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Abstract

Casuistry in its modern form is an applied ethics approach that uses case-based reasoning to achieve ethical convergence from pluralistic stakeholders in the form of expert opinions in paradigm cases. The general but variant ethical decisions can be revised with later cases. This anti-theory has emerged in bioethics as one of the most inﬂuential alternative approaches to traditional ethics theories and religious ethics. Drawing from its classical form in the sixteenth and seventeenth centuries, modern casuistry was developed to answer the need in 1960s’ emerging bioethics for providing ethical decisions and policies for a secular, diverse population. Casuistry in a global context is analyzed for its own strengths and weaknesses and then those facets on an international stage particularly from the context of market pressures and pluralism.

Introduction

This entry details the development of casuistry to its current form, deﬁnes its modern formulation, considers its strengths and weaknesses, and assesses its current challenges to respond with global bioethics to globalization and the questions it entails of moral pluralism.

Casuistry in its current form reﬂects societal changes in the 1960s. The shift was marked in this period among moral philosophers from met ethics (discussing the nature of moral choices) to applied ethics (describing how ethics should be applied to make those choices). Applied ethics and its medically related sub discipline of bioethics increasingly gained momentum in response to three key cultural changes. Contemporary secularization witnessed the exodus of bioethics away from its traditional and religious foundation, rapidly advancing technologies brought with them emerging questions unanswerable supposedly from those traditions, and subsequently public policies were only beginning to take shape (Tham 2008). Principlism was born as a synthesis of and response to multiple ethical traditions, followed by major competing approaches including modern casuistry, virtue ethics, phenomenology, utilitarian ethics, feminist and care ethics, and narrative ethics (Pellegrino 2003; Tham 2008).

Casuistry is a particularly inﬂuential system that seeks to provide variable rules of moral decisions through case-based reasoning appealing to moral intuition (Jonsen and Toulmin 1988). It is prevalent particularly in medical, legal, and policymaking sectors, though it struggles with responding to such globalization trends as market pressures and pluralism (Stigliz 2002).

History And Development

The roots of casuistry can be traced back to the Sumerian Renaissance in which King Ur-Nammu and his son Shulgi around 2100–2050 BC are credited with creating the Code of Ur-Nammu, the oldest code of law (George 2011). This code uses a “If [crime], then [punishment]” structure to create the case-based reasoning characteristic of casuistry.

The Western inﬂuence on casuistry is noted in Aristotle (384–322 BC) and Cicero (106–43 BC), but the main driver of this method’s development as classical or high casuistry was the 1550–1650s’ Roman Catholic Order of the Society of Jesus (Jesuits) (Jonsen and Toulmin 1988). The Jesuits integrated classical rhetoric from Aristotle and Cicero with Roman Catholic case studies to produce this classical formulation of casuistry popular in its time. Yet the Provincial Letters in 1656–1680 by Blaise Pascal damaged much of its popular reputation, speciﬁcally via Pascal’s critique of it in light of its use by the Jesuits within the Sacrament of Penance, purportedly allowing light penances for wealthy donors. This judgment of moral laxity, justiﬁed by casuistic rhetoric, was recapitulated by Pope Innocent XI with his 1679 public condemnation of over 65 propositions from such Spanish casuists as Antonio Escobar y Mendoza and Tomás Sánchez. Falling from grace and outside of dominant ethics and moral theology, casuistry remained dormant until the mid-twentieth century.

During this period of the eighteenth and nineteenth centuries, two particular ethical systems in the Western civilization amassed particular inﬂuence: deontology and utilitarianism. Nonreligious deontological ethics was championed by Immanuel Kant (1724–1804) and paralleled such religious application of his time as in Judaism, Islam, and Roman Catholicism of universal moral principles to particular cases with respect to the individual, but without his foundation resting on religious justiﬁcation for these principles. Kant based his theory on the premise of equal human dignity among persons by virtue of their rationality and autonomy. His resulting ethical system included his categorical imperative and universalization principles to detail moral choices based on equal respect for all persons, including the moral agent in question. Animal ethics and environmental ethics were also ﬁelds in which deontological ethics were eventually applied. Utilitarianism developed in this period by Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873). They began with a different premise that the rightness and wrongness of actions rested in the utility they produced and thus fashioned their theory as a consequentialist approach of the ends justifying the means.

