1

Collectivity, evil and the dynamics of

moral value

Joel Backström and Hannes Nykänen

Our concern in this paper is to make explicit and

question a dominant conception of what morality is; one

which reduces morality to a matter of values and valuation,

an one which, precisely because of its dominance, is

typically not seen as a particular conception at all, but

is simply taken as the self-evident frame of analysis,

both in ethical theorising and in everyday life; and

also, of course, in most discussions of ethics in medical

contexts, for instance in debates about ‘values based

practice’ (e.g. Fulford 2011, and other articles in the

same issue of this journal). However, we argue that the

dominant conception is deeply flawed insofar as it

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implies a repression of the fundamental importance of I-you

relationships. Furthermore, as a consequence of this

repression, what are commonly taken to be ‘personal’ and

even ‘individualist’ moral outlooks are in fact merely

the reverse side of collective norms and values, just as

‘particularism’ in ethics is not a real alternative to

‘universalism’, but rather both are variations on the

same repressive theme. In showing this, we also outline

the sense in which the moral relationship between an ‘I’

and a ‘you’ has an altogether different ‘grammar’ or

sense.

The first section of the paper is a broadly

‘methodological’ discussion of the constantly overlooked

but fundamental difference between moral and merely

intellectual/practical difficulties, and of how the

dynamic interplay between the pervasive tendency (in

moral terms a temptation) to immerse oneself in the

collective, and the contrary tendency to hearken to

conscience in the sense of the I-you, both explains and

renders ambiguous the movement of ‘moral progress’. We

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also discuss the relevance of our perspective for

healthcare ethics. The second and third sections aim to

make the idea of an I-you relation, and its contrast with

a collectivist/individualist perspective more concrete

through discussion of two examples. The fourth section

explains how an aggressive wish to force one’s moral view

on others, and a corresponding indifference towards, or

rather closedness to, the other, is inherent in the idea

of subscribing to moral values (from the I-you-perspective,

morality is not about ‘values’). The fifth section looks

briefly at the Hippocratic Oath from this point of view,

while the sixth anticipates the probable objection that

we present a biased view of collective morality. We point

out that from the collective perspective certain forms of

evil will of course be perceived as good, just as revenge

is sweet to the avenger, but this in fact just

strengthens our case. In the Conclusion, we offer some

remarks on how our perspective illuminates the apparent

problem of relativism.

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What is at stake throughout is to see how collective

morality is a repression of the I-you morality which is

an ethics of conscience. In our difficulties with dealing

with I-you relationships we repress the meaning that

moral encounters have. Thematically speaking, what we say

has obvious points of contact with the I-you-philosophies

developed, in different ways, by Buber (1958) and Levinas

(1969); however, the emphasis we give to the dynamics of

conscience and its repression nonetheless makes our view

fundamentally different from theirs. (For extended

elaboration of the perspective we sketch here, see

Nykänen 2002 and 2009, and Backström 2007, including a

critique of Levinas on pp. 183–192.)

1. Moral understanding and moral posturingOur discussion

is of a general character, but is highly relevant for

understanding ethical problems in the field of health

care. What we present is not a ‘theory’ that could then

be ‘applied’ in various ‘areas’ of practice. Rather, what

we try to do is describe the kind of understanding

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manifested in our moral responses to others – and,

crucially, in our difficulties with these responses. The

institutional and other particular features of the

various contexts where the difficulties turn up are of no

special moral significance. If someone is disdainful of

human weakness, say, this will show itself in an

unfortunate attitude to others in all kinds of contexts.

If the disdainful person is a doctor, both her patients,

colleagues and her children will be exposed to her

disdain. Although the seriousness of the consequences of

this can vary in different situations, the moral problem

is the same in all cases. In this sense, there could be

no special ‘application’ of moral understanding to health

care, or to any other field – even if moral problems of

course always arise in concrete interpersonal and

institutional settings. This insight motivates the common

suggestion that medical students might develop their

understanding of themselves and their patients – in the

broad human, rather than narrowly clinical-technical

sense – by reading good imaginative literature. Clearly,

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the idea is not that doctors should only read novels

discussing fictive doctors and their problems! In the

same way, while not all the examples we discuss concern

medical practice, in our view they are all equally

relevant to developing the moral understanding of medical

practitioners.

The point we have just made could also be expressed by

saying that moral difficulties are not professional

problems even when they arise in professional contexts,

but difficulties in our relations to each other – where,

crucially, part of the difficulty is our urge to avoid

and repress full awareness of the reality of the

situation and our own involvement in it. There is a

legitimate need for policy-guidelines and rules of

procedure, which is intelligible only as an expression of

the moral concern for others whose character this paper

tries to describe. However, the very difficulty of

encountering the other tempts medical practitioners to

have designated ‘ethics-experts’ decide these agonising

moral problems arising in the clinic: the doctor pretends

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that ‘someone else’ will ‘take care’ of her problem,

while the ‘expert’, precisely in virtue of her role as

expert, can tell herself that it is not really her

problem; thus, both manage to distance themselves from

the painful human reality on which a decision is ‘taken’

and ‘implemented’, as though by no one personally. (For

some reflections on related difficulties, see Engelhardt

2012a, Mesel 2013).

This illustrates how one may well avoid real engagement

with moral problems precisely through a certain kind of

focus on ‘dealing’ with them. More generally, it is an

integral part of moral understanding to question claims

to morality. Having moral understanding means, among

other things, knowing that invitations to evil,

destructive actions and attitudes are always disguised in

moral language; evil is never taken to be simply evil by

the perpetrators; minimally someone else is to be blamed

for it. Thus, the ability to discern between genuinely

moral possibilities and moral (self-)deception is itself

a crucially important aspect of moral understanding. And

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any deficiency in that ability is not an intellectual

shortcoming but a moral one, that is, one revealing

destructive, morally deplorable attitudes on one’s own

part, such as hatred, envy, maliciousness, greed,

cowardice, selfishness, vanity, etc. This basic and

crucial, but constantly missed, point can be illustrated

by a simple example. If I make what I take to be a

lucrative business deal, it would be an example of

intellectual error or bad practical judgement if I have,

despite my best efforts, miscalculated or overlooked some

cost of the operation which actually makes the deal a bad

one, financially. However, if I have failed to consider

or to give any weight to the fact that the factory I

invest in uses child labour and pays its workers

starvation wages, this failure is of a completely

different kind: it is not a mistake but expresses my

callousness towards these people who, in my greed or thirst

for success, I’m prepared to brutally exploit for profit.

