This Appendix aims to address issues about the methodology of moral reasoning used in this volume.  Because many, perhaps most readers will not be especially concerned about such issues, we have chosen to address them here, rather than impeding the flow of analysis in the text.

          As much as at any time in the recent past, there is considerable controversy about the proper methodology for ethical analysis, especially in bioethics (Jonson and Toulmin 1988; Gillen and Lloyd 1994; Clouser 1994; Clouser in Gert 1996). Our purpose here is not to resolve these complex issues, only to make it clear that our choice of methodology is reflective (rather than reflexive), and to deflect what we take to be certain spurious but unfortunately predictable objections to our methodology.  We are under no illusion that what we say here will render our work immune from methodological criticisms.  We hope, rather, at least to clear the field of spurious criticisms to make room for serious ones.


I. The Method of Reflective Equilibrium

The Charge of Parochialism

In Chapter One, we noted that we use a familiar method for moral inquiry, that of wide reflective equilibrium.  That method is easily criticized--if represented in caricature form.  In the end, the best defense of this method is to put it into action, as we have done, and let it be judged by its results. 

          There is another way to defend the method--namely, by emphasizing its apparent unavoidability, given the rejection of foundationalism.  In simplest terms, foundationalism is the view that ethical theorizing must begin with indubitable or self-evident, unrevisable moral axioms and deduce subsidiary principles and concrete judgments from them. It is hard to see how any reasoned approach to ethics that rejects foundationalism can avoid relying on the process of mutual adjustment between principles and particular judgments, each conceived as revisable in the light of the other.

          A foundationalist approach in ethical analysis is not promising for several reasons; we will not rehearse them all here.  But we will mention two that are of special significance.  First, the rejection of foundationalism in practical reasoning, including normative ethics, gains plausibility from its rejection in theoretical reasoning in the sciences.  Absent a convincing account of why practical reasoning generally or ethical inquiry in particular is fundamentally different in this regard from theoretical reasoning, the cogency of anti-foundationalist approaches in the philosophy of science lends weight to anti-foundationalism in ethics.  And once foundationalism is abandoned, it is hard to see how reasoned ethical inquiry can proceed without relying to some extent on the method of reflective equilibrium broadly construed (Rawls 1971).

          Second, the idea of wide reflective equilibrium theory addresses perhaps the most common objection to the method--the charge that reasoning that begins with parochial moral beliefs can only end in parochialism, that the method simply systematizes and renders coherent the particular beliefs of the cultural or ideological group among whose members the practitioner of the method happens to be.  This objection overlooks the resources of wide reflective equilibrium, which is wide in two senses: it ranges over a diverse set of moral-theoretical beliefs, including not only general normative principles and particular judgments but background moral concepts such as an ideal of the person and certain conceptions of the nature of social cooperation; and it also includes principles and concepts drawn from different ethical theories, traditions, and cultures, all of which are available to reflective and educated persons in our multicultural world.  In a world in which the materials for reflection were severely limited by cultural insularity, the parochialism objection would be more telling than it is in our world.

          The actual practice of ethical argumentation and consensus-building as it often occurs in medical institutions and in public policy debates concerning biotechnology illustrates, even if imperfectly, the resources of the method for transcending parochialism.  To a large measure, the progress made in gaining reasoned and rather broad consensus on issues such as informed consent, the right to refuse life-sustaining treatment, and other areas of relative agreement in bioethics has been achieved by developing styles of argumentation that allow for considerable convergence of judgment among individuals and groups starting from quite different initial moral orientations, religious or secular.


The Communitarian Challenge

A predictable criticism of the styles of argument used in this volume is that they assume a "liberal-individualist" view of morality and that such a view is deeply flawed. More specifically, the charge would be that the account of the ethics of genetic intervention offered in this volume is biased in favor of individual autonomy and toward individual rights generally. Usually this criticism is voiced by those who are called communitarians, though aside from an animus against what they take to be liberalism, there may be little that all who go by this label have in common (Buchanan 1989).  Later in this Appendix we articulate the sense in which our view is liberal-individualist (and the senses in which it is not).  For now, however, we only wish to emphasize that there is a sense in which the anti-foundationalist character of the method of reflective equilibrium should be congenial to communitarians, and that from a communitarian perspective the source of the method's alleged parochialism--the fact that moral reasoning begins with a set of inherited cultural assumptions about the good, and so on--is a strength, not a weakness.