Tom Beauchamp and James Childress (1940–) adapted these two ethical theories with “common morality” in light of the 1960s’ American societal changes in the form of principlism (Arras 2009). It sought to distance itself from both of these established theories by providing moral justiﬁcation amid moral pluralism by relying more on moral intuition than deﬁned philosophical theory. Their approach largely shaped Western bioethics with their publishing of the ﬁrst textbook in this academic discipline, Principles of Biomedical Ethics, in 1979. It provides one of the most enduring and inﬂuential bioethics theories to the current day grounded on the principles of autonomy, non-maleﬁcence, beneﬁcence, and justice operating with a method of balancing for application to individual cases with pluralistic moral agents.

A former Jesuit priest, Albert Jonsen, participated with Beauchamp in the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974–1978), the ﬁrst national bioethical commission to guide public policy, which produced the landmark Belmont Report (National Commission 1978). There he observed the casuistic undertone of professionals from pluralistic backgrounds arrived at shared ethical judgments, without agreement on the theories that brought them to that point. He subsequently collaborated with Stephen Toulmin to reformulate classical casuistry and so produced neo-casuistry (hereafter referred to as casuistry) as the main competitor to principlism in 1988. Given the dominant form of casuistry currently is the moderate version by Jonsen (Arras 2013), subsequent Bibliography : to casuistry deal with the formulation defended by him. They developed their casuistry system as an anti-theory, rejecting any high theory (i.e., religious, deontological, or utilitarian ethics) or mid-level theory (i.e., principlism) that applies universal maxims to particular cases (Arras 1990). Instead of theorists deductively reasoning downward from their principles in these two theory levels, the casuists used inductive reasoning, building on case speciﬁcs to produce generalizable principles as in English common law.

They further weighted moral intuitions equally instead of giving preference to intuitions derived from the traditional ethical theories. By focusing on the particulars of a moral case, casuistry sought to achieve agreement in moral decision-making through moral intuition without potentially conﬂicting theories or abstract principles. Toulmin and Jonsen thus hoped to allow moral pluralism in ethical dialogue while avoiding the methodological weaknesses of Beauchamp and Childress’ abstract principles and deductivist logic that may fail to produce convergence in ethical conclusions. Whereas principlism provided four principles without hierarchy and thus guidance on how to apply potentially conﬂicting principles, casuistry began providing a deﬁned methodology with moral intuition to derive generalizable maxims from case particulars to reach conclusions. The resultant decades of dialogue between these pioneers of casuistry and principlism resulted in their current agreement (on the importance of principles justifying ethical decisions, but allowing for cases to clarify these principles) such that emphasis rather than tenets deﬁnes the two camps (Kuczewski 1998).

Conceptual Clarification/Definition

Given that the prevailing inﬂuence of the casuistry tradition in bioethics, its deﬁnition for this discussion will be:

Casuistry is “the analysis of moral issues, using procedures of reasoning based on paradigms and analogies, leading to the formulation of expert opinions about the existence and stringency of particular moral obligations, framed in terms of rules or maxims that are general but not universal or invariable, since they hold good with certainty only in the typical conditions of the agent and circumstances of action.” (Jonsen and Toulmin 1988)

This bioethics theory developed to differentiate itself from ethical theories, with their deductive methods from universal principles, in addition to other anti-theories such as feminist or narrative ethics (Jonsen 1991). Casuistry attempts this through a three-step process. First, a contextually vibrant case description is begun that highlights the aspects of the moral dilemma. Second, the case is categorized and compared to past paradigm cases through analogical reasoning to classify the similarities and dissimilarities of the particular cases versus its paradigms. Finally, a moral judgment is reached through inductive reasoning and moral intuition, informed by historical precedent in the background of the sociocultural values of the individuals at the time of the paradigm cases and the particular case. The authoritative opinion of a new paradigm case stands until it is replaced by a newer case judged more favorable.

