brown hands praying against a blue background

Bioethics Forum Essay

Why Bioethics Should Welcome Religion

Bioethics has increasingly turned away from religion, embracing methods of law, philosophy, and empirical sciences. Is that change for the better? Does it liberate the field from forms of reasoning relevant only to adherents of a particular faith, as some claim? Does it safeguard bioethics from “ideological excesses” to which religion is prone, or furnish the field “a detached vantage point”?

We defend a different view. We agree with those who consider the decline of religious contributions in bioethics “a misfortune, leading to a paucity of concepts, a thin imagination, and the ignorance of traditions.”

Welcoming religion in bioethics is key for many reasons. For starters, if bioethics claims to be global, its claims become suspect if the field excludes religion. Most people around the world identify as religious. Since the governments of many countries favour specific religions, religion is also germane to bioethics policy and law.

Even in so-called secular societies like the U.S., where the constitution does not refer to God or the divine, 81% of Americans reported belief in God in 2022. At the state level, all 50 U.S. state constitutions reference God or the divine. Bioethics debates that exclude religious perspectives likely alienate many Americans and make bioethics less relevant from their standpoint.

A further consideration is that knowledge is socially produced and reflects the social position of those producing it. Social epistemologists point out that we rely on others to give our claims a fair hearing. They tell us that people occupying privileged social positions often receive greater creditability and enjoy a monopoly on knowledge production, while the claims of those occupying marginalized social positions often receive less credibility. Marginalizing religious perspectives unfairly privileges people who deploy secular language and methods when debating bioethics issues.

Being epistemically just requires regarding other bioethicists as epistemic peers until proven otherwise, i.e., “persons who are, in the matter in question, equally rational, possessed of the same relevant evidence, and equally conscientious in assessing that evidence.”

If bioethics were to welcome religion, how should the field handle the thorny problem of people engaging across deep differences?

Drawing on Latin American decolonial studies, we propose a pluriversal approach. A pluriversal method frames religious and secular approaches not just as different worldviews, but different worlds. Thus, religion should be understood not just as a belief in certain propositions, but as potentially suffusing many aspects of daily life, from “birthing and death, marriage, family dynamics, diet, dress and grooming,” to “health care (including mental health), the spending and saving of money, interactions with one’s friends and neighbors, and . . . governance.”

Rather than universalizing a single set of secular bioethical principles, a pluriversal bioethics seeks, “a world where many worlds fit.” Pluriversal approaches offer a new paradigm for global bioethics, one that aspires to replace well-established views, such as “common morality” views, that purport to represent all people. Some adherents of principlism, for example, insist that their principles—autonomy, beneficence, nonmaleficence, and justice—are content-thin, “universal norms shared by all persons committed to morality.” When secular Western sources dominate bioethics, this can unwittingly proliferate inequalities in knowledge production and sideline or erase perspectives other than their own.

Our interpretation of a pluriversal method sets ethical constraints on dialoguing across differences. Civility requires engaging respectfully. For example, we reject approaches that require religious people to translate religious commitments into a putatively “neutral” language. Civility insists that honoring persons in their various particularities—whether religious, gender, class, race/ethnicity, or other dimensions, is crucial to respecting them as the actual persons they are and experience themselves to be. For example, a pluriversal approach rejects excluding religious people from bioethics conferencing, but also condemns excluding LGBTQ+ people and those defending LGBTQ+ rights. Addressing both forms of exclusion requires engaging with civility, committing to fairness over the long haul, and seeking change from within.

Change from within commits to resolving conflict and reducing harm by working with those involved in conflict and experiencing harm. Rather than imposing solutions “from the outside,” a pluriversal bioethics supports individuals’ ability to determine for themselves the best way forward as well as which beliefs to hold on to or reject. For example, a pluriversal bioethics condemns maltreatment of individuals accused of witchery or sorcery. It seeks to reduce harm by engaging with trusted authorities, like local churches, that have the capacity to protect vulnerable people. Likewise, in the contested case of female genital cutting/mutilation, a pluriversal approach gives standing to the voices of girls and women, rather than relying, as some propose, on the untested claim that they are being subordinated by men or have false consciousness.

Justice is a twofold ethical constraint that requires both giving each their due and taking steps to ensure that each person feels they are being given their due. When religious and nonreligious people debate bioethics issues, each deserves to be treated fairly and to feel they were treated fairly. Contemporary debates about justice often downplay the importance of ensuring people feel heard and understood, focusing on pure procedural justice. Yet, feeling heard and understood matters too, because it helps create the social glue that prevents communities from fracturing.

Nondomination is the ethical requirement that prohibits others’ arbitrary and controlling influence. Both avowed atheists and devout believers can flout this ethical constraint. The moral violation does not arise from holding any specific worldview but from a mode of engaging (or not engaging) with those who hold different worldviews.

Finally, toleration requires avoiding judging others with undue severity. While individuals are free to criticize others’ arguments, even harshly, personal attacks cross a line. For example, calling a person we disagree with stupid or lazy is malicious and irrelevant to an opponent’s arguments. T.M. Scanlon describes tolerance within a shared association as a normative requirement to recognize “common membership [with others] that is deeper than … conflict, a recognition of others as just as entitled as we are to contribute.” For example, toleration requires holding in check hostility towards a group or government that endorses views we repudiate, such as groups denying climate change. It creates an opening for dialogue that allows people on both sides a chance to state their views and arguments.

Together, these five 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. In this way, pluriversality demands that religious and secular hard-liners make space for those who do not share their views, based on a shared moral commitment to respect each other’s humanity.