          As we understand it, the method of reflective equilibrium is anti-Cartesian in two senses, not one.  First, as already noted, it is anti-foundationalist, rejecting any attempt to deduce ethical principles and judgments from indubitable or self-evident axioms, and accepting the inevitability that even the most basic starting points in the chain of argumentation are subject to revision.  Second, it makes no pretense that the practitioner of the method can operate as a kind of moral "first man," freeing himself from the moral assumptions transmitted through the process of enculturation in the practices of his primary social group, in the way in which Descartes claimed to have freed himself from all traditional beliefs.  Instead, the method of reflective equilibrium assumes that we begin in medias res as social-cultural beings, and that the various beliefs that provide the materials for the process of critical reflection are cultural products--they are not just my beliefs, but our beliefs.

          If it were a tenet of liberalism that ethical reasoning does not begin within a cultural context of belief (or as MacIntyre puts it, a tradition (MacIntyre 1981)), then liberalism and the use of the method of reflective equilibrium would be incompatible.  However, as we understand it, this is not a tenet of liberalism.  All that liberalism--and the usefulness of the method of wide reflective equilibrium--requires is that even the most basic culturally inherited beliefs are in principle subject to revision as a result of critical reflection.  If communitarianism goes further than this--if it holds not only that ethical reasoning must begin within a particular cultural tradition, but also that it cannot go beyond the assumptions of that tradition, that it cannot incorporate principles or ideals imported from outside the culture of origin, then communitarianism flies in the face of much human experience in our multicultural age.  People do come to revise the assumptions of their culture of origin and in some cases to repudiate them and adopt those from other cultures.  Indeed, in our world the boundaries between cultures or traditions are very hard to draw.

          In our view, communitarianism, on its most plausible rendering, rightly emphasizes that ethical reasoning is always rooted in a cultural context, but it is not committed to the very implausible view that cultural contexts are, as it were, hermetically sealed, isolated social atoms.  Understood in this way, communitarianism should find the method of reflective equilibrium congenial, at least if we assume that those of us who are practicing the method are part of a developing tradition of ethical reasoning about matters of public concern, a tradition of eminently social reasoning that seeks to develop a consensus in which people from a wide range of cultural and religious perspectives can participate.

          There is another respect in which our approach should be congenial to thinkers who may broadly be described as communitarian.  Our analysis, more so than most in bioethics perhaps, is deeply contextualized.  We have situated our exploration of the ethical issues of genetic intervention historically, beginning with an account of the eugenics movement.  In doing so, we have operated on the assumption that the historical context matters, that the experience of eugenics is profoundly relevant, not only from the standpoint of ethical theorizing, but also because both the actual public debate about and perception of the new genetics is inevitably colored by that experience.

          Similarly, especially in the chapter on Policy Implications, we have proceeded on the assumption that the economic, legal, and popular cultural contexts within which genetic interventions will be deployed makes a difference as to how the policy issues will take shape. And although we have concentrated primarily on the U.S. context and that of other economically developed liberal democratic societies, we have offered an analysis--drawing in part on our ethical autopsy of eugenics--of what might be called "ethical risk factors" regarding genetic intervention that is sensitive to contextual differences as well.  In particular, we have argued that the greater risk in a country like the United States, which has relatively robust and entrenched legal rights regarding reproduction, comes from market-driven, rather than state-directed eugenics.  It is our hope, therefore, that at least to some extent we have avoided one of the errors rightly or wrongly associated with liberal-individualist approaches: a failure to contextualize the problems under analysis.


II.  The Limits of "Principlism"

In recent years, voices of criticism have been raised against "principlism" in bioethics (Clouser in Gert 1996).  To a large extent, the critics are, in our opinion, attacking a view that is at worst a strawman and at best a vulgarization of the framework for analysis advanced most prominently by James Childress and Tom L. Beauchamp in various editions of their influential book Principles of Bioethics (Beauchamp and Childress 1979).  In simplest (and crudest) form, the anti-principlists' complaint is that bioethics has been impoverished by an approach that mechanically applies to all issues a triumvirate of principles (autonomy, beneficence, justice--the so-called Georgetown mantra, named after the home institution of one of the authors of Principles of Bioethics).

          If that is principlism, then it is obviously a flawed method, if one can call it a method.  Our approach is not principlist in that sense, however.  We do attempt to articulate principles, but we hope to have made it clear that the real work of ethical reasoning is quite complex and arduous and that principles must be argued for, refined, mutually adjusted to one another, and embedded in a coherent ethical theory that is sensitive to cultural, economic, and political context.