If criticised, I cannot say that I just inadvertently

overlooked or miscalculated the ‘moral costs’ of my

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actions; rather, my callousness stands revealed in the

fact that I didn’t consider or care about the people I

exploit. The ‘defences’ I will offer, if I’m unwilling to

acknowledge my wrongdoing, will also not refer to any

mistake on my part; on the contrary, I will try to

present what I did as somehow good or a lesser evil or

unavoidable (‘It’s better for the kids to be able to work

than to be on the streets’, ‘Others pay people even

less’, ‘If we pay more, we’ll be out of business’ and so

on).

Self-deceptive rationalisations of evil are not, of

course, only something private individuals engage in; on

the contrary, social systems may – and do, as the example

of starvation wages should remind us – largely operate in

ways which presuppose systematically self-deceptive

accounts of their justice and reasonableness on the part

of those engaged in them. This means that, in their

everyday talk and thinking about the moral character of

their social arrangements, people will keep misdescribing

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as morally acceptable actions and situations that are in

fact terribly destructive and unjust.

Insofar as this is so, studying morality empirically, in

the sense of simply recording what people in fact say and

claim to believe about the morality of various aspects of

their lives, can only be of superficial interest. The

important thing is rather to understand the self-

deceptive, repressive function people’s ‘official’ moral

‘beliefs’ may fill in their lives – and this, in turn,

means confronting what they say with one’s own moral

understanding of what they are actually doing, including

what they are doing in saying what they say. If a

slaveholder says that his slaves are ‘better off’ as

slaves or that they are ‘naturally unfit’ for freedom, it

would be stupid (in fact, wholly confused) to assume that

this is simply and genuinely what he believes; rather,

these are the kinds of things that must be said by people

who keep slaves, and so feel a need to justify slavery in

some way. Slaveholders do not in any simple sense believe

what they say about slavery; rather they tell others and

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themselves what they wish they could believe, so as to ease their

consciences. The self-deceptive character of their claims

explains the tensions, lacunae and self-contradictions in

them. Thus, for instance, the claim that the slaves are

‘happy’ in their slavery is contradicted by the great

fear of slaves evident in the slaveholders’ behaviour,

most obviously in the brutal machinery of violence

dedicated to keeping the slaves in slavery (for a

striking illustration, see Elkins 1976, 219, and footnote

136; on self-deceptive speech generally, see Shapiro

1996).

If morality cannot be fruitfully investigated by

questionnaire, there is also no reason whatever to assume

that the supposedly ‘critical’ analyses offered by moral

philosophers would be any freer from self-deception than

the ‘official’ accounts ordinary people offer of their

moral ‘beliefs’. The point is, again, that moral

questions are not intellectual questions, and so mere

intellectual acumen, mere critical intelligence, which

philosophers might be expected to possess in good

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measure, will not guarantee lucidity and truthfulness in

thinking about them. This can be seen very clearly in the

history of ethics. It would be ludicrous to claim that

Aristotle was not intelligent enough, not well enough

versed in argumentation, to realise that slavery was

evil, or to make analogous claims about Kant’s racism

(cf. Cambiano1987, Bernasconi 2002). Rather, the point is

that they were so immersed, so at home, in the collective

values of their society, in the ‘moral climate’ of their

time, that they did not want to see these questions

aright, and therefore instinctively argued in ways

calculated to remove any moral worries concerning them,

or refused to consider them as moral issues at all.

Aristotle and Kant did what people constantly do; they

held onto crucial values of their societies. And precisely

because this happens so regularly – although, and this is

crucial, it does not happen always or necessarily – the

moral credentials of the concept of value are so seldom

questioned. To make something a moral value is, in

effect, to declare: ‘I/we will hold on to this no matter

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what; this is my/our conviction’. These values change

historically, we suggest, because there is a pressure –

constant and very real, yet almost invisible, because

repressed – from the moral ‘force’ of inter-personal

understanding, that is, conscience. One aspect of this

historically unfolding struggle surrounding conscience is

vividly depicted in, e.g., the studies by Andrew (2001)

and Ojakangas (2013), but because the philosophically

essential moral dynamics underlying it remains

unanalysed, both writers simply assume that an ethics of

conscience constitutes an individualistic outlook. As we will

show, however, individualism and collectivism are two

sides of the same coin, both being repressions of

conscience.

Historical changes in socially sanctioned moral norms, we

suggest, are largely a function of the need people feel

to appease their conscience – as opposed to simply

ignoring it, which is impossible, or to fully hearkening

to it, which feels impossible. This dynamics of

appeasement makes it understandable, but at the same time

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very misleading to speak about moral progress. Thus, Las

Casas expressed moral insight when he criticized the

enslavement of the Indians, but since he did not wish to

question the very being of the collective life he shared,

he advocated the replacement of Indians with African

slaves instead (cf. Davis 1966, 169–173). Similarly, many

of the later abolitionists were no doubt genuinely moved

by the plight of black slaves, but nonetheless found

nothing amiss – that is, did not allow themselves to see

the evil of – exploiting ‘free’ labourers, including

children, in the most brutal ways. In this ‘progress’ we

see how values change, and how morally ambiguous this is.

Today, merely calling African-Americans certain names is

taken to be a serious moral offence among the educated,

while at the same time our consumer habits presuppose that

millions of people are paid salaries that barely allow

them a standard of living higher than that of African-

American slaves back in the 19th century. As long as one

does not understand the underlying dynamics of moral

difficulties – that is, as long as one is unwilling to

15

radically disentangle oneself from collectivity – this

pattern, where ‘progress’ on particular points is offset

by an intensification of repressive violence elsewhere,

will repeat itself endlessly. (The way these collective

aspects distort conceptions of social justice is vividly

depicted in McMurtry 1999.)

2. The lonely self, the anonymous ‘we’ and the repressed

‘you’

This pattern of ambiguous moral ‘progress’, like social

life generally, is constituted by a persistent tension or

oscillation between an insistence on ‘individual’ and

‘collective’, or, to put it slightly differently,

‘particularist’ and ‘universal’ outlooks. That is to say

that in ethics, individualism or particularity are not

alternatives to collectivism or universalism, but rather

these are two sides of the same coin.

The point here is not the merely ‘logical’ one, that in

speaking of particulars we imply some universal or that

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collectives are made up of individuals. Rather, the point

is that there is a psycho-existential, moral dynamics

whereby a wish for ‘being one’ with others in merging

with and ‘disappearing’ into the group, and a terror of

being left ‘outside’, of ‘standing apart’, being alone

and cast out, alternates with a horror of precisely this

merging; with a wish to be alone, to withdraw from the

group into solitude, to stake one’s claim, express one’s

own opinion, one’s personal values, in opposition to

received views and values. This oscillation between the

lonely self and the anonymous ‘we’ is a result of

repressing the moral charge between individual persons,

between ‘I’ and ‘you’. And the oscillation is

interminable, appearing at once necessary and ultimately

unsatisfying, because it is a repression of what human

beings both fear and long for most: the openness between

‘I’ and ‘you’.

