgust” can be signs of something that lawyers, ethicists, and philosophers of law should investigate further. And even this is true only if the feelings in question have not been “manufactured,” presumably by self-serving politicians, marketing agencies, and the like (social media would be a contemporary culprit).

Second, Devlin presents a preliminary test for the assessment of actions that give rise to disgust:

The expression “the genuine feeling of the society in which we live” points to two directions. Cultures and societies differ, so the laws of one nation may not be applicable in others. We have to scrutinise our true feelings to find the moral guidance needed in our country. Furthermore, we need a more advanced test to detect our “genuine feelings” and to tell them apart from inauthentic outrage.

Third, Devlin went on to explain the moral force of the right kind of intolerance, indignation, and disgust, using an appeal to social stability. According to him, these feelings indicate the boundaries of public morality, which we must not overstep, if we want to keep our society viable. He supported this idea by explaining what the institution of monogamous marriage meant to his own nation:

Devlin’s gist seems to be that the idea of polygamy was disgusting to the English mind of the late 1950s, because people somehow instinctively knew that its acceptance would have signaled the end of British society as they knew it. The feeling was a sign, and the sign alone would not have justified regulations. Since, however, the British people had the right to defend their cultural heritage and their traditional way of life against detrimental influences, they could not have been “denied the right to eradicate” the offensive practice.

In a sense, Devlin was probably right. Since his time, legislators in his country have condoned new practices, and British society is not what it used to be. Tolerance has brought about changes, just as Devlin in fact predicted.

Liberal and utilitarian philosophers of law were quick to come to the Wolfenden Committee’s rescue. In his account, Devlin had stated that the true lawgiver should be the reasonable (as opposed to the abstractly rational) man, or, in terms used by English jurisprudents of his time, “the man on the Clapham omnibus.”^{Footnote 67} The use of this expression prompted two reactions, which quickly became authoritative in liberal circles. In an early criticism, H. L. A. Hart, while initially commending the democratic appeal of the “reasonable man” approach, wrote:

Ronald Dworkin joined Hart in complaining how Devlin,

These contributions carved in stone the reading that Devlin wanted to ban all practices that disgust the “moral majority.” If my three-stage analysis of Devlin’s actual thinking is correct, this criticism misses its target almost completely. The true justification for banning distasteful activities is that they somehow damage the structure of society.

In a later examination of Devlin’s principles, Hart distinguished between two separate theses concerning immorality and the law.^{Footnote 70} According to the extreme thesis, law must protect “morality as such” whenever righteous citizens feel that they are threatened by a disgusting practice. This is the “Clapham omnibus” approach, with its probable flaws. A more moderate reading of Devlin’s views also offered itself to Hart. Shortly after the passage stating, “intolerance, indignation and disgust are the forces behind the moral law,” Devlin wrote:

Passages like this made Hart see that Devlin’s model can also have its foundation in the harm or injury that befalls society if legislators recklessly alter its laws. According to the moderate thesis, laws can legitimately uphold morality if its collapse would be injurious or harmful.

Hart argued, however, that the distinction between the two theses reveals a dilemma that faces Devlin’s model. If we safeguard “morality as such” for its own sake, mob rule follows. But if, instead, we protect morality because failing to do so would be harmful, Devlin’s view becomes indistinguishable from the Millian theory he set out to refute. The debate went on for a while, with added twists and turns,^{Footnote 72} but these considerations are sufficient for now. I have identified the utilitarian and liberal roots of accusations of moralism, the expression “morality as such” has entered the scene, and it is time to introduce two further theories that contribute to the basis of the discussion on moralism and its alternatives.

Conceptual Roots in Utilitarian and Liberal Theories: Sidgwick and Feinberg

Cambridge moral philosopher Henry Sidgwick presented at the turn of the twentieth century a systematic defense of utilitarianism, or universal hedonism, as he called it, which is useful in locating moralism among theories of ethics.^{Footnote 73,Footnote 74,Footnote 75}

Sidgwick’s starting point was that valid moral doctrines must conform to three clear and self-evident intuitions, or principles, that form a coherent whole and are acceptable to all human beings who are capable of combining “adequate intellectual enlightenment with a serious concern for morality.”^{Footnote 76} These intuitions, or principles, are justice, prudence, and the universality of goodness. According to the principle of justice,

This, then, is what the Christian tradition knows as the Golden Rule and Immanuel Kant’s teaching names the Categorical Imperative,^{Footnote 78} and what now bears the tongue-twisting name “universalizability.”^{Footnote 79} The principle of prudence, in its turn, asserts that

A prudential individual does not prefer a smaller immediate good to a greater future good – a very important, if controversial, tenet in debates concerning intergenerational justice. The universality of goodness requires us to pursue general, instead of particular, good. In Sidgwick’s words,

