Axel Carlberg <This email address is being protected from spambots. You need JavaScript enabled to view it.>; http://www.upspring.se

I want to address a question which lies at the core of all our social interactions. Is it possible to connect across cultural divides? Is it possible to understand each other despite the cultural differences that set us apart? To me this is not just an epistemological issue reserved for philosophers of language and anthropologists, but a deeply moral issue which should be everyone’s concern. It has to do with our ability to set and pursue a global agenda of justice and respect for the integrity of creation. There are good reasons for being pessimistic. The latest world climate summit in Copenhagen showed once more the inability of world leaders to talk in a meaningful way to one another; and to give priority to common goals before national interests. It also showed a great divide between the political establishment and civil society. As I live very close to Copenhagen, I was able to follow very closely, through local media coverage, the events there and witnessed how climate and human rights activists and militants were literally pushed around and excluded from the meeting venue; in some instances, despite having valid passes. It was very sad to see.

So the question that I want to address is the possibility and the conditions necessary to formulate a global moral vision. I shall address these issues with the tools of my trade as an ethicist, and more particularly as a medical ethicist. As many other disciplines and specialisations, we also grapple with the question of the foundations of ethics, i.e. with the question of the possibility of establishing a valid, universally accepted moral discourse to resolve the very pressing and important issues that we are dealing with and which can be included under the heading of the value of human life in the ambit of clinical practice.

This issue was confronted head on by the renowned and influential American bioethicist H. Tristram Engelhardt in his earlier work, especially in the book Foundations of bioethics.1 Engelhardt believes that Western society has far too long pursued the Holy Grail of morality; the Enlightenment dream of a moral discourse which would be free from all prejudice, universally acceptable and rationally contrived. This Holy Grail of morality, Engelhardt believes, will not be found because ethics deals essentially with understandings of the good life which are deeply individual and culturally conditioned. Today’s western society is a melting pot of cultures, religions and interest groups. Muslims, Christians, atheists, liberals and conservatives, ProLife and ProChoice adherents have to coexist. These groups and individuals are more often than not divided in their opinion of what is best to do when confronted with difficult ethical issues. To use Engelhardt’s wording we are “moral strangers” to one another. In a society of moral strangers, of radically different opinions of the individual and common good, everybody has to accept the conditions of a secular ethics. Such a secular ethic has to renounce the ambition of establishing a universally valid – and what Engelhardt calls “contentful” – understanding of ethics. Such an ethic must renounce the ambition of seeking transcendent or religious foundations for ethics as well as the dream of establishing an agreement on what is the good life should be for all. According to this understanding, ethics has to shoulder a much humbler role; that of establishing proper rules of dialogue that facilitate discussion and which allow peacefully co-existence among all members of society, despite their deep moral disagreements. In other words, Engelhardt is a proponent of a procedural ethic. He does not believe that ethics can provide answers that resolve substantive moral issues. Answers to such questions are merely political accommodations. An ethicist is foremost a dialogue facilitator. The first answer to the question phrased in the title of this lecture is therefore the following: doing ethics is essentially establishing rules of peaceful conflict resolution of contentious moral issue.

Engelhardt cannot, however, totally avoid the question of the foundation of ethics because the rules of dialogue must ultimately rest on some fundamental moral convictions. This ultimate moral foundation, Engelhardt argues, is the principle of autonomy or permission. Ethics ultimately rests, on the right of any individual to decide for her or himself what the content of that good is all about and to be respected in that choice. Because there is no possibility of determining what is right and wrong in contentious issues, it is the individual who is the ultimate interpreter of morality. Thus personal autonomy is the cornerstone, according to Engelhardt, of modern secular ethics. This means concretely that issues such as abortion, euthanasia, stem cell research, and etcetera should be left to individual discretion as there are intelligent people of good will on both sides. The state should not interfere and dictate solutions on these matters.