Casuistry has been likened to common law as both are case-based methods to arrive at a clear judgment. However, casuistry as an ethical approach is differentiated from law as it bears a heavier burden of truth. By focusing on the moral act, casuistry considers not only the external aspect that law can observe and punish in the context of the act but also the internal aspect and the agent. A clear example of the conceptual divide comes into the former US Supreme Court ruling in Dred Scott v. Sandford, 60 US 393 (1857). As the highest court of law in America, the Supreme Court ruled that African American slaves and their descendants were excluded from constitutional protection and thus citizenship.

The paradigm cases referenced in the court ruling were used to legally justify this judgment, without substantive ethical justiﬁcation. Casuists could contend that their approach can produce more favorable judgments through moral intuition, by appeal, for instance, to the injustice of slave owners denying the constitutional protection of rights for their slaves to life, liberty, and the pursuit of happiness. The cruelty fostered within slave owners by abusing their slaves could be shown by casuistry to negatively affect the owners as moral agents and thus indicate slaves should be protected by the constitution. This anti-theory could therefore produce ethical conclusions about the moral wrongness of failing to protect slaves, even in the absence of precedent cases.

Strengths

Casuistry has several key advantages compared to the current bioethical approaches amid moral pluralism today: (1) procedural efﬁciency, (2) adaptability, and (3) clinician and societal support.

(1) Casuistry’s landmark strength of procedural efﬁciency plays out in its lack of responsibility to determine moral culpability and shared theory justiﬁcation among its stakeholders

A casuist can potentially shorten the possibly lengthy process of determining the intention of the moral agent relating to the moral dilemma and the theory that judges it and rather defer justiﬁcation for the best moral decision to a preexisting case maxim. The maxim does have to be ﬁrst established through the inductive reasoning process detailed above with moral intuition. Jonsen clariﬁes this point that maxims of ethically relevant details of the case guide analogical reasoning (1995) that allows the current case to be linked to a paradigm case directly and clearly illustrating the relevant maxim that can then be applied to the particular case.

This can be an especially favorable strength to clinicians such as on hospital ethics boards. These boards typically must reach a shared timesensitive ethical decision, often with its committee members from divergent ethical theories and levels of training in ethical theories. With use of shared moral intuition and analogy connecting a present case to paradigm case, a decision can promptly be made with procedural justiﬁcation and expediency supporting it.

(2) The adaptability advantage of casuistry as a by-product of its procedural efﬁciency has been argued to be both a strength and weakness for its absence of substantive ethical justiﬁcation for casuistic judgments. Since casuistry allows ethical decisions to be revised when later moral intuition and analogical reasoning indicate so, it can be a robust method arriving at the procedurally right judgment (in contrast to objective rightness that is universal and invariant). Similar to liberal democracies’ constitutions or court decisions, initial consensus can reach shared ethical decisions through accepted procedural grounds and later be adapted as sociohistorical changes develop. This adaptability in a liberal democracy sense contributes to the strength of the political process in America to respond ﬂexibly to extrinsic and intrinsic challenges, including the largest inﬂux proportion of pluralistic immigrant cultures in the world.

Yet casuistry with its particularly strong American inﬂuence must also grapple with the question of whether an ethical judgment by consensus is later shown to be morally wrong (i.e., national policies for forced sterilization of poor immigrants and minorities). A casuist could respond that yes, consensus could describe a morally wrong act as morally right in a particular case, yet this is precisely one of their approach’s strengths that allow revision of that decision after later moral intuition leads to new paradigm cases.

(3) These strengths help garner signiﬁcant clinician support of casuistry due to its casebased methodology being similar to medicine’s case history paradigm exercised in hospital grand rounds (Tham 2008). Support can be society-wide with legal professionals and policymakers considering that common law present in many nations uses a similar case-based approach to governance. There is thus a cooperative interaction with the academic discipline of applied ethics including casuistry and the practice-based professional ethics among medical care providers with their reliance on casuistry. The self-association of historical professions results in professional standards for accountability and thus continued inclusion of members within a profession. Ethical standards are among these that are particularly noticeable in the medical profession, dating back to one of the earliest formulations in the Hippocratic Oath (ﬁfth century BC).

