Our Vocabularies, Our Selves

David Rothman has noted that at least some of the success of the bioethics movement in this country can be attributed to fortuitous timing. In an age of great concern with civil rights, bioethicists had much "in common with the new roster of rights agitators" who were appearing on the American scene.(1) It is, therefore, no surprise that rights talk should have dominated the bioethics world, but such an emphasis has its problems and dangers. In a powerful attack on the uses to which rights language is put in our society, Mary Ann Glendon has written that in "its simple American form [by contrast, she means, with rights language in Western European societies], the language of rights is the language of no compromise. The winner takes all and the loser has to get out of town. The conversation is over."(2) Glendon is only one of a number of thinkers who have argued in recent years that we have mistakenly isolated rights from responsibilities, to the detriment of our common life. I, at least, would not deny that they have a legitimate concern. When our moral language shirvels and narrows to the point where we can discuss disputed issues only in the language of rights, we are impoverished in important ways. However essential that language may be, it is insufficient for everything we need to say. That I have a right to do something does not mean that it is the right thing to do, nor even that I have any good reason to do it. To Judith Jarvis Thomson's now famous distinction between what a pregnant woman has a right to do and what it would be decent of her to do, Philip Abbott quite properly responded: "Who would want to live in a society in which everyone was positively indecent to another and at the same time positively scrupulous in respecting another's rights?"(3) And, although bioethicists have seldom mused about the connections, it is striking that commitment within the bioethical community to the language of rights and autonomy has taken place over two decades in which political theorists--who are more inclined to remember that the language of rights in the West was first developed to discuss the way unlimited rights are given up by those who enter civil society--have debated whether the American founding is best characterized as liberal or republican.(4) We can recognize the truth in communitarian critiques of rights talk, however, without denying that such talk plays an essential role in bioethical reflection. Thus, for example, Beauchamp and Childress distinguish between the "ideal of the autonomous person" and the principle of "respect for autonomy." We may need the principle even if we think the ideal a mistaken understanding of our humanity. And, in fact, when a principle of respect for autonomy is criticized by those who prefer to balance and weigh different values in search of social harmony or consensus, we lose much of the bite of moral reflection as we transform bioethics into public policy. Stephen Toulmin, for instance, wants us to avoid "the cult of absolute principles," which cult expresses, evidently, not our concern for the wellbeing of others but our immature quest for certainty. He argues that ethics is not well served by appeal to principle. "Moral wisdom is exercised not by those who stick by a single principle come what may, absolutely and without exception, but rather by those who understand that, in the long run, no principle--however absolute--can avoid running up against another equally absolute principle; and by those who have the experience and discrimination needed to balance conflicting considerations in the most humane way." The best we can hope for is that "good-hearted, clear-headed people" will "triangulate their way across the complex terrain of moral life and problems."(5) Alas, good-hearted people sometimes find themselves standing at selection ramps balancing conflicting considerations, and "[a]ny account of morality which does not allow for the fact that my death may be required of me at any moment is thereby an inadequate account. …