Engelhardt is a clear thinker and it is not difficult to be swayed be his arguments. His theory of personal autonomy as the lowest common denominator in ethics as well as his procedural interpretation is politically realistic. In pluralistic western societies, it is not difficult to see others as moral strangers, especially when you work with ethics where you constantly have to negotiate between rivalling views. But there is a blind spot in Engelhart’s theory which I shall identify and which can be seen as the starting point of my exploration of the possibility of a contentful secular theory of ethics. What Engelhardt does not realise is that his theory has also a foundational ambition which is not exempt from a context-sensitive critique. To be specific, his theory of personal autonomy is also an attempt to ground ethics on a conviction which he believes will transcend the difference of opinions among moral strangers. In doing so, he overlooks the fact that his view is very much the expression of a particular culture – American liberalism – which can be reasonably criticised and in turn transcended. His view that the individual stands along against the state, and that we are moral strangers to one another is indeed founded on a suspicion about others that isolates the individual from her community.

The British philosopher Onora O´Neill has written an important book with the title Autonomy, trust and bioethics where she clearly addresses the issue.2 She sees the overemphasis on the principle of autonomy in modern bioethics and ethics in general as a great threat to public trust and the common good. This overemphasis on has led to an interpretation of autonomy as total self-realisation. In the name of autonomy today, you can claim the right to advanced fertility treatments that drain public resources from other areas, foetal diagnostic procedures that can discriminate against unborn girls and the disabled as well as to claim the right to being euthanized. This interpretation of individual autonomy as self-realisation does not correspond to the original sense of the word in the writings of Emmanuel Kant and John Stuart Mill, considered to be the fathers of autonomy. In their writings was autonomy something else. According to Mill autonomy was the expression of personal character, and Kant does not talk about so much about personal autonomy as the autonomy of reason and law. Autonomy, in the original sense, is in other words not doing what you want to do always, but quite the contrary, it is conforming to what is required by the decrees of reason.

O’Neill sees this overemphasis on individual autonomy as a threat to the common good and to the proper understanding of human rights. To claim, as some people do, that euthanasia is a right, or that access to all types foetal diagnostics is a right is in itself misleading. She points out that a human right must always be with an obligation to do something or to refrain from doing something. To respect somebody’s rights is other words to do something concrete for him or her or to refrain from doing something. If a right cannot be observed by concrete actions towards an individual it is not a right in the proper sense of the word. The right of self-determination and autonomy is only a right in the sense that an individual has the right not to be misled, coerced, harmed or destroyed, but the right to self-determination cannot be appealed to to argue for increasing services to enhance self-realisation such as unlimited access to foetal diagnostics, genetic tests and euthanasia. These are not per se a condition for an individual not to be misled, coerced, harmed or destroyed.

Now, why is this argument important for us? In my rich country we have been placed in the absurd situation that resources have been directed, in the name of individual autonomy and self-realisation, to provide costly services to a few, while our elderly have to wait, sometimes for years, to receive fairly low-tech hearing aids. Globally, we can also see the problem that the inflation of the language of rights and the claims of self-realisation has brought with it. While a large number of people are still denied basic rights and services, others are overconsuming goods and services and claiming the right to more.

The important contribution that Onora O’Neill has made to the bioethical discussion is to question the idea of autonomy as the starting point and end of secular ethics. For her, trust is the proper foundation of ethics. When you trust, you don’t have to claim rights and trusting others opens also the moral subject to the realisation of the importance of the common good. In a society where people can be trusted and agreements are respected the individual has to see her or himself as an integrated part of a larger context, the society, where my rights cannot be claimed in isolation of the common good. The claims of individual autonomy undermine trust.

Now let us pursue the idea that trust is the proper foundation of ethics. What is trust and where does it come from? The lexical definition of trust is the following ”an assured reliance on the character, ability, strength, or trust of someone or something.” In other words trust is constituted by competence, honesty and benevolence. Competence is essential because trust involves and “assured reliance” or a conviction that the person that you are dealing with will deliver what he or she has promised. Honesty and benevolence are equally essential as trust presupposes that people are generally good and want to help. The other features of trust are the following:

• It involves self-surrender and is therefore risky

• It involves an obligation to respond to the trust shown

• It demands benevolence, not indulgence (I do not have an obligation to do whatever is asked of me)