Armed with these principles, Sidgwick proceeded to evaluate three main “methods of ethics,” or moral theories: dogmatic intuitionism, universal hedonism, and ethical egoism.^{Footnote 82}

Dogmatic intuitionism states that actions are morally right if they conform to our everyday ideas concerning right and wrong, good and evil. In Sidgwick’s view, this approach is problematic. The common-sense intuitions of virtue, right, and duty often fail to pass the test of coherence, which is a background requirement of successful theories of ethics alongside the principles (coherent intuitions) of justice, prudence, and the universality of goodness.^{Footnote 83}

Universal hedonism demands that we always aim at promoting the general good. Unlike dogmatic intuitionism, this theory does form a coherent whole, and it does conform to all the required basic principles. This alone, however, does not prove universal hedonism to be the best theory of ethics. Ethical egoism, according to Sidgwick, also satisfies the central demands of ethics, albeit in its own way, although it is incompatible with universal hedonism.

Ethical egoism says that I must always aim at maximizing my own happiness. This does not necessarily violate the principle of justice, because nothing prevents ethical egoists from universalizing their view. It is my duty to maximize my happiness, but it is nobody else’s duty to share this task with me. All human beings have an obligation to promote their own happiness. Similar thinking applies to the universality of good. From the point of view of the universe, my good is no more important than the good of others, but from my own personal point of view, it is. We can all consistently hold that our happiness trumps the happiness of others.

In the end, Sidgwick could not convince himself of the superiority of utilitarianism, or universal hedonism. He thought that proof of the existence of God and an afterlife and post-mortem rewards and punishments could settle the issue in favor of his preferred doctrine, and founded in 1882 the Society for Psychical Research^{Footnote 84} to seek evidence of these. A few decades later, however, he had to admit that the effort did not bear the desired fruit.^{Footnote 85,Footnote 86}

For my purposes here, the important detail in Sidgwick’s construction is that he lumped together all nonconsequentialist and nonhedonistic moral views under the pejorative heading “dogmatic intuitionism.” As I shall indicate in the sections on justice below, this opens the door for seeing all rivals to utilitarianism and ethical egoism as a shapeless collection of incoherent moralism. Since the collection includes many respected theories of individual and political morality, Sidgwick’s judgement may have been slightly premature. Interestingly, however, it reflects later twentieth-century views on the matter, including those of the notable American jurisprudent Joel Feinberg.

In his colossal four-part The Moral Limits of the Criminal Law,^{Footnote 87,Footnote 88,Footnote 89,Footnote 90} Feinberg dissected the liberal instinct reflected in Mill’s “one very simple principle.” According to Mill’s principle, the threat of other-regarding harm is the only legitimate reason to coerce citizens, and to curtail their freedom. For the purposes of his own analysis, Feinberg considered the role of criminal law in checking four general types of unpleasantness. Is it legitimate, he asked, to restrict the liberty of citizens if the aim is to prevent harm to others, hurt to others, offenses to others, and other kinds of unpleasantness to others? In the ensuing examinations, Feinberg introduced countless variations of each type of violation or experience, much in the way Jeremy Bentham had done two centuries earlier.^{Footnote 91}

Feinberg defined “being harmed” in a twofold way that removes it from simply having been put or left in a harmful condition and extends it to the realm of positive, existing law. We are harmed when our vital interests are frustrated and we are wronged, that is to say, our rights are violated.^{Footnote 92} The exclusion of the more Millian sense of being harmed makes it difficult for Feinberg to justify legal obligations to help people in need. He manages it, and barely so, by a complex narrative involving bad Samaritan statutes and an intricate model of indirect wronging in these particular cases.^{Footnote 93} The appeal to vital interests and their frustration makes it easier to distinguish between trivial and nontrivial “harms” in a more colloquial sense. Some harm may befall me if my colleague has put salt in the sugar shaker I use for my porridge, but this is hardly a matter for law or morality. It is better to concentrate on instances that are more serious, perhaps ones that we can say involve violations of rights. This, however, changes the focus in an interesting way.

Feinberg finds legitimately protectable legal rights in property and contracts. On private property, he writes:

What Feinberg does not take into account here is that property laws differ from jurisdiction to jurisdiction. A harmless trespass may violate the rights of landowners in the United States, but not the rights of landowners in countries with everyman’s rights to move around even in privately possessed territories.^{Footnote 95}

The other significant exception in Feinberg’s view concerns voluntary contracts:

These two specifications to the harm principle move Feinberg from the utilitarianism of Mill, Sidgwick, and Hart to a more deontological (rule-based as opposed to outcome-based) liberalism.^{Footnote 97,Footnote 98,Footnote 99} They also indicate, with Feinberg’s many other caveats and intermediate principles, that his view is open to an array of traditional ways of thinking when it comes to interpreting the moral foundation and limits of the law. This will lead to interesting findings in the section on justice and its role below.

