An ideology establishes in moral reflection the secular equivalent of orthodox belief. Such an orthodoxy is needed to render plausible the imposition of a robust content-full national health care policy which would forbid the private collateral provision of basic health care services, not to mention luxury provision of services. Moreover, to defend such an all-encompassing approach, one needs reliable defenders of the reigning morality. "Ethicists" are then involved in the framing of health care policy, not just as persons who can (1) clarify arguments, (2) analyze contentions, and perhaps (3) indicate ways of collaborating with moral authority in limited fashions despite significant differences in moral vision, but as persons who can report on what content-fully is the just, fair, or good thing to do. Ethicists become the equivalent of secular priests whom an administration can identify as having the grace of true belief. Just as governments in Christian Europe once turned to their theologians to justify their policies regarding divorce, the secularization of property, or the preaching of a crusade, so, too, there is the temptation to ask secular "ethicists" to provide a similar justification. To carry this metaphor further, the moral consensus of the administration becomes a consensus fidei. In addition, there is the temptation to create the contemporary equivalent of the Donations of Constantine through reconstructing past moral and constitutional history so as to anoint the morality that supports an administration's health care policies.
These temptations are powerful. Those who miss the community they experienced in the churches and synagogues of their youth may, after a loss of faith, seek those bonds in the large secular society. They may then desperately proclaim, and then attempt to justify, the existence of a single secular moral community that can provide for them what they once knew in the intimate bonds of religious commitment. They will then also confuse society with community . . . and claim that society should be made in the image and likeness of the community they think should be realized for all. The Clinton proposal is not a communitarian alternative to individualistic approaches. It is, rather, (1) a denial of the necessary moral space provided by civil society, (2) a denial of the diversity of moral visions and communities compassed by American society, and (3) a confusion of community and society.
Those who confuse society and community may also see such visions of communality as useful in socializing citizens around the support of their country, and in papering over moral differences and disagreements in order better to exploit the resources of citizens in the realization of goals chosen by particular administrations. There will also be the hope that one can give the authority of morality and reason to particular governmental policies. These temptations drawn from concerns about community life and the realization of governmental policies will often be tied to opportunities to advance the profession of "ethicist", not to mention the careers of particular ethicists. All of this is only too understandable. An ideology functions well by bringing together the interests of numerous individuals in a collective illusion of rectitude, so as to achieve common goals with the minimum of dissent.
The difficulty is that close examination reveals that the Enlightenment project has failed. Though we are one society, we are not one moral community. We do not in fact share one content-full moral narrative. We are separated in disparate moral communities in disagreement about matters of substance. One finds in moral philosophy and bioethics as many and as different accounts of justice, fairness, and moral probity as there are major established religions. This moral diversity calls out for a recognition that bioethics is a plural noun. There is not one bioethics. Honestly facing the plurality of bioethical understandings requires informing citizens regarding this diversity, as well as regarding the particularity of the content of the moral commitments that underlie proposed health care policy. The recognition that bioethics is in the plural may in secular terms be as painful as the recognition by America's founding fathers that, from the national perspective, religion would be in the plural for America. As some founders experienced the pain of denying themselves an established religion, we, too, must experience the pain of denying for ourselves an established, all-encompassing understanding of justice and fairness. After all, for many their secular moral beliefs play a role analogous to that of religious conviction.
(H. Tristram Engelhardt Jr, "Health Care Reform: A Study in Moral Malfeasance," The Journal of Medicine and Philosophy 19 [October 1994]: 501-16, at 508-10 [parenthetical reference omitted])
Note from KBJ: Much of what Engelhardt said about the Clinton health-care proposal (a.k.a. HillaryCare) in 1994 applies to ObamaCare in 2010.
Keith Burgess-Jackson, J.D., Ph.D. 