Casuistry’s adaptability advantage surfaces again in the context of such a professional code to help revise it based on greater moral reﬂection. It can side with Beauchamp and Childress’ non-maleﬁcence principle present in the Hippocratic Oath (“Do no harm”) while also agreeing further with Beauchamp on the resultant conclusion about the importance of informed consent (Faden and Beauchamp 1986), even when the oath mandates withholding patient information: “Conceal most things from the patient” (Hippocrates (1923); Jones trans.).

Applied ethics with casuistry can strengthen such professional ethics through systematic reﬂection and study particularly when a profession’s ethical standards can become questionable or sociohistorical changes dictate intervention, as the Nuremberg Code (1946) following the Nazi physician-led experiments on prisoners. Such codes have experienced a surge in the last 70 years with the increasing globalization of the medical profession. The World Medical Association’s Declaration of Helsinki (1964) subsequent to unethical patient experiments in the 1960s ensued, followed by the Belmont Report (1978), International Ethical Guidelines for Biomedical Research Involving Human Subjects of the Council for International Organizations of Medical Sciences (CIOMS) (2002), United Nations (UN) Declaration of the Rights of the Child (1990), UN Declaration on the Elimination of Violence Against Women (1993), UNESCO Universal Declaration on the Human Genome and Human Rights (1997), UNESCO Universal Declaration on Bioethics and Human Rights (2005), and UN Declaration on the Rights of Indigenous Peoples (2007).

In these global political codes designed to inform professional codes, there is a prevalent deference to casuistry reasoning to justify case-based maxims that can then be updated by medical professionals with new technological or practice advances among such professionals accustomed to regular revisions of common medical knowledge. Casuistry thus syncs well with the training paradigm and subculture of medical professionals, both individually and collectively.

This method can inform ethical decision-making often with logistical or resource constraints preventing rapid consulting with an ethical expert able to apply ethical theories for prompt medical decisions. Though such deference to the authority of established maxims enshrined in paradigm cases begs the question if such an ethical procedure provides adequate justiﬁcation. A pediatric surgeon can perform a surgical operation to save a newborn’s life with the same technical accuracy of the mentor who trained him or her, though the technique could be ﬂawed and ineffective in the ﬁrst place. It does not follow logically that deference to the mentor (i.e., paradigm case for casuistry) necessarily produces the right action (i.e., decision judged in a case to be the most morally right).

Weaknesses

The procedural efﬁciency of casuistry including its adaptability and favor among clinicians can also lend itself to key weaknesses on both (1) anthropologic and (2) ethical methodology grounds.

(1) By severing any formal ties to ethical theory, casuistry also cuts out the moral agent central to the moral act. Failure to do so would commit casuistry to a particular vision of the person, his or her nature, and the nature of moral decisions made by the person as an individual and member of a broader community (Tham 2008). Investigations into these concepts after the high ethical theories of the Enlightenment led Edmund Husserl (1859–1938) to break from the Kantian tradition and found phenomenology as a subdiscipline of philosophy to analyze consciousness, experiences, and human decisions. But even before him, Thales of Miletus (624–546 BC) began what became the subdiscipline of metaphysics to investigate the nature of being itself, necessary for a person to even experience moral intuition in the ﬁrst place. Max Scheler (1874–1928) integrated phenomenology and metaphysics into an independent subdiscipline, philosophical anthropology.

So when casuistry developed its modern formulation as an anti-theory reaction to high ethical theories, it also rejected any given philosophical anthropology. But since ethics is a human endeavor governed by metaphysics and phenomenology, casuistry by default committed itself to an anti-phenomenology and anti-metaphysics by becoming anti-ethics theory. This implicit metaphysical rejection necessarily restricts casuistry to consider moral value only given to a decision if moral intuition supports it from paradigm cases. Similarly, Kant’s explicit metaphysical rejection (of human knowledge being unable to extend outside empirical time and space to metaphysical questions) restricted moral value in his ethics to only be given by motives driven by universal principles (McGinn 1993).