Feinberg himself eventually concluded that however liberal we might want to be, we may have to extend the scope of criminal law to cover certain particularly unpleasant yet harmless offenses and wrongdoings. For those who want absolute theoretical purity, this means that Feinberg failed in his effort to justify a truly liberal morality of the criminal law. Since the exceptions are rare, we can also conclude that, largely, he created an astonishingly complete antimoralist system with realistic concessions in the face of the complexity of social life.

Instances of Bad Moralism

If we follow Mill, Sidgwick, Hart, and Feinberg, then, we can justifiably coerce free, informed, competent human beings only by appeals to prospective harm inflicted on others without our interference. Everything else is, in one sense or another, moralism.^{Footnote 100} Coercion in this formula has many faces. We can physically confine people’s movement, psychologically manipulate or force them, or make them do or omit things by explicit or implicit threats of punishment. Criminal law is one instrument of coercing people, but there are countless others, including everyday emotional blackmail in families and small groups, and the social pressure toward conformity produced in communities, societies, and nations both spontaneously and deliberately. In bioethics, most cases involve healthcare services or medical and related research.^{Footnote 101} Several candidates of moralism, or coercion, that cannot be justified by the harm principle, offer themselves in this context.

Lifestyle and diet seem to have a considerable impact on people’s health. Authorities stress that a balanced diet with not too much saturated fat or sugar correlates with a longer and healthier life. Alcohol, drugs, and reckless lifestyles, on the other hand, are associated with shorter life spans and increased morbidity. With convenient normative background assumptions, these facts provide a basis for moralistic regulations and policy.^{Footnote 102,Footnote 103,Footnote 104} If we believe that individuals are primarily responsible for their own health-related choices, and that self-induced ill-health is therefore not the state’s concern, we can be reluctant to extend public health services to citizens who have diet- or lifestyle-related health issues. When the state makes this known to the population, the population faces a liberty-restricting threat that is not justified by the harm principle. If citizens do not decide to live in accordance with advice from the health authorities, they cannot expect the medical services delivered to those who comply.

New technologies hold the promise of making us genetically, biologically, and physically stronger and better. Voluntarily chosen treatments and enhancements related to them would not violate the harm principle, because our own choices justify the courses of action and their outcomes. Many believe, however, that we should not embrace all the opportunities offered by emerging technologies.^{Footnote 105,Footnote 106,Footnote 107,Footnote 108,Footnote 109} Although they could make at least some of us stronger, longer-lived, more intelligent, or more compassionate, they somehow present a danger to our humanity and sociability. Interfering with community structures that we have developed spontaneously and traditionally presents risks that we cannot reduce to simple considerations of harm. Nevertheless, some say, we should ban these technologies based on the wider communal concerns.

As genetic testing advances, hereditary disorders become detectable in embryos even before they are implanted and pregnancy begins. This offers a harmless method of selecting human offspring, if we do not count arresting embryonic development in vitro at the blastocyst level as a harm in a morally and legally relevant sense. Disability scholars as well as minority and difference ethicists, however, have levelled strong criticisms against such selective practices.^{Footnote 110,Footnote 111} They argue that the biological and physical differences that medicine tries to eliminate are not in and by themselves disabilities in need of eradication. Social attitudes and structures can compensate for people’s different capabilities, or they can fail to do so. In the latter case, we all jointly create disabilities as social constructs. Genetic selection is therefore futile and dangerous and must not be condoned, let alone encouraged. Harmless in the technical sense as it might be, it is an affront to equality between people and we should harness possibly law, and certainly public opinion, to curb it.

If we build a health care system purely on such principles as equal access and social responsibility, the outcome could be that every citizen in need gets the same public services, and no one can purchase any additional private services.^{Footnote 112} This is not a reality anywhere in the world: social democratic welfare states allow private healthcare,^{Footnote 113} and systems that are more socialist have been vulnerable to under-the-counter payments and other kinds of minor and major corruption. On the level of political morality, however, this is a possibility. Such a system would produce yet another type of restricted harmless activity. Even if individuals could show that they inflict no concrete harm on others by buying extra treatments and care, the state would have to prohibit them from pursuing this option. The justification could be found in the “greater good” introduced by Stephen and Devlin, but the outcome would still be coercion that cannot be straightforwardly based on the harm principle.