          In order to make it even clearer that our analysis does not commit the sin of principlism, it will be useful to elaborate our earlier simplified account of the method of wide reflective equilibrium upon which we rely (Daniels 1996). The central methodological assumption of this volume is that the broadly coherentist view or "method" of justification that Rawls (1974) calls "wide reflective equilibrium" not only offers a promising account of the justification of ethical theories, but also gives valuable gudance for practical ethics. The process of working back and forth between our moral judgments about particular situations and general reasons and principles that cover particular situations is familiar to anyone who reasons about matters of right and wrong. Sometimes we use this process to justify our judgments, sometimes our principles.

          We can still ask: Why should we accept the principles that explain our considered moral judgments? To answer this question, we must widen the web of justificatory beliefs. We must show why it is reasonable to hold these principles and beliefs, not just that we happen to do so. Seeking wide reflective equilibrium is thus the process of bringing to bear the broadest evidence and critical scrutiny we can, drawing on all the different moral and nonmoral beliefs and theories that arguably are relevant to our selection of principles or adherence to our considered judgments. Wide reflective equilibrium is therefore at the same time a theoretical account of justification in ethics and a process that is relevant to helping us solve moral problems at various levels of theory and practice.

          The key idea underlying the method of wide reflective equilibrium is that we "test" various parts of our system of moral beliefs against other parts of our general system of beliefs, seeking coherence among the widest set of moral and nonmoral beliefs by revising and refining them at all levels. For example, we might test the appropriateness of a purported principle of justice by seeing whether we can accept its implications in a broad range of cases and whether it accounts for those cases better than alternatives. Rawls appeals to such a test in A Theory of Justice when he imposes a condition of adequacy on the principles chosen in his contract situation, requiring that they match our considered moral judgments in reflective equilibrium.

          Our moral beliefs about particular cases count in this process. They have justificatory weight; yet they are not decisive, and what weight they have is provisional. Even firmly held beliefs about particular cases may be revised. For example, if a principle incompatible with such a firmly held belief about a particular case accounts better than alternatives for an appropriate range of cases we seem especially confident about, and if the principle also has theoretical support from other parts of our general belief system, we may revise our particular belief and save the principle. Unless we are willing to indulge in dogmatism and abandon all claim to reasonableness, we cannot insist on the particular belief without supplying reasons for doing so, and we must show that those reasons are superior to those in support of the principle that clashes with the particular belief.

          Wide reflective equilibrium requires that we bring to bear all theoretical considerations that have relevance to the acceptability of principles, not just of particular judgments. These theoretical considerations may be empirical or they may be moral. Thus one task of ethical theory is to show how work in the social sciences, for example, has bearing on moral considerations.

          It is very important to understand how diverse the types of beliefs are that are included in wide reflective equilibrium, as well as the kinds of arguments that may be based on them. They include our beliefs about particular cases; about rules and principles and virtues and how to apply or act on them; about the right-making properties of actions, policies, and institutions; about the conflict between consequentialist and deontological theories; about partiality and impartiality and the moral point of view; about motivation, moral development, strains of commitment, and the limits of ethics; about the nature of persons; about the role or function of ethics in our lives; about the implications of game theory, decision theory, and accounts of rationality for ethics; about human psychology, sociology, political and economic behavior; about the ways we should reply to moral skepticism and moral disagreement; and about moral justification itself.

          As is evident from this partial list, the elements of moral theory are diverse. Moral theory, according to this method, is not simply a list of principles, as the principlist caricature would have it.        

          There is another, more sophisticated version of the anti-principlist objection, which deserves more serious consideration.  This is the view that there is something incomplete and inadequate about a conception of ethics that is concerned only with principles of action, understood as rules specifying what is right, wrong, and permissible--even if the list of principles is much richer than the Georgetown mantra, and even if the principles are embedded in a coherent web of nonmoral and moral beliefs.

          Perhaps the most plausible interpretation of this complaint is that it overlooks the essential role of highly particularized judgment in the moral life and that hence it gives short shrift to virtues, so far as these are dispositions to judge and be motivated to act in the right way, in the right circumstances.  In other words, anti-principlism in some cases at least is a new name for an old ethical stance, one that has recently experienced a revival under the title of "virtue ethics": the rejection of a conception of morality that identifies it with a body of rules of action, that ignores or neglects the importance of virtues, and that places too much confidence in the usefulness of general principles as guides to a diversity of richly nuanced particular situations.