To get this repressed possibility into view, consider the

following example from George Orwell (1968, 22),

depicting a kind of awakening from the delusions of

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collective identifications, or of groupishness, as we will

call it (we borrow the word from Haidt 2012, although he

takes it to have a morally positive sense). Reporting

from the front during World War II, Orwell and a Belgian

journalist come across a dead German soldier, just a

young boy. It turns out that this is the first dead

person the Belgian has actually seen with his own eyes in

four years as a war-propagandist at the BBC. Orwell

relates how the Belgian’s attitude was completely changed

by the encounter: he looked with disgust at the bombed

cities and the humiliations the Germans were made to

suffer. Upon leaving he even gave the rest of his coffee

to the Germans at whose house they had been quartered,

although a week earlier the mere thought of giving

anything to a boche would have been repellent to him. As

he confessed to Orwell, the sight of ce pauvre mort down by

the bridge had suddenly awoken him to the terrible

meaning of war.

One might say that the encounter with the dead boy opened

the Belgian’s eyes to how he had allowed himself to

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become inhuman in giving himself over to a groupish

attitude of ‘us’ against ‘the enemy’. He had expected

only to see, and to rejoice at seeing, dead Germans, but

instead he saw a dead boy, and wept. His insight was a

moral and existential one, that is, it was not about

collective issues – about ‘what Germans are like’, for

instance – but about how callous he had allowed himself

to become in regard to other human beings. It was his

giving himself over to groupishness that made this

callousness possible and that, eo ipso, stood in the way

of this insight. This is not a fortuitous circumstance;

rather, groupishness is a repression of interpersonal

understanding. One cannot, for instance, entertain both

‘attitudes’ at the same time.

The Belgian’s experience vividly illuminates the reality

of our relationship to particular others. It would be

very misleading, however, to see his response as speaking

for ‘particularism’, as this is typically understood. For

as Orwell brings out, the encounter with the dead boy,

with that particular person, wrought a sea-change in the

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Belgian’s attitude to others quite generally. One might

say that the encounter constituted, for him, a

‘universal’ challenge to his way of relating to other

human beings and to himself in that relation, and the

universality lie precisely, paradoxical as this may

sound, in his being struck, touched, by the reality of

this individual other, the dead boy. Obviously, it was

not any general policy, principle, or evaluative attitude

that allowed the Belgian to ‘see’ the dead boy; on the

contrary, the boy’s presence shattered his adherence to a

set of groupish attitudes and beliefs. But his changed

behaviour after the encounter can also not to be

understood in terms of his having adopted some new policy

or principle (say ‘Help people whenever you can, Germans

included’). Rather, his behaviour expressed a sympathetic

openness to others ‘effected’ by and through his opening

himself to the boy. One can only open oneself, open one’s

heart, in relation to concrete others, but the meaning

and ‘effects’ of this opening are not restricted to this

or that particular person or situation. The point is well

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captured by the protagonist in one of Nick Hornby’s

novels (2004) who, shortly after having very

uncharacteristically befriended a completely ‘uncool’

adolescent boy, falls in love with a woman for the first

time in his life, and reflects: ‘Once you open your door

to one person, anybody can come in’. This is the

universality of love or sympathy, quite unlike the

universality of a principle subsuming all cases falling

under it.

Naturally, the universality of love does not mean that a

person who opens themselves to another is thereby

guaranteed to be as open and loving in their dealings with

everyone else, or indeed in their later dealings with the

one to whom they opened up; thus the Belgian may soon

enough have fallen back into all kinds of closed,

collective or egocentric attitudes – sentimentality,

self-pity, hatred, etc. But the point is to acknowledge

the orientation or perspective revealed, to the Belgian and to

us, in his encounter with the boy; its meaning remains

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not just to be noted but to be further explored, regardless

of how often and how badly one may fail in this task.

The Belgian’s response to the boy was, then, if one

wishes to say so, radically ‘universal’ in its radical

‘particularity’, and vice versa, but it was neither

‘universal’ nor ‘particular’ in the sense that this

distinction has in relation to principles or norms,

where, e.g., a bureaucrat judging all applications

according to the same set rules contrasts with one making

discretionary decisions, whether corrupt or well-

intentioned, based on her sense of the situation and

character of the individual applicants. This means that

the fundamental moral dimension revealed in our example

is untouched by the lively debates between the virtue

ethicists and others who insist on the importance for

morality of uncodifiable judgments of the particular

case, and the Kantians, consequentialists and others who

stand by the importance of universal, or at least general

and somehow codifiable, rules and principles. From the

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point of view our example is meant to illuminate, this

debate seems beside the point.

Particularists have always criticized Kantian and

consequentialist theories (and Kantians have criticized

consequentialists) for their blindness to the fundamental

importance of our relationship with individual others;

that is, for their inability to account for this

relationship satisfactorily within their basic

theoretical frameworks (e.g. Stocker 1976, Blum 1980,

Blustein 1991). We would not disagree with this

criticism, rather find it not radical enough, but we will

leave this aside, and instead note that particularists

themselves are typically just as vulnerable to it as

those they criticize. Thus, the Belgian before the

encounter, in his nationalistic, war-mongering mood,

could well have thought of himself, and of the character

of morality, in virtue-ethical terms, as a matter of

developing, through responsible participation in the life

of one’s community, certain moral sensibilities and

powers of judgment.

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In his particular case, patriotism and loyalty might have

been central virtues, but he might also have thought in

terms, e.g., of the right to self-defence against German

aggression, the duty to defend the innocent and to uphold

the traditions of European culture against Nazi

barbarism. What his specific values were, and how far he

thought in terms either of (codifiable) principles or

rather of virtues (an implicit sensibility), is beside

the point, for his blindness to the evil of war, finally

revealed to him in his encounter with the boy, could have

been as complete whatever the variations on this level.

Such blindness is not caused by theoretical confusions,

or by having faulty principles, or by being deficient in

the virtues. Rather, it manifests one’s wish to give

oneself over to a collective identification, to commit

oneself to a cause which one defends alongside others.

These others may be many or few, or indeed found or

declared to be non-existent, so that one fights alone. A

collective morality does not have to be shared by

everyone in a society; it may be the morality of a small

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subgroup, or even only a fantasy in a single person’s

head about how ‘we’ ‘should’ be together. The

‘individual’ aspect of collective morality is fundamental

to it, and inseparable from its ‘universalist’

pretension. Thus, someone may express her collective

belonging in the words: ‘As a European, I think that...’