• Social norms and practices enhance or undermine trust (Francis Fukuyama: low trust and high trust)

• It is a given of human encounters

Knud Logstrup, a Danish philosopher in the phenomenological tradition, writes:

”Trust is not of our making, it is a given. Our life is so constituted that it cannot be lived except as one person lays him or herself open to another person and puts her or himself into that person’s hands either by showing or claiming trust. By our very attitude to one another we help to shape one another’s world. By our attitude to the other person we help to determine the scope and hue of his or her world; we make it large or small, bright or drab, rich or dull, threatening or secure.”3

So my contention is that trust lies at the foundation of ethics: Because:

? It is a given and we are naturally trusting: Logstrup talks about trust as “a spontaneous manifestation of life”:

? It is universally accepted as a condition of mutual understanding

? It involves a praxis, it is not only a rational discourse. Trust is not built up by discussing issues but by doing things together; by sharing experiences with one another. There is an essential difference between a discussion and a dialogue. Etymologically a discussion is a process whereby an issue is analysed through separation “dis” and shaking “quatere”. When we discuss we separate and sunder an issue. A dialogue is something else. It is a process of coming together through (dia) a meeting of minds (logos) and experiences.

So as you might have seen, we have moved very far from Engelhardt’s idea of moral strangers. We do not have to content ourselves with a procedural understanding of ethics where we limit ourselves to formulating rules of non-violent engagement in a context of suspicion. We can also treat substantive issues because trust offers us the possibility of meeting one another’s differences in a benevolent way. In doing so, we do not have to content ourselves by formulating our rights or claiming more self-determination. We can also start looking at the common good.

The fact that we usually are trusting individuals cannot obscure the fact that we live in societies where there is a great deal of distrust and that we interpret the world and the meaning of our lives very differently. So how can we engage in a dialogue on the common good in this context of cultural distrust?

Departing from the lessons drawn from the tragedies of recent European history, the French philosopher Paul Ricoeur has formulated an ethical theory of dialog which I believe can also be applied to other settings.

As you might know, Ricoeur’s point of departure is always language. According to him, language is what set us apart from one another and at the same time connects us to one another. In his theory he formulates three “models for the integration of identity and alterity according to an increasing order of spiritual density” which he believes are a precondition for an ethics of dialogue.4 These models are:

Model of translation. Despite the fact that we speak many different language, translation is always a possibility, despite that it requires much effort: Such translation is possible at the lexical, semantical but also at a hermeneutical level. We can learn to understand each other at the deepest level of thoughts and emotions. It requires effort, attention and benevolence.

Model of exchanging memories. History, as personal, national and cultural, influences the way we think, feel and talk about things. As memory is an essentially narrative phenomenon, Ricoeur consider such exchange of narratives as essential to the task of doing ethics find a common ground for seeking justing

Model of forgiveness. The deepest level of spiritual density is the model of forgiveness which goes beyond justice and the principle of reciprocity. At this level we move from a model of the exchange of memories of glorious deeds and founding events to one of the exchange of memories of suffering; first as endured and then as incurred on others. At this level of discourse the order of the narrative must be reversed. As Ricoeur says: “It is necessary this time to proceed from the suffering of others; imagining the suffering of others before re-examining one’s own.” This giving of forgiveness, according to Ricoeur, has immense curative value, not only for the guilty but also for the victims.

We have gone from a thin, “contentless” and formal understanding of ethics, to a thick, “contentful” and real interpretation of the common good based on the reality and force of trust. This trust is not a theory but a practice instituted by human beings engaging in common efforts of pursuing the common good, which may include the practice of dialogue in redressing past wrongs.

Reference List

(1) Engelhardt HT. The foundations of bioethics. New York: Oxford University Press, 1986.

(2) O'Neill O. Autonomy and trust in bioethics. Cambridge: Cambridge University Press, 2002.

(3) Logstrup K. The ethical demand. Notre Dame: The University of Notre Dame Press, 1997.

(4) Ricoeur P. Reflections on a new ethos for Europe. In: Kearney R, ed. Paul Ricoeur: The heurmeutics of action. London: Sage Publications; 1996;3-13.