People can say that they want procedures, and they may in fact rationally want procedures that are not, all things considered, good. The standard Millian approach to these cases is simple. We can establish that the agents in question are competent, that they have adequate information, and that no one visibly forces them to make the choice we think suboptimal. Once we have satisfied these requirements, individuals should be free to make their own mistakes. Some theorists and practitioners argue, however, that this is not enough. When individuals refuse a life-saving blood transfusion on religious grounds, or require medical professionals to mutilate their bodies for esthetic or cultural reasons, the choice may not be, in the final analysis, sufficiently genuine. Choices dictated by oppressive cultural or social pressures need not be considered autonomous or authentic, and they need not be respected. The harm principle and voluntariness notwithstanding, we can have in such cases a justification for interfering with inauthentic decisions.

It seems, then, that the harm principle is under threat from many directions. Following the original logic introduced by Mill and Sidgwick, every suggestion in this section is an instance of bad moralism. They all have their supporters, though, and it would seem hasty to dismiss them summarily. Let us see how a classification of approaches to justice can illuminate the matter.

Six Approaches to Justice

Justice means different things to different people. In theory, we all agree that the core ideas of justice include equality, equity, impartiality, and taking into account all those affected by our decisions. Beyond this, however, disagreement reigns. Whose equality? What kind of equity? The equality and equity of exactly what? How should we take people or other entities into account? What is the criterion of “being affected” by our decisions? Answers to questions like these expose several partly-conflicting ideologies, or political moralities.^{Footnote 114} I outline here six of them, each with its distinct background suppositions and normative conclusions.^{Footnote 115}

Libertarianism emphasizes the rights and responsibilities of individuals. The most important of our rights protect our life and physical integrity, and enable us to make tenable contracts and to possess private property. Only active, detrimental interventions by other individuals count as violations against these. If your natural ability to survive and get along is limited, no one else is to blame. If the social order prevents you from having a good life, no one else is responsible, at least not as far as political justice and the role of the state are concerned. We all make our own fortunes, and we alone are answerable for them. If others (intend to) violate our rights, the state protects us, which is why legitimate state functions include the army, the police force, and the justice system. Voluntary contracts between individuals must account for everything else—social security, education, healthcare, and the like. To fund these, the state would have to collect taxes, involuntarily if need be, and thereby violate people’s rights to private property.^{Footnote 116}

Socialism is the ideological opposite of libertarianism. Socialists maintain that libertarians promote an economic, social, and political order, capitalism, which has deprived individuals of control over their own lives and presents a threat to their genuine freedom and rights. A moderate formulation argues that at least the responsibilization of the worse-off should stop. The strategy has no rational basis, as individuals can end up being sick, poor, or unemployed for a plethora of historical, cultural, familial, social, political, geographic, and genetic reasons without any fault of their own.^{Footnote 117,Footnote 118,Footnote 119} This is why joint social responsibility and a caring welfare state are better options than the libertarian night-watchman state. Formulations that are more radical pave the way for revolutionary ideologies. The proletariat are alienated from the product of their work, from other people, and even from their own true selves. They have to become aware of themselves as a class and go to war against capitalists in the hope that the resulting dictatorship of the proletariat or the eventual classless and stateless (communist) society will set them free.^{Footnote 120,Footnote 121}

Utilitarianism states that every agent—individual, group, community, authority, government—should always impartially aim at the greatest possible good of the population. The “good” in the formula is definable in many ways. It can mean subjectively, objectively, or inter-subjectively perceived wellbeing or need satisfaction, and it can mean economic, evolutionary, or even esthetic flourishing. The greatest good, in its turn, can refer to the number of those enjoying it, to the total amount of enjoyment in the population, or both.^{Footnote 122,Footnote 123,Footnote 124} Some philosophers, and especially economists, have favored the fulfilment of rational preferences, which they believe we can scientifically measure and compare.^{Footnote 125} Preferences are rational in the sense they mean, when we form them autonomously and deliberately, with adequate information of the consequences, and realistically take into account the contexts in which we form and pursue them. The distinctive feature of utilitarianism is the instrumentalization of all traditional and theoretical values and norms. No rights are protected and no duties are assigned for their own sake. If they promote the greatest good, they are defensible; if not, they are not.^{Footnote 126}

Communitarianism is strongly opposed to the instrumental thinking advocated by utilitarians. According to the creed, historically-shaped communities and their organically-developed traditions and role assignments form the foundation of our life together and provide the best framework for our collaboration at all levels.^{Footnote 127} The key to our beneficial shared solidarity is that we do not try to calculate and master everything, but recognize and admit that our lives contain certain “given” or “gift” elements that are, and always will be, outside our own control.^{Footnote 128,Footnote 129,Footnote 130} Once we have admitted our limits, we can realize how much we depend on each other and begin to protect the structures that make mutual help possible.^{Footnote 131,Footnote 132} Philosophical interpretations of communitarianism tend to be compatible with the principles of liberal democracy, but other readings are also possible. An emphasis on the superiority of “our culture” and the inferiority of “others” can lead to exclusive nationalism and xenophobia.