With these ethical constraints in place, efforts to welcome religious perspectives can succeed. By aspiring to be a field friendly to difference, pluriversal bioethics models the civil discourse the world so sorely needs.

Nancy S. Jecker, PhD, is Professor of Bioethics and Humanities, University of Washington School of Medicine. @profjecker

Caesar Atuire, PhD, is a philosopher and health ethicist at the University of Oxford’s Nuffield Department of Medicine. @atuire

Vardit Ravitsky, PhD, is President of The Hastings Center. @VarditRavitsky, LinkedIn.com/Vardit-Ravitsky

Mohammed Ghaly, PhD, is Professor of Islam and Biomedical Ethics at the Research Center for Islamic Legislation and Ethics at Hamad Bin Khalifa University, Doha, Qatar.  @IBioethics

Vina Vaswani, PhD, is Director of the Centre for Ethics and Professor, Department of Forensic Medicine, Yenepoya University, Karnataka, India. LinkedIn.com/in/vina-vaswani

Voo Teck Chuan, PhD, is head of the SingHealth Office of Ethics in Healthcare and an advisor to SingHealth Duke-NUS Medical Humanities Institute in Singapore.
LinkedIn.com/in/teck-chuan-voo

Read More Like This

Hastings Bioethics Forum essays are the opinions of the authors, not of The Hastings Center.

  1. Interesting… I always considered that bioethics has strong foundations in religion and that is, in fact the strength of bioethics: to bring the humanitarian, humane and to some degree a universalist viewpoint in all its facets to the resolution of ethical problems. As religions are diverse, so must solutions be diverse: there are always various options to resolve ethical dilemmas, and both religion and science, in addition to rationalization, adaptation to changes and many other factors that should and must be considered… To me, this has been obvious for a long, long time… They are truly some of the reasons why I entered medicine and why I had been closely involved in the ethics of the healing arts and sciences….

  2. Thanks for the proposal. I think there is another way for bringing religion to the bioethics field: through the experience of the religious bioethicist. Given the dialog must be developed from rational arguments, it’s the role of the believer bioethicist to make the translation between ethical contents and her faith experience.Furthermore, it can serve as a testimony of one’s own belief placed in the common place of the bioethical reflection, without impeding this. Realities such as revelation or the dogma of faith can hardly have a place in a bioethical consensus that reaches everyone.

  3. Thanks to the authors for this reminder of the continuing relevance of religion to bioethics, which is especially true at a time when, at least in the United States, dialogue between groups with very different views–the authors mention climate change, for example–is increasingly fraught, with at least some of the difficulty in communication originating in the religious-secular divide.

    Of course, the need to understand and respect religious convictions is not news to clinical bioethicists who must regularly address the differences that arise about how to “do the right thing” when patients, families, healthcare givers, and even institutions bring different religious views (sometimes recognized as such, but often deeply felt as self-evidently true without knowledge of their religious roots) to making choices about healthcare interventions along life’s course.

    Finally, may I suggest that principlism can be useful in conversing with people whose approach to bioethics originates in their religious views if, as the authors say, principlists avoid insisting that the religious adherents accept their formulation as the only way to express “the common morality.” As Shulman and Fins reminded us in their 2022 Hastings Center Report article on the forgotten role in the birth of bioethics played by the Christian ethicist James Gustafson as a teacher and mentor at Yale to Tom Beauchamp and Jim Childress, among others [vol 52, no. 2 , pp. 21-31] , Gustafson never described himself as a bioethicist. Instead, he gently applied his explicitly religious framework to reasoning through to an understanding of the issues with which this new area of discourse was grappling.

    It could be reassuring to religious adherents to know that principlists can find common ground with their reasoning and do not insist that adherents must abandon their religious vocabulary in order to participate in the “pluriversal” discussion of policy and law as well as of clinical decisions. Indeed, it has always seemed to me that the “common morality” poses much less challenge to religious approaches to bioethics than does outcome-oriented systems of determining what is right, whether they are expansively utilitarian or narrowly empirical, such as cost-benefit analysis, with benefits described solely in financial terms, as though that is “value neutral.”

  4. This is a welcome essay, although bioethicists involved to any extent in clinical consult work have long recognized the need to include religious beliefs and practices in the care of patients and in work with families, not to mention professional caregivers. Whatever the authors may mean by the term ‘religion,’ it needs to be recognized that an increasing number of people in the U.S. see themselves as ‘spiritual’ rather than ‘religious’ with a wide range of eclectic practices, rituals, and beliefs–some systematic, many not. So, the tolerance for differences and the willingness to engage differences may be larger and more complex than the authors suggest. Rather than just welcoming religion we need a bioethics that recognizes and respects the spiritual dimension of human affairs, including ethics.

  5. Thank you for your provocative text. If I understood correctly, in a pluriversal society all members must show respect for the other (as in the view of Lévinas). Think of the other as an objective. In an individualistic society everyone is off for the races and all seek to expand their own moral objectives; this seems to derive in a perverse plurality and we all end up relativising everything. Perverse plurality seems to me very different from a pluriverse view as exposed by the authors. And still, we require the establishment of a solid foundation that can sustain all members of this pluriverse. Can we find this foundation? Can the idea of ‘human rights’ be considered? Do we need something else apart from religion, culture, science, economy, etc., to form a sufficiently strong foundation that can be acceptable to all? Where will we all stand on to construct this pluriverse? Just asking…

Leave a Reply

Your email address will not be published. Required fields are marked *