She is making a universal claim about what a ‘European’

way of thinking is supposed to be – but of course she

might find that she is alone in feeling this way, as it

were ‘the only true European in all of Europe’. And even

if a value or ideal someone expresses is said by her to

be ‘only the way she personally feels’, the point is that

the ‘grammar’ of this ‘personal’ avowal of moral ideals

and values is still collective insofar as it is expressed in

terms of collective – or, as it is usually expressed

today: intersubjective – validity; of an agreement if not

actually expected, at least ideally hoped for (‘Any

reasonable/sensible/educated/noble person should see that…

– but I know of course that most people do not see it in

this way’).

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Conversely, the grammar of collective normativity

presupposes personal moral responses insofar as the very

morality of collective norms depends on particular

persons endorsing and taking responsibility for them. In

other words, collective morality and personal moral

outlooks share the same grammar. By contrast, the

encounter with the other person, when one opens oneself

to it, or is opened by it, in the way the Belgian was,

destroys this ‘grammar’ by revealing how it actually

serves as a repression of and escape from the I-you

relationship. The repression is effected precisely by

referring to general concepts and conditions; for

instance by seeing a person as an enemy, or taking a

certain callousness (obviously, not under that description)

to be demanded by loyalty. Thus, the encounter with the

other makes issues frighteningly clear; it puts one’s up-

flaring emotions of hatred, fear, disgust, etc. into

perspective and reveals the corruptness of the loyalties

one has sworn to. The challenge it implies exposes the

evil, inhuman aspect not just of this or that collective

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allegiance or personal commitment, but of all of them, of

the very grammar in which they all share.

As should be clear, then, the insight illustrated in

Orwell’s depiction of the Belgian is not about making or

honouring ‘personal commitments’, but on the contrary

about having the defensive armour of one’s value

commitments, however ‘personal’ (in the sense of

idiosyncratic) or widely shared they may be, shattered by

and in the encounter with the other. The Belgian was

changed by his experience; he did not hold onto his ‘core

commitments’, in this case fighting the Germans to the

end, even in the face of the dead boy. Alas, that

possibility of keeping oneself closed, refusing to see even

when faced with the most terrible reality, is realised

all too frequently.

3. Scene from a county hospital

As the Belgian’s case reminds us, our feelings for and

understanding of particular persons are not, at the most

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basic level, about selfish or egocentric emotional

cravings, as the traditions of philosophy and psychology

have tended to assume, but are the very stuff of

morality. The dead boy was a stranger to the Belgian,

there was no special liking or connection between them

prior to the encounter. What the Belgian awoke to, we

suggest, was what the Bible calls love of neighbour, as

opposed to the ‘parochial’ preference for some people as

against others that philosophers often identify with

love. It is simply about the heart’s openness to those

one meets.

Obviously, there need not be a war for this openness to

be in various ways refused, limited and perverted through

subservience to collective identifications, and one may

also ‘do good’ to others while still closing oneself to

them. Carl Elliott relates an incident from his student-

years at a county hospital in the southern US, where an

intern introduced one patient, an elderly woman, almost

permanently vegetative, saying ‘Think of it this way.

She’s a plant; you’re the gardener; your job is to make

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sure she is watered’, and then moved on to the next

patient. Elliott comments that the remark is

understandable in the context of county hospital reality,

‘where exhausted and often bitter residents take care of

America’s sick and disabled poor’; ‘This is the vacuum in

which attitudes toward severely impaired patients

develop, and the intern’s remark reflects those

attitudes: hostility at having to take care of such a

patient, a sense of futility surrounding her future, and

a sensibility trained to ignore deeper questions

surrounding life and death’ (2001, 95–6).

Clearly, the setting Elliott describes is a moral problem

in itself, with its widely shared attitude of hostile

condescension to the poor (in the absence of which

poverty on a large scale would simply not be accepted in

a wealthy society), compounded by a similar attitude to

the permanently ill and disabled. Like the poor, they

tend to be reduced to their pitiable condition by the

better off who, to repress a guilty sense of their

privilege and unwillingness and/or inability to help and

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be there for the afflicted, present them as somehow

‘wholly other’ than themselves, as mere ‘cases’ or

‘conditions’, and/or as somehow to blame for their

condition. And the afflicted, of course, tend to share

these social attitudes, and thus accept their

stigmatization in humiliated helplessness.

The example also illustrates how the hostile resentment

felt by the doctor towards his patient creates a tendency

to think of the situation in terms of the patient’s

‘rights’ and the doctor’s ‘duties’. The failure to heed

one’s conscience, to address the patient as a ‘you’, is

compensated for, but at once repressed, by focusing on

rights, duties, values, norms, interests, etc. These

concepts function to limit both the scope allowed to

indulging one’s hostility and the scope of the moral

demands placed on one to what is declared ‘reasonable’

and ‘appropriate’. We see here how the repression of

conscience leads to a proliferation of new moral

concepts.

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The everyday reality of the kind of setting described by

Elliott is itself the moral problem, quite apart from any

dramatic ‘moral dilemma’-situations, and, given this

reality, no ‘ethical guidelines’ supplied by ‘experts’

will help a doctor see and respond to the human being in

her patient; what is needed, rather, is for him to find

his own humanity, buried under layers of destructive

social identifications. To ask ‘And how does one do that?’

would obviously be misplaced. There is no method for

this, any more than there is for forgiving someone or for

overcoming other genuinely moral difficulties.

Nonetheless, the task of the doctor, beyond the

essentials of alleviating the patient’s suffering and/or

‘fixing’ her problems in the physical sense, is precisely

to see her, to respond as one human being to another,

thus helping the patient to live with, and in spite of,

her affliction (cf. Berger 1995, Buber Agassi, 1999).

Still, someone might ask what all this means in concrete

terms concerning, say, ethical problems in embryonic stem

cell research, therapeutic and reproductive cloning,

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genetic enhancement, organ donation or end-of-life

issues? Our point is that whatever laws or policies are

adopted, their moral significance can reside only in what

we have called an ethics of conscience. One can adopt

health-care policies for any number of reasons; their

moral character is determined by the extent to which they

are motivated by conscientious concern for the people

affected. The fact that we are ‘unable’ to state ethical

rules that would be valid without exception and

universally accepted is not a shortcoming. On the

contrary, the urge for generality that manifests itself

in the idea that one should be able to state such rules

is, we have suggested, one way of repressing conscience,

i.e. of stifling the kind of moral imagination that goes

with concern for particular persons. By saying this, we

are not speaking for particularism, context-sensitivity

or the alleged necessity for ‘making exceptions’ to any

rule. Such particularist thinking still focuses, just as

much as does the universalism it ostensibly criticises,

on the issue of moral rules, their generality and

32

validity, and this is the very focus we criticise. Still,

someone might insist: what is one to do about the ethical

dilemmas that can arise in a case of organ donation, say?