          We reject the extreme version of this position, according to which an account of virtues can replace the articulation of a coherent and powerful set of moral principles.  We cheerfully acknowledge, however, that a complete moral theory would give a prominent place not only to principles and to their limitations as guides for conduct, but also to virtues.  We do not offer a complete moral theory, however, and the part of moral theory we have focused primarily on--that which provides guidance for how institutions ought to be structured--requires the articulation of principles. Principles are needed to evaluate existing institutions and to guide institutional design; reliance on the judgment of virtuous individuals (even if we could identify them without recourse to principles) is no substitute for principled public debate about the ethical character of our common institutions.

          Nevertheless, much of what we have said regarding the morality of inclusion (especially in Chapters Three and Seven) pertains as much to virtues as to principles.  This is also especially true regarding our ethical autopsy of eugenics, as well as our conclusions about the importance of combining a commitment to preventing disabilities with an attitude of respect for the equal worth of those who have disabilities.  In that sense, our analysis is at least not guilty of the grosser sins of principlism. 


III. A Liberal Framework

The principles we began with (and have taken as revisable in the process of moving toward wide reflective equilibrium), as well as those with which we conclude our analysis in this volume, are in a broad sense liberal principles.  Liberalism, however, is not one thing, and it is certainly not the thing that most who take themselves to be critics of liberalism are criticizing.

          There are vigorous conflicts among liberal theorists, some of which we have explored in earlier chapters.  (Consider, for example, the rival understandings of equal opportunity explored in Chapter Three.)  However, there are some fundamental ideas that we believe are common to the most plausible variants of liberal moral-political theory, and which have played a formative role in our reflections.  (The characterization of liberalism that follows owes much to lectures presented at the University of Wisconsin in the Spring of 1997 by Harry Brighouse.)


          1.  Moral individualism.  From a moral point of view, it is only individuals who ultimately count.  (Collectivities can have moral value, but only insofar as they affect the condition of individuals.)


          2.  Equality of persons.  With regard to the most basic questions of morality and so far as the design of basic institutions is concerned, individuals count equally.


          3.  The subjects of justice are persons who are capable of being critical choosers of ends.  At least so far as the justice of basic institutions is concerned, individuals are to be conceived as beings whose preferences and conceptions of the good are not fixed, but are rather subject to criticism and revision over time.


          4.  The distinction between the private and public spheres. Institutions that reflect a recognition of moral individualism, the moral equality of persons, and the capacity of persons to be critical choosers of ends will create and protect a significant private sphere in which individuals, either as individuals or as members of communities, can freely pursue and critically revise their own conceptions of the good.  (And hence there are significant limitations on the use of public authority and the power of the state, including, on some accounts, the requirement of state "neutrality.")


          These are not offered as a complete specification of liberalism, but will suffice for our purposes. Moreover, we will not attempt to defend these principles here--to do so would require a major treatise in political philosophy. It will be useful, however, to head off several common misinterpretations of these elements of liberalism.

          First, it is crucial to understand that these are normative theses. They are not psychological generalizations intended to apply to all individuals in all societies.  Nor are they ontological theses.

          Thesis 1, moral individualism, is a claim about what ultimately matters from a moral point of view, not about what sorts of things there really are.  Hence, liberalism is quite compatible with the ontological view that there are irreducible social wholes or collectivities--that groups exist and that they are not reducible to the existence of individuals.

          Thesis 2, the moral equality of persons, is not the claim that people always recognize themselves or others as moral equals.  Hence pointing out that in some societies some people do not regard themselves as the equals of others or that they cannot conceive of themselves as equals is no criticism of liberalism.

          Nor is Thesis 3 a psycho-social generalization about human beings.  It is about the relevance of a certain capacity of human beings, from the standpoint of justice.  As such it is perfectly compatible with the statement that many human beings never realize this capacity for critical revisability, nor wish to realize it.  So, for example, it is no criticism of liberalism to point out that the "obsession with autonomy" is a Western attitude.   Nor does the third liberal thesis imply that people's preferences or conceptions of the good are formed independently of cultural influences, or that individuals ever completely free themselves of the normative assumptions of their cultures of origin.