The practical implication of this theoretical move is that casuistry is not required to view the individual in a given case as a moral agent affected by the moral decision. This is counter to practical moral experience as either virtue and vices are developed in a moral agent based on repeated moral or immoral decisions. Societies typically denounce corrupt political leaders, who usually develop their vice of greed through increasingly large decisions to accept bribes. Yet casuistic reasoning could justify at the time the 1950s’ widespread testing of Gregory Pincus’ oral contraception pill on Puerto Rican women without informing them of the side effects or experimental nature of the pill, nor the trial’s intended purpose to obtain Federal Drug Administration (FDA) approval for American women’s use (Eig 2014). By the time new paradigms could be set that deemed such exploitation as unethical with 1970s’ American congressional hearings, multiple fatal heart attacks and strokes had been linked to the pill.

This anti-theory in ethics thus does not necessarily provide any additional safeguards for populations aside from the law, which can be subject to politics and changing societal will. Casuists, like utilitarians (calculating how an intended outcome can justify the means), cannot necessarily account for undesirable consequences of their moral decisions even if they have egregious unethical results. This process can perpetuate unethical underlying societal values and distorted moral formation of the persons making those decisions, dragging on for centuries without correction. History has no short supply of such cases, including current lax child sex trafﬁcking laws in Asia or the 1960s’ American Civil Rights 100 years after slavery was abolished.

(2) This anti-anthropology of casuistry thus includes key ethical methodology weaknesses:

a) Exclusion of the central actor in ethics, the moral agent, with both the external aspects (physical action external motivations or barriers to action such as physical coercion) and internal aspects of the moral act in question (the moral agent’s intention, virtue or vices, internal motivations, or barriers to action including psychological duress)
b) Subsequent inability to distinguish relevant differences in the moral action given externally similar but internally different contexts (i.e., the external pressure of clinicians encouraging two different immigrants to prematurely withdraw life support from their family members, while each immigrant internally is differentially inﬂuenced by their home country’s culture with one supporting and another rejecting this decision)
c) Methodological failure to identify or resolve situations of conﬂicting moral intuitions, latent societal values, and divergent interpretations of societal values
d) Comparative failure to demonstrate its superiority as a bioethical approach to its close antitheory rival of principlism, as principlism has a clearer methodology by appealing to a balance of its four enumerated principles
e) Deterioration into moral emotivism to resolve such above situations (Juengst 1989)

The inevitable implication of the above weaknesses is that the procedurally efﬁcient casuistry trades the short-term win of a consensus ethical decision for the long-term loss of a political co-opting of the ethical process to be a simple majority vote. Sustainable and consistent ethical human progress thus can never be assured by casuistry as it (a) can cut out consideration of the necessary human elements of the ethical process – the individual as a moral agent, within the context of their culture and its societal values, who faces a moral dilemma that will have consequences on him or her. Though this anti-theory does not explicitly reject consideration of these elements, it does fail to justify their prioritization in moral intuition as it makes optional their consideration.

The practical implication is that paradigm cases made so without consideration of these elements can perpetuate neglect for seriously assessing the humanity central to the human ethical process. As long as the casuistic consensus dictates moral intuition does not have to consider such elements, justiﬁcation by agreement can devolve into political will. Patients and physicians have no higher appeal to moral standards if they fall in the minority ethical view for a maxim (i.e., informed consent for the Puerto Rican test subjects) judged not inﬂuential enough to deﬁne a new paradigm case in casuistic reasoning.

The subsequent continuation of underlying abuses of persons and/or subpopulations in a society due to (b) and (c) can complicate ethical convergence of casuists who may disagree about societal values, particularly those that are latent in the culture as rampant though silent discrimination. With no clear advantage in (d) over its closest rival, casuistry as an anti-theory in ethics fails to discharge the burden of proof why it should be prioritized in crafting bioethics decisions apart from any other approach, including ethical theories or moral emotivism of (e) that it cannot prevent itself from being degraded into to act without reﬂective procedure or justiﬁcation.

Paradoxically, the casuistry project to achieve ethical convergence in pluralistic societies undermines itself through failure to allow substantive discussion of its ethical foundation. As it adapts with predominant changing interpretations of exemplary cases, it excludes many inﬂuential ethical theories and approaches that ﬁnd strict casuistry unintelligible. Examples of such conﬂict include the Eastern tradition of Confucianism prioritizing virtue development of the moral agent above ethical norms, and Hinduism and Buddhism de-emphasize such norms to focus rather on right ordering of relationships among humans with spiritual growth and nature. The multiple millennium traditions of Judaism, Islam, and Christianity particularly Roman Catholicism highlight authority-based interpretation of revealed texts as a complement to human reason to inform ethical norms and virtue development of the individuals adhering to those norms.