Capability approaches criticize preference utilitarianism for encouraging suboptimal choices. Capability theorists believe that a choice can be autonomous and rational in its context, yet remain determined by oppressive circumstances, attitudes, and customs. Tradition may dictate that a woman’s place is at home with her family, and a woman’s expressed preference to stay in her native village instead of seeking work in the city could have been imposed on her by tradition. In such cases, we should not see the externally restricted “adaptive preference” as authentic or authoritative. Instead, we should promote the opportunities, capabilities, and positive freedoms of repressed groups, so that their members can make genuinely autarchic decisions about their lives. Some capability theorists believe that the empowering policies should be adjusted to the circumstances prevailing in different societies without trying to devise universal rules.^{Footnote 133,Footnote 134} Others have opted for a list of fundamental capabilities fit for all.^{Footnote 135,Footnote 136,Footnote 137} Martha Nussbaum has famously argued that the most important things for all human beings are “life; bodily health; bodily integrity; senses, imagination and thought; emotions; practical reason; affiliation; other species; play; and control over one’s environment.”^{Footnote 138}

The ethics of identity and recognition is an alternative to popular liberal theories of justice, and can, as such, be seen as opposed to justice altogether.^{Footnote 139} One of its early formulations is Carol Gilligan’s ethics of care, which stresses caring and special relationships between people rather than calculations of utility or theories of rights and obligations.^{Footnote 140} Gilligan concentrated on women’s moral development. Lawrence Kohlberg had concluded in his research (studying only boys and men) that moral development reaches its peak in outcome- and duty-based thinking.^{Footnote 141,Footnote 142} In her own investigations on girls and women, Gilligan found that they progressed further and eventually developed special relationships, the bond between mother and child being the paradigmatic example. This difference, she argued, must be recognized and cherished. The approach was feminist to begin with, but identity theories currently include other positional doctrines with starting points in post-colonialism, sex, gender, and sexual orientation. In social reality, these form the foundation of identity politics.

Figure 1 shows schematically the six approaches to justice, arranged by their shared and clashing background assumptions.^{Footnote 143}

Figure 1.

Approaches to justice.

The vertical dimension separates the economic creeds of capitalism and socialism. Horizontally, the theorists on the right believe in the universality of moral norms and values, while those on the left argue that different groups may have different life experiences, and consequently, their own legitimate positional claims and expectations. Universalists, on the right, also tend to stress concrete values related to human wellbeing; and positionalists, on the left, more abstract traditional, spiritual, or political values. Communitarians in the top left corner disagree with utilitarians in the bottom right corner on the benefits of planning and social engineering. In the bottom left corner, identity and recognition ethicists might find the closed lists of human good in the top right corner theoretically suspect, although on the political level these two essentially feminist positions seem to find more common ground than should be expected in purely conceptual terms.

The question of what occupies the center of the figure has no clear answer. One possibility would be to locate there the core ideas of justice—equality, equity, impartiality, and the like. The competing approaches produce, however, conflicting interpretations of them, and it would therefore be misleading to claim that the notions could somehow remain intact in the middle. Another possibility would be to place in the center some quasi-contractual compromise model such as John Rawls’s theory of justice as fairness.^{Footnote 144,Footnote 145,Footnote 146} Since Rawls gravitates more toward libertarianism than socialism, he could share the mid-position with, for instance, Jürgen Habermas, who with his doctrines of communicative action and discourse ethics could inhabit the lower middle position.^{Footnote 147,Footnote 148,Footnote 149} In political life, compromises between interests and ideologies populate the area.

Do Considerations of Justice Turn Bad Moralism into Good Moralism?

When we match approaches to justice with alleged cases of bad moralism in healthcare policies and biomedical research, the results are interesting. Figure 2 schematically presents the types of moralism presented above, before the section on justice.

Figure 2.

Types of moralism.

In the top left corner of Figure 2, we see an objection, for instance, against the genetic enhancement of human beings. According to our tradition, the objectors say, we can never fully control our destinies, and our solidarity rests on this fundamental realization. Since genetic manipulation would dangerously strengthen our false sense of mastery and weaken our traditional and beneficial commitment to mutual help, we should not condone it.

In the bottom left corner, a similar complaint challenges genetic selection, especially prenatal screening that aims at preventing the birth of babies with serious hereditary disorders. The practice, activists argue, while widely accepted, is an insult to the human worth and dignity of disabled people, sending the message, “It would have been better had you not been born.” To safeguard the group identity and to ensure the recognition of disabled people, we need to shun reproductive genetic tests.

