Bioethics as civic discourse.

In one of the most innovative and controversial works of bioethics in recent years, Setting Limits, Daniel Callahan urges us to embark on a deeper public conversation not only about the end of life, but also about the ends of life. He calls for a "public philosophy" of aging that can, he believes, emerge from sustained, open argument about the nature of the good life and the place of aging and health within such a life. In this regard-and quite apart from any of the particular moral or public policy positions the book defends-Setting Limits is an argument by example for one understanding of what bioethical discourse can and should be. The purpose of bioethics is precisely to raise substantive questions about the human good and the good society, questions that will give flesh and sinew to the skeletal framework of theoretical concepts such as autonomy, beneficence, justice, rights, caring, and the like. Can we, in our pluralistic, individualistic, and liberal American culture and society, have anything like a reasonable, philosophically serious public discourse about the good? Even if our public (as well as our personal) deliberations and decisions could be oriented by some substantive conceptions of the good, would this be desirable, or would it endanger some of our most deeply held public values, like freedom, privacy, and toleration? Would a bioethics devoted to promoting such a discourse-a bioethics of the good, we might call it-even be possible sociologically in America with its ethnic diversity and pluralism? Given the wide influence that bioethical inquiry has had and will surely continue to have in medicine, science, law, and public policy, these are not idle questions. It is probably fair to say that most bioethicists are made exceedingly nervous and wary by talk of the good and by the specter of something like a public philosophy that would impinge on the private moral choices of individuals, either through the force of social approbation or, worse still, through the coercive power of the state. Having been worked up into a bad temper by Setting Limits, they turn for comfort and reassurance to On Liberty. The most prevalent alternative to a bioethics of the good, however, does not derive from Mill or the utilitarian tradition so much as from the heritage of liberal contractarianism and constitutionalism, today most forcefully represented in political theory by john Rawls and in bioethics by Tristram Engelhardt. This bioethics of the right holds that public moral discourse should be limited to a general framework of principles of justice and procedural standards that are sustained by what Rawls refers to as an "overlapping consensus" within our pluralistic society. This framework prescribes only minimal rules of civic duty and legal order; it places constraints on individual choice and liberty only in the name of protecting those same values for others; it creates an orderly world of rights and settled expectations where individuals and private subcommunities can form their own plans for life and pursue their own conceptions of the good in their own way. Is a bioethics of the right still a rich enough vein to mine, or should we collectively attempt to create a bioethics of the good? Can that quest succeed? Would the field of bioethics be richer and would our society be better served if it did? My own view is that a large part of the mission of bioethics ought to be to promote and to nurture a deeper, more thoughtful public discourse about substantive questions of the good life and the good society. …