Religion and bioethics—holy allies or wholly at odds?
A response to Jecker and colleagues
In a recent opinion piece published in the Journal of Bioethical Inquiry, I challenged Jecker et al.'s proposal for a 'pluriversal approach' to religion in bioethics. While their intentions may be sound, their framework is, at best, conceptually imprecise, with many of their arguments failing to withstand scrutiny, undone by flawed analogies and internal inconsistencies. Contra their aims, I argue that this approach not only does a disservice to bioethical discourse but also undermines the very inclusivity it claims to foster. In what follows, I lay out why 'pluriversalism' is conceptually incoherent yet why rejecting it need not entail the exclusion of religion from bioethical inquiry.
First of all, I do not argue that religion has no place in bioethics or ethical discourse. On the contrary, and reflecting on my own experience, thinkers and colleagues shaped by religious traditions have, at times, led me to revise my own views without sharing their specific commitments, for example by deepening my appreciation for the moral significance of interpersonal relationships and the role of character, habit, and tradition in shaping morality. I have also come to see widely accepted customs and laws not merely as social conventions but as, to some extent, constitutive of morality itself, shaped by experience and governed by principles such as reciprocity, as emphasized in the philosophy of Burke or Scruton. In this, I often find common ground with both religious and secular thinkers alike.
The crucial point is that we all hold certain commitments and beliefs that may not be universally shared. While my worldview may be best described as largely naturalist, this does not absolve me of the responsibility to justify my commitments or to articulate the foundations of shared moral intuitions. In this respect, I am in no different position than those with religious convictions. What ultimately matters is whether one's premises are reasonable and whether one's conclusions follow from them. This principle has been articulated by Brian Earp in a reply to Nigel Biggar, who argued that religion deserves a special place in secular medicine. Earp responded by asserting that religious individuals undoubtedly deserve a place at the table of bioethics, continuing: "Who ever said they didn't? However, once they have taken their rightful seat, they shall have to engage in moral debate according to the very same rules of philosophical discourse as everyone else."
And this is, at its core, the central issue, the sense in which bioethics should, if anything, be universal rather than pluriversal: that we engage in accordance with the established norms and methodologies of the discipline. To offer an analogy, if I agree to play tennis, it is understood that I will adhere to the rules of the game and meet on a court, rackets in hand. It would be quite strange for my opponent if I insisted on playing with a billiard cue or on a golf course instead. Similarly, in ethics, engagement is expected to take place within the shared epistemic and rational boundaries of the field, which include critical reasoning, logical coherence, among others.1
An additional important place for religion at the bioethics table is its role in shaping biopolitics. Regulatory boundaries surrounding medical and biotechnological practices should, arguably, reflect the values of the society they serve. Bioethical deliberation can play a crucial role in translating these societal values into law. However, the roles of citizens and bioethicists are governed by fundamentally different norms. Citizens are entitled to raise demands that may not align with the ethical frameworks applied in academic discourse. They may, in fact, demand things that are considered irrational within those frameworks. In this sense, while the fundamental principles may remain roughly the same, the 'game' is still being played, though, to borrow the tennis analogy once more, perhaps not in the same manner as contemporary lawn tennis, but in a locally understood version, such as courte-paume or royal tennis.
However, Jecker et al.'s attempt to integrate religion into bioethics in any other terms, that is through the concept of pluriversalism, fails to convince. They argue that this framework serves as a normative tool for navigating difference and, when extended to religion, promotes greater justice while enhancing bioethics' global relevance. The authors argue that "pluriversal views generally assert that people live distinct, internally coherent existences, and that these different worlds should coexist, and even flourish," and that, through this lens, ethical conundrums should be resolved in ways that allow "different worlds to coexist." However, curiously, they impose certain constraints, namely refraining from harming others and avoiding the destruction of "other worlds." While the latter principle is presented as drawn from decolonial studies, the non-harm premise seems somewhat arbitrarily chosen, creating the impression that religions are only welcome insofar as they adhere to certain universal principles, such as harm avoidance, thus smuggling in at least some form of universalism through the back door.
Furthermore, while the non-harm principle seems to appeal to universalist ethics, their purported pluriversal justification for why "other worlds"—understood as alternative ways of knowing, being, and acting—should not be destroyed fails to convince. Not all such ways appear inherently worth preserving; some may indeed warrant restraint or eradication altogether. For instance, "Nazi morality" and the Nazi way of acting represent ways of knowing and behaving that one might argue are better eliminated than preserved.