In the top middle square of Figure 2, individuals receive more extensive services, if they choose the healthier lifestyles recommended to them by medical and nutritional authorities. The extra services are a reward for taking responsibility for one’s own life, and it would be doubly wrong not to employ this system of incentives. It would punish good, responsible citizens. Moreover, it would reward irresponsible citizens, discourage people’s personal health efforts, and lead to an unnecessary waste of public funds.

In the bottom middle square, affluent individuals can be denied the opportunity to buy health services that are not available to all through a public system. It would be, defenders of social responsibility maintain, unfair to have citizens in unequal positions regarding the most important goods—health and well-being—based solely on the amount of money they or their parents or protectors have managed to accumulate. Equality prevails only if we eradicate this possibility.

In the top right corner of Figure 2, beliefs and attitudes produced by oppressive cultures are not allowed to influence people’s health choices. Citizens may not refuse life-saving treatments on religious grounds, nor require mutilating procedures for esthetic or cultural reasons. Although voluntary decisions cannot, by definition, harm those making them, pressure from peers and social habits cancels the voluntariness of these choices and makes it our duty to ignore the individual’s expressed wishes.

In the bottom right corner, we have, finally, the view that defies all the others. This is the utilitarian position insisting that the liberty of individuals can only be legitimately restricted to prevent harm to others. Mill thought that paternalism, moralism, or some other tainted form of thinking motivates every other policy. Sidgwick followed suit by lumping most other theories together in the category of dogmatic intuitionism. When we revisit the matter in the light of different views on justice, we may have to reconsider the normative force of their classifications.

Figure 3 schematically presents the connections between types of moralism and approaches to justice.

Figure 3.

Types of moralism and approaches to justice.

The perfect geographical fit between the selected instances of moralism and chosen theories of justice in Figure 3 is, of course, due to my editorial work—things do not just naturally fall in their places as depicted. This does not matter, however. Although other types and approaches exist, and although the location of views in Figure 3 is not precisely set, the doctrines and opinions presented in it suffice to show the need for careful consideration when we examine ethical suggestions and solutions that do not conform to Mill’s liberal utilitarian credo.

It turns out that what at first might look like emotion, ideology, or over-confidence in reason is in closer scrutiny an expression of a solid ethical outlook that simply has different presuppositions from the “do no harm” philosophy. Mill and Sidgwick shared a commitment to altruism (the good of others is as important as my own good) universalism (possibly including cosmopolitanism), individualism (individuals are capable of shaping their lives at will, and this is good), wellbeing (as the only intrinsic value), and utility (as something reliably calculable), as well as an aversion to tradition (as a relic of the past). Change any of these presuppositions, which are up to a point, popular in contemporary healthcare and medicine but by no means carved in stone, and you get a different result in terms of norms and values. What a liberal utilitarian might reject as unenlightened dogmatism then returns as a reasoned conclusion of libertarian, communitarian, socialist, identity, or capability argumentation.

An important point to note is that utilitarianism, too, can be moralistic in the same sense as the other approaches to justice. This stems from two sources: decision making under uncertainty and the definition of fundamental values.

As for uncertainty, we do not know all the consequences of our actions, and we therefore have to choose the range that we deem as relevant for ourselves. One standard option is to choose the relatively short-term, reasonably expected outcomes of our activities.^{Footnote 150} We can calculate these with some accuracy, and they will often provide good grounds for practical decision-making. Other options include, however, pessimistic and optimistic interpretations. Some say that we should avoid doing anything that can feasibly have catastrophic consequences.^{Footnote 151} Others retort that we should endeavor to promote processes that could have fantastically good consequences.^{Footnote 152} Pessimists can say, for instance, that we should not allow blood donations from healthy foreigners in the fear of infectious diseases. Optimists could say that we should allocate the blood service’s resources to creating cheap synthetic blood in the future. Both arguments are, in their own way, utilitarian, or pseudo-utilitarian, but they both deviate from the standard view. While the possible but improbable foreign threat can be deflected by the ban on donation, and while synthetic blood might possibly become a success, the person needing the donation here and now will be left without blood and harmed unless we abandon these strategies. Disproportionate fear and hope can make utilitarian, or utilitarian-looking, solutions moralistic, that is to say, make them go against (one version of) the harm principle.

As for the definition of fundamental values, we have already seen how James Fitzjames Stephen managed to turn the utilitarian creed against Mill by understanding human good differently. For Mill, the only intrinsic goods were pleasure and absence of pain, but Stephen wanted to maximize those pleasurable experiences that have a link with our moral character. Stephen’s initially utilitarian position then took a moralistic turn when he included semi-theological elements in his theory of value. Henry Sidgwick also had his religion-related issues. He remained hanging between the altruistic or utilitarian, and egoistic or libertarian stances due to his belief that only the proven existence of God and an afterlife could tip the scales toward universal altruism.