Well, can there be any other answer than to ask, in

conscience, what it means to have concern for both the

donor and the organ-receiver, not allowing this concern

to be perverted or trumped by considerations of, say,

social expediency or the status of the persons involved?

Obviously, we do not oppose laws or rules or policies per

se, we simply point to the perspective from which alone

their moral relevance, for good or ill, can be seen.

4. Groupishness, values and moralistic aggression

We hope to have shown that whatever groupish reactions

people have – and we do not in any way wish to downplay

the psychological power of such reactions – they are not

what makes us moral. However, such reactions are

certainly related to moral issues in that they are

33

inextricably connected, as our discussion has indicated,

to interpersonal moral difficulties. We will now try to

say something more about this.

Groupishness essentially includes hostility. It is

crucial to see that this hostility is not directed only

towards out-groups but also towards every member of the

group itself. The hostility takes the form of a constant,

threatening demand for loyalty to, and respect for the

authority of, the group. Everything is well and good, and

the demand may not be felt as a demand, as long as you

conform to ‘our’ values, but if you do not, you will be

treated as a traitor. We will call this integral

hostility of groupishness collective pressure (for more on

this, see Nykänen 2014). It is crucial to see that this

pressure works precisely through insisting on values and

ideal demands, on an ethos, so that doing the ‘done’ thing

is never presented as, and so in effect never really is

simply a matter of doing what others want one to do.

Collective pressure is distinguished from privately

exerted pressure precisely by its anonymous character, by

34

its referring to the presumed authority of the judging gaze

of a supposedly ‘impartial spectator’, to use Adam Smith’s

term. A single person can very well exert collective

pressure on another, or on herself, but then she does not

say ‘Unless you do as I tell you, I’ll make you sorry for

it’, but on the contrary: ‘I’m not only speaking for

myself here; what you did was simply shameful (unfair,

tasteless, and so on)’. In bowing to this pressure, one

affirms one’s belonging; one’s being ‘one of us’.

What this means is that moralism is part and parcel of

groupishness. Moralism is, typically, a strongly felt

individual response, but centred on notions of how ‘we’

collectively should live. Moralism is a violent affair; a

form of intimidation. If the intimidation is collectively

accepted it is called ‘moral indignation’, otherwise it

is branded as, precisely, ‘moralism’, ‘bullying’,

‘bigotry’ and so on. Consider the case of an aggressively

righteous man who is constantly looking for a pretext to

intervene in other people’s affairs. His attitude is

fundamentally hostile and destructive, and yet it is not

35

only compatible with his being very decent, helpful and

even considerate to those who do not provoke his wrath,

but he actually needs precisely the foil of helpfulness

and decency towards certain people in order to legitimate

his aggression against others, and so the evil in him is

systematically intertwined with what appears good in him,

and with behaviour that would really be good, were it not

for this intertwinement. Thus, when helping an old lady

in distress, his helping is inseparable from his wish to

‘punish’ those ‘responsible’ for her plight.

It is crucially important to see that the very meaning of

the righteous man’s – or, as we will say, the bully’s –

perspective, which focuses on what he considers, and

thinks everyone should consider, appropriate and

inappropriate behaviour, involves shunning and repressing an

I-you encounter with those he takes himself to be

defending and helping, in this case the old lady. If he

were to open himself to her, his moralistic urge to

condemn others for what they do would disappear, because

in the relation between I and you there is simply no

36

place for indignation – although there is room for fierce,

but non-moralistic anger, as also for understanding, joy,

sadness, and forgiveness. Violent moralising and openness

between two people are not only mutually exclusive, but

the former is a repression of the latter. For the bully

to enter into an I-you relationship with the old lady

would mean for him to open himself to her; thereby, he

would stop being a bully. By contrast, insofar as he

remains a bully, he will be interested in her only to the

extent that her situation seems to confirm his

preconceptions and to justify his moralistic aggression –

where the preconceptions are really in the service of his

aggression, as is clear from the fact that he will resist

changing his views in ways that would make it harder for

him to justify the aggression. Indeed, his aggression may

easily turn on the old lady herself, if she does not want

to be part of his ‘crusade’, say if she responds to his

violent condemnations of those he supposes responsible

for her plight – e.g. her neighbours or children who have

failed to help her; ‘So typical of the younger

37

generation; they care only for themselves’, the bully

thinks – by understanding their motives and refusing to

condemn them, even if their behaviour makes her sad. This

is not what the bully wants; he wants them in unison to

lament the state of society and express their craving for

discipline and punishment for those who violate their

values.

Some may feel that our example depicts a marginal and

thus irrelevant case, but we disagree. The wide appeal of

groupish fantasies of aggression, moralism and

scapegoating is amply demonstrated for instance in the

constant demand for books, movies and news-stories

depicting some person, group or nation as ‘evil enough’

to ‘deserve’ the harshest punishment and humiliation

imaginable, which is then duly administered to them in

the climax of the story. The whole point of these stories

is to get their audience to adopt the perspective of the

moralistic avenger; to share the violent fantasy.

Collectivity is constituted by endless alliances and

enmities. Violence and the threat of dissolution are thus

38

inscribed into the essence of collectivity, and this is

why an external enemy, just like the sacrifice of a

‘scapegoat’ can have such a strong consolidating effect

on the internal tensions of a collective and bring such

relief (on the pervasiveness of these violent dynamics,

see Girard 1977 and 2001).

Fantasies of punitive violence certainly enter medical

context, too, although the focus is, or is supposed to

be, on helping and curing rather than punishing or

hurting people. The notion of disease itself as

punishment for sin or transgression is widespread in many

cultures, including our own, where we do not ‘officially’

believe it, but where private fantasies and punitive

institutional practices nonetheless often reveal its

disavowed presence (cf. Sontag 2001). One might also

think of the widespread sentiment that certain categories

of people, like smokers and others whose socially

stigmatized lifestyles cause them health problems, do not

‘deserve’ to be treated at all, but should be ‘punished’

by being left to suffer and die, or again of the striking

39

aspect of self-punishment (on the level of private and

collective fantasy) in dieting and otherwise ‘keeping

healthy and fit’.

The moralistic perspective of collective morality is

premised on subordinating human beings to the demands of

moral principle. Thus our bully can accept anyone as a

‘friend’ who agrees with his principles and his values,

while anyone who does not potentially becomes his enemy.