The application of the pluriversal constraint in concrete cases remains difficult to understand. While the authors designate harm to others as an exclusion criterion for a pluriversal approach to religion in bioethics, they appear to overlook this principle in certain manifestly harmful practices, such as witchcraft-related maltreatment and the severe repercussions faced by individuals accused of witchery or sorcery. In these instances, they argue that pluriversalism seeks to navigate radically different ways of knowing and "support the coexistence of many worlds." Elsewhere, they argue that while pluriversalism acknowledges the existence of harmful ideas such as witchcraft, it nonetheless "seeks to reduce harm by engaging with trusted authorities, like local churches, that have the capacity to protect vulnerable people." This raises concerns about potential inconsistencies: why is this case treated differently, for instance, from Nazi morality within the framework of pluriversalism? The criteria for determining which forms of harm fall within or beyond the boundaries of pluriversalism remain undefined.
Jecker et al. proceed to outline several principles, such as justice, change from within, non-domination, and tolerance, which they argue provide reasonable normative guidance for addressing bioethical questions. Indeed, these are valuable principles in practice, as they can facilitate meaningful change and foster compromise. However, their approach does not appear particularly novel within bioethics; rather, these principles function more as procedural norms or an etiquette for engaging with individuals and communities who hold radically different worldviews. Elsewhere, the authors seem to temper their claims, stating that the "ethical constraints serve as a bulwark against absolutism and zeal. They apply equally to religious and secular people, placing differences between them within a framework of mutual respect." While such a framework is certainly worthwhile, it would benefit from a less attention-seeking and more conceptually precise formulation.
This theme runs throughout the authors' analysis. A particularly striking example is their discussion of a conflict between Canadian Indigenous communities and a government department over the fate of a young, lost orca whale, believed by the Indigenous community to be the spirit of their deceased chief. In such cases, compromise should not be dictated by scientific authority or a refusal to engage with Indigenous beliefs. Rather, a resolution should be sought that allows both 'worlds' to coexist. However, when considering broader ethical principles for the treatment of abandoned orca whales, especially in cases detached from this specific cultural context, the issue becomes more complex.
This closely resembles a classic case study in medical ethics. When treating a Jehovah's Witness patient, it is essential to respect her refusal of blood transfusions and to seek a compromise that both honors her beliefs and ensures the best possible medical outcome. But the conversation shifts when a Jehovah's Witness philosopher steps into the bioethical court, not as a patient, but as a participant in policy debates on blood transfusions. Here, the expectation is different: rather than invoking religious doctrine as a self-sufficient argument, the philosopher must engage within the parameters of moral reasoning, either setting aside certain premises or offering a public-reason-based account of the sanctity of blood.
In such cases, it is arguably more important to continue playing tennis and perhaps invite others to momentarily set aside their billiard cues in order to engage in a joint game. Failing to adhere to philosophical rigor and playing outside the rules not only misinterprets tolerance, but also risks a dangerous path. The authors further explain that certain explanations may "be more compelling to people in [religious] societies" or may "resonate better" with specific religious communities when grounded in explicitly religious reasoning, such as when the prohibition of polygamy is justified through a particular interpretation of the Quran. However, appeasing others with palatable outcomes is not the central task of ethics. It would be far more productive to invite others into a debate based on shared rules; bending those rules is, in essence, a soft form of bigotry, assuming that others are incapable of playing by them. Perhaps even more troubling, such an approach to inclusivity not only encourages flawed reasoning but also bestows it with unwarranted credibility, particularly concerning when these views perpetuate harm, as seen in attitudes toward women or sexual minorities.
Taken together, Jecker et al.'s attempt to integrate religion into bioethics in a 'pluriversal' sense—beyond merely accepting individuals with diverse convictions, whether religious or non-religious, while adhering to the rules of the game—ultimately falls short, relying on flawed analogies and internal inconsistencies. Had they instead refined their concept with greater conceptual clarity and focused on articulating foundational principles for navigating the moral complexities that arise when deeply held religious beliefs conflict with prevailing secular bioethics—an area where their article does provide insightful examples—their argument would have been more persuasive.
As Udo Schüklenk has noted elsewhere, contributions grounded in religious assumptions may cater to different audiences and journals. While examples such as those mentioned here—i.e., reasoning that is religiously motivated but follows public-reason-based modes of analysis—should arguably be considered by the broader bioethics community, others that explicitly construct premises on the truth of specific religious convictions, and then analyze the policy and regulatory implications of these beliefs for particular bioethical questions, may be relevant only to individuals who share those beliefs or to those interested in understanding how religious scholars who adhere to a particular religion would argue about these issues.