'Malleable Morality: Re-Shaping Moral Judgments in Health Policymaking' by Shelly Simana in (2023) 51(2) Journal of Law, Medicine & Ethics 344 comments
In contrast to the increasing skepticism and distrust of experts by a significant portion of the public, experts are generally well-trusted by governments to act in the public’s interests. Governments hold that relying on a group of experts with the appropriate expertise and knowledge is necessary to make policy decisions. They consider expertise a trustworthy source of credibility that is “synonymous with truth.”
In this article, I focus on a particular type of experts — “moral experts.” Such experts have specialized knowledge and understanding of moral philosophy and ethics (e.g., public health ethics, clinical ethics, and research ethics), and are frequently called upon to advise governments on health-related moral dilemmas. The involvement of moral experts in health policymaking can take many forms: these include, inter alia, holding positions in public service, participating in advisory committees, organizing policy forums, and publishing reports with the goal of influencing policy in a particular health domain.
It should be stressed that the article’s arguments are not confined to moral experts; rather, they could also apply to other experts whose decisions involve making moral judgments. Consider the design of machine learning-based solutions for health services as an example. When creating and building AI systems, designers and developers implement a set of moral values that act as decision guides. As a result, they make moral judgments in the course of their work.
This article questions the apparent causality of reasoning in national and international health policymaking, addressing the gap between how moral experts ought to make and how they do in fact make moral judgments on moral dilemmas related to health, health care, and public health. By “moral judgments,” I mean judgments that involve normative assertions (e.g., “mask mandates are justified”), as opposed to descriptive or factual assertions (e.g., “The R0 of Covid-19 is between 5-7”). For this purpose, I employ two observations from the Social Intuitionist Model (SIM) of moral reasoning, which was developed by the social psychologist Jonathan Haidt. These observations shed new light on the role of moral experts in health policymaking, particularly in areas that raise complex moral issues. I argue that these two observations suggest that it should not be up to moral experts alone to address moral issues of this nature and that cooperation at both the national and international levels is essential.
In this article, I focus on a particular type of experts — “moral experts.” Such experts have specialized knowledge and understanding of ethics (e.g., public health ethics, clinical ethics, and research ethics) and moral philosophy and are frequently called upon to advise governments on health-related moral dilemmas. The involvement of moral experts in health policymaking can take many forms: these include, inter alia, holding positions in public service, participating in advisory committees, organizing policy forums, and publishing reports with the goal of influencing policy in a particular health domain.
The first observation relates to the process by which individuals form moral judgments. According to Haidt, moral reasoning is a “post hoc invention meant to rationalize spontaneous moral intuitions.” Meaning, intuitions come first, followed by strategic reasoning. When individuals engage in moral reasoning, it is usually after an instinctive process led them to a particular judgment. Interestingly, individuals may not even be aware of the moral intuitions that guide them and may be even less aware of their origin. Haidt further suggests that one of the only reasons for engaging in moral reasoning is to better prepare for social situations in which individuals may be required to justify their judgments to others.
This observation can be placed within a vast body of philosophy and moral psychology literature that emphasizes the importance of emotions and intuitions. This literature first appeared in Adam Smith’s and David Hume’s writings and was then stressed by psychologists like Freud who assumed that judgments are “driven by unconscious motives and feelings, which are then rationalized with publicly acceptable reasons.”
Haidt’s first observation implies, I argue, that even expertise in ethics and moral philosophy — which is the kind of expertise we expect moral experts will bring to the table — does not necessarily guarantee moral judgments that are largely based on reason and less on moral intuitions. This observation suggests that experts’ moral judgment may be subjective and devoid of deliberate reasoning and reflection; it may ultimately reflect experts’ personal moral intuitions and be guided by an intuitive response. For this reason, I believe that we should start questioning the status of moral experts as reasoned “consultants” and ensure that health policy remains accountable to the interests and needs of the public.
Haidt’s second observation concerns the malleability of one’s moral intuitions, and hence moral judgments. He explains that moral reasoning is not always self-constructed and is mostly received from the outside. In other words, moral reasoning occurs in a social setting, where individuals can challenge each other’s moral judgments and generate new intuitions. Haidt maintains that these new intuitions are more likely to result in nuanced and multi-faceted moral judgments because venturing outside of one’s own “moral matrix” helps to develop moral humility and overcome one’s sense of self-righteousness.
I claim that the second observation uniquely demonstrates the value of public engagement and participation and paves the way for a more democratic approach to health policymaking. Specifically, this observation implies that experts’ moral judgment is malleable and may be more reasoned if experts discussed the mitigating factors involved in moral dilemmas with multiple stakeholders, such as individuals representing different backgrounds, cultures, and fields of study. Since it may be challenging — if not impossible — to deny experts’ initial moral intuitions, vigorous public engagement with experts’ moral judgments has the potential to provide a basis for both a well-functioning health system and a just society.
Public engagement and participation promise to restore rationalism in health policymaking by upsetting experts’ initial moral judgments, introducing them to new moral intuitions, and using their reasoning capability to adjudicate conflicts between competing intuitive moral judgments. With a refined moral judgment, moral experts would be able to provide more reasoned recommendations. Moreover, public engagement performs a democratic function by lending legitimacy to health policy decisions that may otherwise be based solely on the normative judgments of experts and other non-elected officials and agencies.
To summarize, in this article, I suggest that experts’ moral judgments may be intuitive, and that the reasons they offer to justify those judgments are likely to be post hoc rationalizations. Consequently, moral experts may make suboptimal decisions from the public’s perspective. Moreover, I contend that health policy should not be developed exclusively based on the moral judgments of a selected group of experts because these judgments may not always be reasoned. Moral experts can benefit from having their moral judgments questioned through open discussion and debate with members of the public and other stakeholders who may have different moral intuitions and judgments. Ultimately, by opening experts’ moral judgments for evaluation, it would be possible to engage with and consider the judgments of non-experts, promoting more democratic decision-making processes. Overall, I call for a broad public dialogue over health-related moral issues, challenging the prevailing notion that moral reasoning is “beyond the competence of untrained minds” and stressing the importance of not conducting moral deliberations “by expert bodies behind closed doors, with little or no accountability to wider audiences.”
The article is constructed as follows. In Part I, I discuss the role of moral experts in health policymaking. I show that experts have been given a dominant role in health policymaking processes, and that the policy recommendations they provide are often not contested. I also address challenges that arise from placing a greater reliance on the moral judgments of experts.
In Part II, I discuss how SIM can be used in the context of moral experts. I begin by explaining that moral experts, like everyone else, may be motivated by their moral intuitions. Upon receiving a request for policy recommendation, moral experts may develop moral judgment instinctively, and their moral intuition would guide this judgment. I then explain the malleability of experts’ morality. Drawing from SIM, I argue that experts’ moral intuitions can be open to influence from a wide range of stimuli emanating from the social milieu in which they are embedded. This suggests that experts’ moral intuitions and, by extension, their moral judgments on moral issues might shift if they were exposed to individuals from various backgrounds and points of view. Overall, I propose a different lens through which we could challenge rationalism when it comes to moral dilemmas related to health and advance an argument for public engagement in health policymaking.
In Part III, I demonstrate that international cooperation on issues that have global effects is vital. I use a case study on the governance of gene-editing technologies to highlight SIM’s practical implications. I argue that the governance of these technologies is currently dominated by experts and propose other governance alternatives that are both more democratic and just.