It is not that his adherence to values creates these

enmities and conflicts merely as unintended side effects;

rather, the adherence is possible only within a situation

seen in terms of conflict, of enmity and alliances. For

obviously, one cannot insist on a moral principle everyone

self-evidently agrees with. If this point can seem

doubtful, it is only because a claim to universality is of

course implied in the assertion of moral principles, to

the effect that everyone – every ‘decent person’, every

‘real patriot’, and so on – should acknowledge the

authority of the principle asserted. But the point is

40

that this claim to universality is an insistent,

threatening demand directed at those who do not or might

not agree. One cannot insist that 2+2=4 precisely because

here agreement is indeed universal, i.e. the agreement is

not of a kind that leaves room for disagreement as an

intelligible option. Similarly, albeit in a very

different sense, for the Belgian whose eyes were opened

to the evil of war in being opened to the dead boy, there

was nothing to insist on, no ‘value’ or ‘principle’ he

could rally others around, although – or rather,

precisely because – his was a case of moral understanding

in the highest degree.

Collective morality is not a monolith, but rather a

precarious balance between people insofar as they define

their position vis-à-vis each other in terms of moral

principles and values. These principles and values are

actually one person’s demands on others, but in their

collective articulation they acquire the appearance of

general, impersonal and authoritative rules of conduct.

If I alone demand that you repair your house because I

41

find it distastefully shabby, that might seem arrogant

and arbitrary: Who am I to tell you how to live? But when

a few others, or perhaps all the neighbours, join me, the

demand seems automatically to acquire moral legitimacy; I

voice it more confidently and indignantly now that I can

speak for ‘all of us’, and you probably feel quite

intimidated and perhaps ashamed – even if what motivates

the others’ demand may be precisely the same, mean and

narrow-minded attitude that actuates me, say a desire to

have our neighbourhood, that is, ourselves as its

inhabitants, look ‘better’ than the people in the city

housing across the park. This kind of moral ‘alchemy’,

whereby common agreement is felt to magically turn the

basest, most cowardly motives into moral ‘gold’, is a

fundamental mechanism of collective morality, whose aim

is not to understand anything, but to try to make the

world accord with one’s wishes, or more precisely to

discredit the challenge others, by their way of being,

may present to one’s wishful and fearful fantasies.

42

One could say that to go very far in presenting morality

as just our collective norms and values, nothing else, is

to move in the psychopathic direction – and this is so

whether one is then inclined to ignore (like the

delinquent) or heed (like the respectable conformist)

this morality reduced to social norms. The Belgian, by

contrast, moved in the opposite direction, and so might

the bully in our example – only then he would cease being

a bully. He and the old lady would then express their

sympathy for each other; not approval for each other’s

values; the communication between them would not be

structured by certain moral opinions, but by the

sympathetic attention they give each other. The

ascendancy of values, however, is an index precisely of

our fear of going in this direction, of opening ourselves

to each other. In this fear, we create common values with

their grammar of prescriptions or rules of conduct. In this

repression, it is the rules, not human beings, that set

the tone, and this makes us feel safe.

43

Note, however, that openness between individuals is not

the same as, although it may sometimes come to expression

in, being very interested in personal details concerning the

other; nor, correlatively, does it mean a lessened

interest in general social arrangements, e.g. in the

pensions-arrangements of old ladies and gentlemen. But it

does imply the absence of moralistic-aggressive interest in

both personal details and social arrangements, whereby,

e.g., the sad personal details of this old lady’s poor

life are sentimentally focused on as a foil for indignant

outbursts against corrupt politicians who have created a

bad system, as one enjoys pitying her and despising the

politicians, the one feeling feeding off the other.

5. Being good on Sundays

Those who are suspicious of our account will no doubt

accuse us of bias; we seem only to point to the

troublesome aspects of groupishness, while systematically

leaving out the good ones. To dispel this impression, or

44

rather to expose the preconceptions which inevitably give

rise to it, is the very point of this paper, but there is

no single clarification that will do the job. Our aim is

to show the destructive dynamics of groupishness. Once

this is clearly seen, the temptation to speak about

‘good’ forms of groupishness will disappear.

The idea of a good groupishness is a mirage of a similar

kind as the idea of good power or good violence. However,

the illusion is, in a certain sense, constitutive of

society. This can be illuminated by pointing for instance

to the way a slaveholding society is held together by the

slaveholders’ refusal to involve themselves in I-you

relationships with the slaves. To a superficial eye, most

of the social activities in the society may well seem to

be untouched by slavery. The Sunday church service, say,

might appear to be a benevolent social gathering, a case

of ‘good groupishness’. But the moral character of this

gathering becomes clear only by considering what, or

rather whom, it excludes, namely the slaves. The apparent

benevolence of the gathering, as of the myriad other

45

social activities of the slaveholders, is premised on no

slaves making themselves present in an ‘inappropriate’

way (a vivid sense of what this means concretely can be

gleaned from the classic account of life in the post-

slavery, but deeply racist South in Griffin 1996).

The moral character of a social practice depends on its

openness; on the extent to which those taking part in it

are not qualified by implicit or explicit social norms.

In cases where there are no such qualifications we have a

gathering of people without groupishness. This implies

that those involved are not constrained by ideas about

what ‘kind’ of people would or would not be welcome to

join the gathering, that is, that they do not feel uneasy

about having any particular kind of people around. New

faces, or new expressions on familiar faces, are not met

with friendly distancing, polite rejection or awkward

silence – just to mention some ‘civilized’ manifestations

of the merciless collective pressure that defines

groupishness.

46

In groupishness, love is repressed, but not excluded.

This means that the possibilities and difficulties that

open up in particular human relationships are present,

but in a distorted way. The point is that love is not

simply absent from groupishness, but rather restrained and

repressed in it. If love were just absent – whatever that

would mean – there would be nothing to repress. But the

repressions are there, and they cannot be ascribed to the

traditional conflict between selfishness and devotion to

the common good; the basic conflict, instead, rages

between love and its repression, where both private

selfishness and groupishness are aspects of this

repression.

It is because love is indeed present in it that

groupishness might seem to be morally good. And on the

other hand, since groupishness is a defence against love,

the fact that love is repressed and restricted is not felt

to be simply unfortunate, but the groupish togetherness

may be experienced as pleasant, enjoyable, cosy,

relaxing, exhilarating or even euphoric and ecstatic.

47

Our claim is not, then, that the Sunday church service,

say, is a gathering that is evil ‘all through’. On the

contrary, we suggest that there can be no such thing as a

simply evil collective; the notion of ‘absolute evil’

makes no sense because love or interpersonal sympathy can

never be simply abolished; its inescapable presence can

only be repressed and denied. The evil aspect of

collective morality is this repression of love, which

takes the form of the conditionality of the togetherness; of

violent demands collectively placed upon those who are

accepted as members of the Gemeinschaft.