Casuistry ignores the Eastern and Western religious concern with the internal nature of moral decisions for virtue development, along with the additional Eastern concern for rightly ordered relationships. Or more accurately, casuistry skeptically under-weights such concerns in an ethical discussion as universal maxims that can be heard but not drawn from, as they are antithetical to the casuistic approach. Baruch Brody’s pluralistic casuistry at prima facie may offer a promising approach to resolve this moral incongruence (Brody 2003), yet his casuistry form also lacks a methodological and theory-based justiﬁcation for resolving conﬂicting moral intuitions without moral emotivism. Casuistry in its various current strains therefore lacks a common moral language with the majority of the global community who are members of these religious tradition families.

The Promise Of Casuistry For Globalization

Diversity in cultures, philosophical systems, and religions heightens the importance of global ethics amid this rich pluralism. With no clear champion of a global ethic, casuistry offers a compelling approach as it complements two of the three dominant approaches: the theory of “overlapping consensus” by John Rawls (1921–2002) and international human rights. Casuistry can be strengthened and strengthen in turn through its ethics structure and systematic procedure the profoundly inﬂuential political philosophy of Rawls. Like Kant and modern casuists, Rawls attempted to provide a pluralistic procedure, without formal ties to previous philosophical or religious traditions, for achieving ethical convergence (Rawls 2005). In his theory of justice as procedural rather than metaphysical justice, Rawls asserted that rational persons from diverse backgrounds can have their consensus overlap on the good life and thus moral standards keeping with societal protection of them for all citizens. The concrete structure and methodology of casuistry is a less developed ethical correlate of this approach and articulates in the ethical context a Rawlsian insistence on procedurally arriving at the right decision by shared intuition.

Yet both approaches can struggle with globalization questions in which variations can exist within and across nations in the extent to which individuals desire to or even are able to guide consensus through intuitions. Chinese ethicists may object to its communist government that a team of Chinese biologists in April 2015 gnomically engineered human embryos with unpredictable heritable impact on future generations, but the ethicists’ consensus may lack adequate power to impact policy change. Yet whereas casuistry offers no philosophical foundation justifying its conclusions or methodology (rejecting ethical theories along with phenomenology and metaphysics), Rawls’ shared conception of equality and fairness attempts to justify the arrival to the decision by consensus in question.

International law as an intellectual descendent of the political philosophy school of Kantian idealism also can integrate well with casuistry. This legal framework exert growing sway in global affairs through the support of member states and institutions having a shared conception of human rights and dignity, as detailed in the profoundly inﬂuential United Nations (UN) 1948 Universal Declaration of Human Rights. But like casuistry that entails ongoing hopeful improvements in paradigm cases, there are struggles to facilitate at the UN level a more robust consensus process. For example, underrepresentation of members of the Global South states (Central and Latin America, Africa, and most of Asia) persisted during drafting of the UN Educational, Science, and Cultural Organization 2005 Universal Declaration on Bioethics and Human Rights among other more recent declarations (Langlois 2013) attempting to add a uniﬁed global voice of member states to the international law corpus. Notwithstanding, from the UN to the World Health Organization, casuistry’s focus on authoritative paradigm cases plays smoothly to international law’s development avoiding theoretical justiﬁcation from pluralist members to rather argue for shared ethical decisions.

International law goes a step further for casuistry, as Rawlsian justice did for this anti-theory by positing its foundation in human equality by virtue of equal human dignity and correlate rights and duties (as a shared but undeﬁned assumption, in contrast to Rawlsian procedural-based approach to arriving at that assumption and then reasoning forward from it). The 1948 Universal Declaration of Human Rights and 2005 Declaration on Bioethics and Human Rights (Article 12) both afﬁrm that equal human dignity and rights are prioritized over global pluralism’s possible curtailing of such rights (i.e., the international community of member states allowing female genital mutilation out of pluralistic respect for a given state’s view allowing such practice).

