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vol.3 issue5The foundations of Bioethics por H. Tristram Engelhardt, Jr.: comentarios a la reseña de James F. DranePublic health services: should they respond to demand or necessity? author indexsubject indexarticles search
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Revista Panamericana de Salud Pública

On-line version ISSN 1680-5348Print version ISSN 1020-4989

Rev Panam Salud Publica vol.3 n.5 Washington May. 1998 




To the editors:

In the nearly quarter of a century over which I have published some 30 books, I have never responded in print to a review. Surely, I have received reviews with which I was not fully pleased. I believe authors should usually not respond to their critics with letters of correction, but through other books and articles. However, I will for the first time make an exception in order to defend my character, which has been brought into question.

Professor James Drane's review of the second edition of my book, The Foundations of Bioethics (New York: Oxford University Press; 1996), puts matters in a way that may be seriously misleading regarding the goals of the book and, most importantly, my character. The review, which appeared in the Revista Panamericana de Salud Pública/Journal of Pan American Health (1997;2(6):435­438), can be read as suggesting that I personally favor abortion and infanticide and other such immoral actions. This is false!

The Foundations indicates why it has become impossible in public policy to interdict much that one may know is wrong. I will try to illustrate what is at stake with an example outside the field of health care policy by comparing my position to that of a person who, while opposed to cocaine use, argues that the United States' drug enforcement policy has led not only to the corruption of the police and the proliferation of crime, but also to the exporting of evil to countries around the world, those of Latin America in particular. One might therefore be fully opposed to the use of such drugs while deciding that a policy of legalization is morally unavoidable. One's political opponents might wish to characterize that position as pro-drugs. They would obscure the simple distinction between concluding that legal proscription is inappropriate and arguing for the use of drugs.

Pace Professor Drane, The Foundations in both the first and second editions makes it quite clear that I, the author, am not arguing for abortion, infanticide, embryo abuse, abuse of the mentally incompetent, physician-assisted suicide, or like interventions when I indicate why such practices are becoming unavoidable in a peaceable post-Christian secular society. Instead, the book in each edition shoulders the task of addressing the philosophical foundations of the moral diversity and disagreement that characterize our postmodern, post-traditional societies. To acknowledge the crisis of our cultures and their inability to articulate the wrongness of abortion, infanticide, and physician-assisted suicide is not to approve of abortion, infanticide, and physician-assisted suicide. Announcing that the house is on fire does not mean that the messenger started the fire or hopes that the house will burn down.

Let me now briefly illustrate this point with regard to the review. Professor James Drane characterizes me as "a utilitarian who condones the killing of severely defective infants and profoundly demented adults." However, The Foundations states: "This volume's exploration of the general secular moral significance of such acts as abortion and infanticide should be interpreted not as a defense of those acts, but as a disclosure of the impotence of secular morality and the tensions and disappointments of postmodernity" (p. 280). A word to the wise should have sufficed.

Professor Drane states that "he [Engelhardt] argues for what he calls a 'polytheistic presupposition'" (p. 436). In the text, immediately after my reflections on the polytheistic character of our society, I write: "This volume does not celebrate the chaos, or even much of the diversity, and surely not the moral perversity and vacuity of this landscape" (p. 10). In the first edition of The Foundations I clearly state "Some may wish to see this volume as a defense of a secular pluralist ethic. That would be a mistake. My intent has not been to defend that ethic but rather the very opposite" (1991, p. viii). My intent has been to give an account of the moral geography of our condition. But this does not mean I celebrate our condition. I bemoan it. Does Professor Drane think that, if a physician makes a diagnosis of a fatal illness, the physician is responsible for not having made a less threatening diagnosis? Should one deny the character of our circumstances? To the interested reader and to Professor Drane, who might wish to be aided in understanding these matters better, I commend a recent book: Minogue B, Palmer-Fernández G, Reagan J, eds. Reading Engelhardt. Dordrecht: Kluwer; 1997.

There are many other points to which I am very tempted to direct a strong response. The issues of disagreement I have with Drane's interpretation of The Foundations are legion. This is not the forum. It is enough that the reader should understand that, though I acknowledge the post-traditional and post-Christian character of our culture, its character is not something I celebrate. Quite the contrary.


H. Tristram Engelhardt, Jr.
Department of Medicine, Baylor College of Medicine
Department of Philosophy, Rice University
Center for Medical Ethics and Health Policy
One Baylor Plaza
Houston, Texas 77030