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11/17/2015

What Should Clinicians and Bioethicists Tolerate?

by J.S. Blumenthal-Barby

Last week I attended a talk by German philosopher Rainer Forst on “Toleration and Democracy”. Professor Forst, a student of Habarmas, was named “the most important political philosopher of his generation” in 2012. Forst began by noting the tension between toleration and democracy. On the one hand, democracy demands something more than mere tolerance of others and their perspectives—something more along the lines of recognition and respect. In this way, and paradoxically, every tolerance is a form of intolerance. As Goethe said, “To tolerate is to offend.” Yet on the other hand, democracy cannot get by without toleration.

Forst articulated three components of toleration:

  1. Objection: the “tolerated” is somehow objectionable.
  2. Acceptance: there are reasons why it is right or required to tolerate what is objectionable.
  3. Rejection: the line drawn where we would no longer accept the tolerable but outlaw it.

Forst noted that toleration is a “normatively dependent concept,” meaning that sometimes toleration is good and sometimes it is not (an analogy was the concept of solidarity).

Finally, he noted that there are really two very different conceptions of tolerance:

  1. The Permission Conception: authority grants the minority permission to keep doing what the authority finds objectionable with a general expectation that they will be somewhat discreet about it. Note that this is the conception that is (paradoxically) a “form of intolerance.”
  2. The Respect Conception: a reciprocal stance that two people adopt towards each other of tolerated and tolerating; of epistemic humility regarding the truth or the good; and of recognizing each other’s right of justification.

What I want to ask here, in the context of bioethics, is when a certain practice or behavior should be tolerated in the permission conception, tolerated in the respect conception, or rejected.

I am not going to provide the answers, merely some food for thought, but I believe that Forst’s conceptual framework is one that could be utilized in bioethics for examining important questions regarding the right or “fitting” attitude towards various practices that we observe.

Consider the following examples:

Example 1: A patient treats his family members rudely.

Example 2: A patient makes harmful health and lifestyle choices.

Example 3: When interviewing women from another culture about reproductive and sexual autonomy, you discover that the vast majority of them did not consent to their first sexual experience and found it absolutely traumatizing.

The list goes on.

It would be an interesting exercise for bioethicists to ask ourselves whether to tolerate these examples and others. And, if we are to tolerate them, what that “toleration” means given the various conceptions outlined by Forst.

 

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