Someone might still wonder why the evil of conditionality

would have to affect the good that takes place in

collectivity. To make this clear it might be useful to

think of a community where one is definitely not at home;

that of the Mafiosi, say. What is the goodness in the

togetherness of Mafiosi? And what is the evil? If you

were there, what would you say and not say, do and not

do? Certainly you understand perfectly well what is meant

if someone says ‘In that company you don’t...!’ It is this

48

conditionality of the togetherness that is itself

threatening; here its evil appears. At the same time it

this conditionality that gives the members of the

collective the sense of belonging to a ‘we’. What makes

the Mafiosi feel good about their togetherness is

precisely what you find evil in it; it is the

exhilarating sense of violent power and absolute

‘loyalty’, i.e. unlimited submission to the hierarchy and

values of the group that draws young men to the mob.

However, not one of the gangsters fully and simply

affirms all their values, all the aggressive, moralistic

demands of the group; their membership is conditional on

accepting brutal humiliations and terrible guilt (Mike

Newell’s 1997 film Donnie Brasco gives a better depiction

of this dark heart of the constellation than most films

in the mafia-genre with its endemic romanticising

precisely of the ‘loyalty’ and ‘community’ of the

gangsters). In the end, then, the gangsters are, just as

is every member of every collective, completely alone, for the

conditionality of collective ‘belonging’ concerns every

49

member just as much; if you ‘overstep the line’, if you

‘refuse to play by the rules’, or if you just unwittingly

do something, or find yourself in a situation, which

turns you into an ‘untouchable’, a ‘liability’ for the

others who wish to retain their status in the group, you

are out in the cold, and no-one will be there for you –

unless, that is, there is someone, some ‘I’, who

addresses you as ‘you’, and thereby, of course, becomes

an outcast herself.

Being part of a collective feels good when interpreted as

an escape from the moral anguish that one is tortured by

over revealing oneself as ‘I’ to a ‘you’. But just as we

saw in the case of the Belgian, it feels bad, evil, when

exposed by the light of conscience, in which the longing

for the ‘you’ comes to the fore. The ultimate good

feeling of collectivity is ecstasy; its ultimate bad

feeling is self-disgust (which may subjectively be felt,

e.g., as shame, guilt or depression). The good feeling of

conscience, by contrast, is love, while its ‘bad’ feeling

is sorrow. What in the collective morality feels good –

50

say triumphing over an enemy or humiliating someone who

‘deserved’ it – is revealed as evil when seen in the

light of conscience. The point is thus that the very

feelings that are ‘good’ and bad in the collective

understanding stand in a repressed and repressing

relationship to conscience and love, as the example of

triumphing over a beaten enemy shows. Thus, to say that

we have given a biased picture of collectivity by

ignoring all the good feelings that are part of

groupishness is to evade the question, which is precisely

what one is feeling ‘good’ about in collectivist

settings.

It might be objected, however, that we have focused

unduly on feeling. The good things that collectivity has

to offer should be understood in terms of justice and

fairness – not feeling. Without entering the question

concerning the relationship between morality, feeling and

reason, we will simply point out that this suggestion

misses, in a similar way as the previous one, our basic

point, which is that the evil of collectivity resides in

51

its defining features; its conditionality, its urge to

present moral issues as conditioned upon certain commonly

adopted ways of living. Such conditions characterise what

is usually termed ‘values’, and values of course

presuppose moral principles: ways of acting that

systematically sustain these values. Collectivity is

defined by the values that determine who is accepted as a

member, and its ‘morality’ consists of principles that

further the interests of its members. These ‘moral’

principles, the principles of ‘justice’ and ‘fairness’

among them, are thus conditional; they are valid only for

members.

Understanding the fundamental moral dynamics these

examples point to is not dependent on any empirical

findings in social psychology. Rather, our intention is

to extend the implications of the reflections in the

previous sections by showing how the benevolent aspects

of groupishness are internally related to the aggressive

ones. Both consolidate groupishness in their specific

ways. The good feeling at the Sunday gathering is of a

52

kind where every white person can feel safe; the goodness

in question will not be of a kind that, for instance,

invites black people to join the gathering. The good

feeling presupposes that no one expresses the thought

that blacks are fellow human beings. Good and evil

qualify each other here: The ruthlessness towards blacks

is as it were redeemed by the goodness showed other

whites, at the same time as this goodness is made ‘safe’;

less good, by excluding blacks.

6. The Hippocratic Oath: Love as profession?

The Hippocratic Oath could be seen as an implicit

recognition of the worrisome sides of collective

morality, in that it admonishes doctors to ignore the

collective belonging of the patient, whatever it may be.

In other words, the physician should accept no conditions

for helping someone. The problematic aspects of this oath

are that it is indeed an oath – i.e. a public speech-act

through which one binds oneself to a certain way of

53

acting in front of the collectivity, thus making oneself

liable to blame and shaming if one fails to discharge

one’s sworn obligations – and that it avows a set of

principles for a particular profession. The oath is thus

trying, in an awkward, paradoxical way to hint at the

basic moral relationship in which all human beings not

only should stand, but in a certain sense always and

inescapably already do stand, to each other. As Alfred

Tauber puts it, taking the oath means that ‘As a

physician, I cannot … discard my white garb. This ancient

costume defines me in a way that transfigures me to

conform to an ethical mandate that I neither can escape

nor forget, ministering to the ill as a fundamental act

of response’ (1999, 84).

One could say that the oath is a way of trying to side-

step or suspend the hostility that collecticity, i.e.

each of us insofar as we give ourselves over to it, feels

towards the I-you relationship. By giving the moral

concern announced in conscience a collective form – an

oath, the ‘costume’ of a particular profession – doctors

54

as it were strike a deal with collective morality by

making it seem as if following one’s conscience were the

privilege and special responsibility only of a particular

profession, and as if it was actually their professional,

collectively determined, role that somehow ‘transfigured’

(Tauber) their individual humanity and gave them (but

only as doctors) a sacred ‘right’ and ‘duty’ to help,

even to help those individuals otherwise considered

enemies or disreputable. The paradoxical ‘subtext’ of the

Hippocratic Oath is thus that people are to be helped no

matter how lacking in social status they be; but only if

and where society (the fount of all social status)

demands that this be done. – Here, the role of doctor can

be compared to that of judge or priest, or, for that

matter, of philosopher, scientist, or poet; these are all

‘impossible professions’ insofar as they are roles in a

certain sense defined by the demand that those inhabiting

them should treat social roles, and the prestige and

power (or their lack) that go with them, as fundamentally

irrelevant.

55

Naturally, we are not arguing that the Hippocratic Oath

should be abolished! Given the inclination, the massive

temptation, for people to give themselves over to

collective ways of thinking, through which the most

terrible evil becomes legitimated, it is very important

indeed to have various social constraints in place

whereby these evil tendencies (e.g. the tendency to leave

wounded enemies to die a slow and painful death) are at

least partially checked. But this does not change the

fact that we are here dealing with fundamentally

paradoxical, ambiguous matters. Thus, given that war is

endemic between human groups, rules of war are a good

thing, but it is still the case that war itself, however

‘well regulated’, is a terrible evil, and that the

business of regulating it is morally ambiguous through

and through, in the same way as negotiating with

terrorists is.