Since Mill, Stephen, and Sidgwick’s time, various interpretations have been given to what is good, beneficial, and healthy, and what adds to the goodness and quality of our lives.^{Footnote 153} In the health industry, in both private and public sectors, the pursued good is often, and quite naturally, health as a physical and mental condition.^{Footnote 154} This can leave out cultural, social, and ethical considerations that arguably belong to the definition of good as inherently as the absence of disease, illness, and disability.^{Footnote 155,Footnote 156}

Paradoxically, “health utilitarianism” can then inflict non-health-related harm on individuals and become a form of moralism. Whether or not this is an accusation or an accolade is, at this time, unclear, but the possibility serves to show that conceptual charges of moralism are impossible to avoid in any view on ethics and justice.

Justice, Moralism, and Approaches to Bioethics

Theories of justice can form alliances, as shown by Sidgwick’s egoism-altruism balancing act; and as seen in defenses of unhindered capitalism since Adam Smith.^{Footnote 157,Footnote 158} Smith’s idea was that governments should leave economic transactions untouched (libertarianism) and let the invisible hand of the market produce the greatest wealth for the nation and its inhabitants (the aim of utilitarianism). This combination, also known in the philosophy of economics as the myth of classical liberalism, could serve in bioethics as an attempt to justify the form of moralism claiming that individuals are responsible for the diseases caused by their suboptimal lifestyle choices. To be exact, within libertarian thinking it is our own task to take care of all our needs, including all our health needs. If, however, we have allowed altruistic elements in our healthcare system, as often happens in real life, we can constrain their influence by drawing a line between conditions that we can label self-acquired and those that we cannot, and claim that the freedom to private property redeemed by the maneuver will boost economy and fund more altruism.

The most notable clusters of moralism, morality, and justice in bioethics can, however, be found in the approaches to medical, healthcare, and research ethics sometimes referred to as “American” and “European,”^{Footnote 159,Footnote 160,Footnote 161,Footnote 162} and possibly their overall rival, feminist bioethics. Figure 4 places these schematically on the map of moralism and justice shown in Figure 3.

Figure 4.

Justice, moralism, and approaches to bioethics.

The “American principles” of autonomy, beneficence, justice, and nonmaleficence find their places easily in the liberal top-and-right half of Figure 4 – the triangle marked AMER. In the Belmont^{Footnote 163} and Georgetown^{Footnote 164} model, justice is understood as universal impartiality with a general ear on local customs and attitudes. Beneficence and nonmaleficence are essentially utilitarian principles, although very few proponents of the model would like to admit it. Respect for autonomy, the cornerstone of the approach,^{Footnote 165,Footnote 166} takes at least three main forms. It can mean Millian antipaternalism against patronizing medical practices; genuinely equal opportunities and autonomous choices as opposed to cultural and social repression; and economic freedom of contracts and commerce.

What the “American principles” cannot accept is as enlightening as what they can and do. Social responsibility in the sense of socialized medicine, or universal public healthcare, is a pill too bitter for most champions of the principles, although there are exceptions.^{Footnote 167,Footnote 168} Recognition and identity politics are not usually on the agenda either, although changing cultural attitudes create pressures in this direction. Some traditional and community values are embraced, but full-fledged relativism is frowned upon.^{Footnote 169,Footnote 170} All in all, the proponents of the approach are confident that an efficient healthcare system that respects the rights of individuals to autonomous decision-making and private property is both beneficial and ethically tenable.

The “European values” of autonomy, dignity, precaution, solidarity, vulnerability, and subsidiarity occupy the antiliberal bottom-and-left half of Figure 4—the triangle marked EUR.^{Footnote 171,Footnote 172,Footnote 173} In this approach, autonomy does not just mean negative individual freedom from constraint, but also and primarily the positive freedom of moral agents to do what is good and right.^{Footnote 174,Footnote 175} Dignity is the inner worth of human beings as rational agents or as socially, culturally, and spiritually constructed persons; solidarity is the recognition of our spontaneous or silently accepted mutual dependence; and regard for vulnerability is a reminder of our need for special relationships in the protection of our integrity and self-respect.^{Footnote 176,Footnote 177,Footnote 178} Subsidiarity is a plea for self-determined decision making on local and group levels, against attempts at universal governance where it would be futile or detrimental.^{Footnote 179}

The supporters of the “European values” typically spurn the liberal emphasis on the freedom of individuals to do and be what they like. As members of their reference groups, people are members of communities (communitarianism), special factions (identity politics), or class (socialism) first, and the abstract independent individual is a dangerous illusion. It is not entirely in our own hands to acquire and possess property, although libertarians would have us think so. Family and circumstances play an important role in these. Likewise, it is not always within our own reach to be able to do all the things people in other environments and circumstances can do. Disability and disease make us dependent in ways that cancel this. Last, but not least, it is wrong to think that human happiness and flourishing could be defined and promoted in terms of the pleasure, well-being, or preference satisfaction of individuals, as utilitarians think. These definitions of the good ignore our finer features as social, communal, and spiritual beings, and commitment to them can only lead to shortsighted hedonism.