          Similarly, the fourth liberal Thesis is not to be confused with a related empirical generalization--that all societies recognize a private and a public sphere.  It is compatible with it being the case that there are societies that do not feature a clear distinction between a public and private sphere, much less a recognition that the distinction is important.

          In large measure, the liberal tradition can be seen as an on-going, vigorous debate about what these four tenets mean, about what the best justifications for them are, and about how best to realize them in the social world.  Because both their meanings and their justifications are perpetually debated, it is incorrect to say they are dogmas of liberalism.


Negative and Positive Rights; Freedom and Well-being

Among the disputes that go on within the liberal tradition, two are especially significant: the controversy over whether, or to what extent, liberal justice includes positive rights, and the disagreement about whether liberty or self-determination is a separate, irreducible value, or a component of well-being broadly understood.  Despite other differences, the authors of this volume endorse a view of the proper scope of public authority and state action that includes positive rights.  In other words, like most modern liberals, but unlike libertarians, we believe that justice toward persons conceived as critical choosers of ends requires the provision of certain goods that are valuable as flexible means that facilitate the critical formulation, revision, and effective pursuit of a wide range of conceptions of the good.  Among these goods are health care services, especially so far as these facilitate the critical and effective pursuit of a conception of the good by preventing or removing harms and obstacles to opportunity.

          We also believe that the liberal case for positive rights is greatly strengthened if the whole set of basic rights, negative as well as positive, is seen to be justified by appeal to a plurality of morally significant interests that persons have.  In this sense, our view is not "rights-based;" we regard rights-principles as something that must be argued to, using the method of wide reflective equilibrium and in such a way as to emphasize the importance of rights as protectors for certain crucial interests.

          The most important of these interests, somewhat crudely, are the interest in welfare and the interest in self-determination, where the latter understood as the capacity to function as a critical chooser of ends.  A person's interest qua critical chooser of ends, what might be called self-determination (or autonomy) interest, consists in the achievement of optimal conditions for developing and exercising the capacity to formulate and rationally revise over time a conception of the good.  This is not the only important interest, however; persons also have a morally considerable interest in effectively pursuing the ends that they set for themselves in their conceptions of the good and whose attainment constitutes their welfare.

          Different ethical theories, including different versions of liberalism, assert different connections between welfare and self-determination.  On some theories, self-determination is merely a component, albeit a very important and weighty one, of a person's welfare comprehensively understood.  According to other theories, self-determination is an irreducible, primary value, weightier than or at least as important as welfare.  Each approach has its attractions and difficulties.

          The most obvious difficulty for the second type of theory is that it immediately faces the task of either arguing convincingly that the interest in self-determination and that in welfare are always or generally compatible or, if they are not, how it could ever be good or rational for someone to sacrifice welfare for the sake of self-determination (Buchanan and Brock 1989).  Fortunately for substantive ethical inquires such as ours, in most cases the two views about the relationship between welfare and self-determination yield the same practical results.  For this reason, though we have in several instances taken a stand on rather deep theoretical issues that divide liberals (such as the meaning of equal opportunity or the subject matter of theories of distributive justice), we have not found it necessary to do so here.  Our analysis is compatible, we believe, with either resolution of this fundamental dispute in ethical theory.


Justifying the Liberal Framework

What justifies our reliance on a liberal framework for our ethical inquiry? The short answer is that, as our brief remarks about the method of wide reflective equilibrium indicate, we (like everyone else) must start somewhere.  The longer and somewhat more satisfying answer is that we believe that a liberal approach to moral and political philosophy is to date the most carefully worked out and best defended approach available.  In our opinion, there simply are no antiliberal or nonliberal (for instance, communitarian) moral-political theories that come close to the degree of systematic argumentation and power that we find in the writings of liberal thinkers such as John Rawls, Joel Feinberg, Ronald Dworkin, Thomas Scanlon, and Joseph Raz.  Communitarian writings have tended to be criticisms of liberalism rather than constructive theories in their own right. 

          Finally, there is another reason--what might with some irony be called a communitarian reason--to explore the resources of a broadly liberal approach.  We are attempting to provide guidance for a certain kind of society--a society like our own but with far greater powers of genetic intervention.  Our society, at least in the basic contours of the political culture and legal structure in which issues concerning genetic intervention are likely to arise, is a liberal society-- or at least strives to be.  Hence we are doing what communitarians say we must: beginning the task of moral inquiry within a tradition, our tradition, and attempting to grapple with the problems of a particular society, our society.