Nonetheless, it is also true that making rules of war is

not simply and wholly evil, whatever that would mean, any

more than the slaveholders’ Sunday church services, or

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any other aspects of collective morality. But a crucial

aspect of the goodness these human activities could have

manifested has been repressed precisely by what is

generally taken to be their morally most important

aspect, namely their value-character. To be sure, what

values prescribe occasionally accords with conscientious

responses (‘In our society rape is considered a very

serious offence’), but their collective underpinning

represses conscience even in these ‘good’ cases, and due

to this repression, collective values can also be as

evil, as morally corrupt as one pleases (‘In our society,

homosexuality is not tolerated’, ‘In our society, freedom

for niggers is not tolerated’). The point is that insofar

as one stays within collective values, within repression,

one cannot acquire a perspicuous view of moral

corruption; one is not in a position to tell evil from

good.

It could be objected that the meaning of the Hippocratic

Oath can be interpreted differently. This is of course

true. But here one has to ask oneself what an account of

57

morality, collectivity, individuality, etc., that could be

interpreted in one way only would be like? The question

is not whether or not the accounts we give can be viewed

differently. Critical remarks must rather show which

moral problems our account distorts or fails to address,

which moral issues it obscures, and in which ways the

suggested different accounts are more illuminating, or at

least point to moral possibilities we have ignored.

Collectively and individually, we are constantly tempted

to deceive ourselves into thinking that morality is about

common values and personal responsibility for them; this

temptation is an outgrowth of our anxious fear of each

other. In this common self-deception, we repress our

sense of being an ‘I’. Depersonalisation is a defining

feature of groupishness, and so it is not surprising that

‘losing oneself’ in the collective ecstasy of a ball-

game, a concert or a massacre, has always been regarded

as the most sublime, but also as the most terrifying,

form of human togetherness (cf. McDougall 1927, Moscovici

1985, Haidt 2012). However, only an ‘I’ can perceive the

58

other in the way the Belgian did in Orwell’s story. By

contrast, when the ‘I’ is silenced, ‘lost’ in the group,

there is no one there to see the terrible tragedy in the

young German soldier lying dead by the bridge. It takes

an ‘I’ to feel a ‘you’.

7. Conclusion

We have tried to show how collective moral responses,

including the insistence on one’s ‘personal’ values and

commitments, are repressive reactions to moral responses

between individual persons. This means that collective

moral responses cannot be understood as being sui generis.

Instead, they involve a refusal to acknowledge certain

moral possibilities. If morality would really consist in

nothing but common values kept alive by personal

responsibility for those values, there could perhaps be a

morally neutral ‘science of morals’ that describes those

values and their functions. But this is not the case.

Instead, acquiring moral understanding is itself a moral

59

struggle that, among other things, and very centrally,

involves uncovering the corruptness of collective

morality with its pompous concepts of value, principle,

condition, responsibility, duty, virtue, etc.Most

standard views of ethics create an opposition between the

universal and the particular and, connectedly, between

altruism and egoism. What we have tried to show is that

the perspective where these dichotomies arise is a

repression of the I-you perspective. The moral task of

being open towards the other is not about calibrating

legitimate particular interests and values against

universal or common interests, values and norms. It is

rather that these pseudo-problems arise as a repression of

the difficulty of being open with the other. Neither

particularist nor universalist accounts can make sense of

ethical engagement; the impression that they could

results from avoiding the real moral difficulty, which is

always between an I and a you. This is the basic problem

and it cannot be accounted for by talking about

legitimate interests, duties, values and norms. We are

60

not suggesting people should ignore legitimate interests,

duties, etc. Our point is that moral understanding cannot

be made intelligible in terms of such concepts.

In moral philosophy generally, and in health-care ethics

in particular, the so-called problem of relativism arises

because of the apparent inability to formulate

universally accepted norms and values. As a recent writer

notes: ‘Across the world, there are persons who call

themselves bioethicists. But there is no agreement as to

what ends they are doing what they do, as to what they

should be doing, or even as to what they are doing’

(Engelhardt 2012b, 1). This, Engelhardt thinks, is

because ‘there is no longer any final perspective in

terms of which there could be one canonical morality or

one bioethics’, and so ‘morality and bioethics become

intractably plural’ (ibid., 6–7). From this perspective,

‘the claim that humans share a common morality’ appears

‘incredible’ and should be understood as ‘special

pleading on behalf of a particular morality’ (ibid., 3).

61

However, our point is precisely that particular normative

views or collective moralities always make a claim to

general validity (‘What we see as right is right!’) at

the same time as they constitute a collective

togetherness, the other side of which is precisely the

exclusion of those who are ‘other than us’ (‘They have no

sense of decency or humanity!’). The combination of

pretensions to universal validity and actual disagreement

is, then, a defining feature of the dynamics of

collective moralism. When philosophers or bioethicists

enter to make claims on behalf of either universalism or

relativism, they are simply rearranging the elements of

the game of groupish moralism, without questioning its

basic dynamics. What we have tried to show is that there

is, in a sense, nothing relative whatsoever about our

conscientious engagement with each other; the moral

challenge, however, lies in acknowledging this engagement.

In the medical context, it is crucial to see that this

challenge does not (of course) only confront health care

practitioners, but equally their patients. One could say

62

that the moral problem between doctor and patient is to

find their way through the web of collective stereotypes

and prejudices to engage with each other as human beings.

Such engagement is what moral understanding consists in.

We are not arguing that health-care ‘ought’ to be

patient-centred (that patients should be at the centre

should go without saying), or suggesting concrete

measures for making it more patient-centred, but rather

trying to say something about why genuinely centring on,

responding to, the patient is bound to be so difficult,

and about why this difficulty, which needs to be faced,

cannot be solved by insisting on the importance of ‘moral

values’, since the role of values is typically, as we

have tried to show, part of the moral problem.

(Additional problems with values-discourse are addressed

in Backström 2015.)

Morality cannot be seen only as an object of study and

understanding, but must rather itself be seen as a basic

form of understanding. However, ‘moral understanding’ is a

somewhat inadequate term for our struggles with the

63

difficulties we have in being open with each other. These

difficulties also, and characteristically, find

expression in difficulties of understanding; in our not

listening, not wanting to understand, refusing to see,

ignoring, glossing over, being unfair, falsifying,

avoiding, etc. Amidst our difficulties we concoct moral

ideas that comfort us, and cling to groups where our

fear-laden ideas are best at home. In doing so, we turn

morality, and by extension philosophy, into discourses

meant to comfort us by qualifying the challenge that

being open to others poses to each one of us.

64

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