Feminist bioethics ranges from identity and recognition politics to capability policies, with some elements of socialism in evidence. The square marked FEM in Figure 4 shows its location on the map of views and theories. Like philosophical feminist ethics more generally, this approach has a tense double foundation.^{Footnote 180,Footnote 181} In the eighteenth and nineteenth centuries, Mary Wollstonecraft and John Stuart Mill believed that women and men are fundamentally capable of the same things—in thinking, feeling, learning, politics, and work alike.^{Footnote 182,Footnote 183} Against them, however, others argued that women’s virtues are different, and better, than men’s are. Catherine Beecher held that women are the moral backbone of societies, managing households, safeguarding the virtues of their family members, and taking on a Christ-like role of self-denying benevolence.^{Footnote 184} Elizabeth Cady Stanton agreed that women do tend to sacrifice themselves for their families, but she also argued that two further advances would be beneficial: women should exercise their virtues also in the public sphere and should tend to their own self-development.^{Footnote 185} Charlotte Perkins Gilman created a science fiction image of an all-female world in her novel Herland in 1915,^{Footnote 186} and Shulamith Firestone produced a radical Freudo-Marxist version of feminism in her The Dialectic of Sex in 1970.^{Footnote 187,Footnote 188} The important tension, then, is between universalism (sex and gender make no difference in matters of virtue) and positionalism (sex and gender make all the difference).

Feminist bioethics has, accordingly, two strands, exemplified by Carol Gilligan’s care ethics and Martha Nussbaum’s justice ethics.^{Footnote 189,Footnote 190,Footnote 191,Footnote 192,Footnote 193} Since these are on different sides of certain crucial divides, criticisms are possible in both directions. Care bioethicists can argue that Nussbaum’s attempt to make virtue universal and compatible with all sexes, genders, and sexual orientations ends up perpetuating hegemonic male heteronormative values in a new disguise. Justice bioethicists can claim that in their endeavor to make female virtues distinct and visible, Gilligan-style theorists drift into conceptual unclarity and relativism. Both sides can find redeeming factors in the other, however. For feminist justice bioethicists, the care ethics concentration on women and other marginalized groups is an important reminder of whose capabilities, rights, and opportunities should take priority. For feminist care bioethicists, Nussbaum’s presentation of capabilities as thick (as opposed to thin)^{Footnote 194} values should be a welcome move. (Unsurprisingly, ethicists who agree on the idea of thick values, but want to interpret them traditionally^{Footnote 195} or religiously,^{Footnote 196} find much fault in Nussbaum’s^{Footnote 197} bioethical views.)

According to this definition, feminist bioethics cannot be communitarian, utilitarian, or libertarian. This appears to present a paradox. The characterization seems plausible (Ayn Rand’s^{Footnote 198} take on bioethics would probably be far out of place in a Feminist Approaches to Bioethics^{Footnote 199} conference today), yet women who are involved in bioethics and may consider themselves feminists in some sense can and do come from all schools of thought. Feminists conducting postcolonial and family-based studies can have clear communitarian leanings, and women in bioethics with feminist leanings who support the right to private property or want to promote the greatest happiness of the greatest number are not unheard of.^{Footnote 200,Footnote 201,Footnote 202} All that this shows, however, is that people do not always fall neatly into philosophical categories. As I have argued elsewhere, the champions of “American principles” and “European values” do not respect geographical boundaries, either. These are just names given to conceptual and normative clusters on the map of moral attitudes and approaches to justice caught in Figure 4 above.

A final thought on the “gap.” In Figure 4, I have left a diagonal top-left-bottom-right border area that belongs neither to the “European” nor to the “American” domain. This is deliberate. The gap marks the polarization between nationalist-populist thinking top left, and cosmopolitan-elitist thinking bottom right. No precisely matching bioethical approaches exist, or at least I have not come across a book of fascist bioethics or coldly calculating, unemotional, and amoral utilitarian bioethics. The former seems to choke in academic discussions due to scholarly commitment to communal solidarity, recognition-related compassion, or a libertarian sense of economic interests. The latter does not blossom in its pure form, because social responsibility and respect for individuals from the neighboring approaches crossbreed with the logic of utility. Not that we need them, but now that the political world around us may be grouping behind these creeds, bioethicists, too, should keep an eye out on these possible developments. If I am right and the major current approaches to bioethics fall into the places shown in Figure 4, we appear to be blind to this potential gap and polarization.