Casuistry thus would reject such universal maxims, but still offers an ethical approach to allowing such inﬂuential maxims to be considered in ethical discussion more so than religious considerations (as casuists can argue that Rawlsian and international law intuitions like those within own approach are nonbinding on individuals, whereas one can argue global religions can posit universal binding truths on others by virtue of their shared human nature).

Globalization Challenge To Casuistry

A particular challenging context for ethical approaches regardless of their strength to weakness ratio is the growing appreciation for pluralism in diverse cultures, philosophical systems, and religions. Nobel Laureate and former World Bank chief economist, Joseph Stiglitz, captures how “market fundamentalism” amid this concurrent technologically and economically driven globalization asserts the staunch belief that free markets are the optimal means for societal progress, led by economic growth maximizing individual freedoms to pursue ﬁnancial self-interests (Stigliz 2002). The 1980s’ and 1990s’ globalization practices of the World Bank and International Monetary Fund (IMF) making unilateral nationwide economic adjustments according to this belief portray this economic theory, only to learn its consequent damaging effects (i.e., the tumultuous Russian transition to capitalism and the 1997 Asian ﬁnancial crisis). The counterfactual to market fundamentalism is that free markets are inefﬁcient at economic improvement (and thus societal improvement) when economic information and societal institutions are weak, resulting in possible abuse of those populations.

Global South bioethicists, Solly Benatar et al., invoke a casuistic appeal to “fundamental morality” and international law (Covenant on the Rights of the Child) to condemn lack of respect for populations, concurrently with an American bioethics treatment of it (2006). Their critique illustrates implicitly how casuistry as a uniquely American bioethics product can be so divided with cultural conﬂicts deﬁned between liberals and conservatives that their also divided moral intuitions impede or prevent shared conclusions. Yet it remains unclear if the robust and efﬁcient procedure of casuistry alone with its surface-level and transient ethical decisions is operational in this human global ecosystem in which profound economic incentives regularly conﬂict with moral intuitions about exploitation of populations.

This development uniquely impacts casuistry due to market fundamentalism’s inﬂuence in the increasingly economic powers of certain transnational pharmaceutical, research, and insurance companies. As casuistry can support (and by correlate cannot necessarily reject) the realism political philosophy maxim that “might make right,” pharmaceutical companies, for instance, can argue through casuistic lines that exploitation of a population as a testing group for a drug can support their economy and thus justify the exploitation. Extended periods can result for the casuistic (and international law) consensus to make judgments against such ethical violations.

This anti-theory can thus encounter difﬁculty generating ethical convergence on a decision in this context, not only due to the pluralism of the involved international actors (i.e., global companies, developed nations using the companies’ products, and developing nations where those products are created) but also due to casuistry’s lack of shared decision-making that can facilitate further exploitation or decisively prevent it.

An example of such casuistic debate is with multinational pharmaceutical company executives who can highlight past cases of similar abuse and thus reason promptly that such an unethical decision should not be repeated. But the executives can also invoke market fundamentalism and utilitarian intuitions (which more people beneﬁt from a life-saving drug in a wealthy developed nation compared to the abuse of a poorer developing nation in which the drug was tested). They can thus allow such intuitions to inﬂuence their shared moral intuition and thus hand select paradigm cases that conclude the ends justify the means.

Either situation is equally probable as casuistry ignores the internal aspect of the act (i.e., vice versus virtue development within the company executives intending to use the developing peoples to test the drug) and the nuances of the sociocultural context of the decision (i.e., not being required by casuistry standards to resolve the ethical dilemma with stakeholders in those nations through a common moral language, amid different ethical theories).

Without substantive theoretical foundation, casuistry cannot guarantee that safeguards today on human dignity and rights – the central shared assumptions for the majority of the international institutions and laws attempting increasingly to govern possible ethics abuses – will not be overturned tomorrow for unethical practices when the balance of cases swings the other way. Stigliz’s argument from the World Bank and IMF damaging 1980s’ and 1990s’ practices provides such example of casuistry justifying unethical decisions. The lack of a sufﬁciently inﬂuential global oversight body for these institutions and the reliance on casuistry’s time-variable ethical decisions did not aid the prompt correcting of these decisions.

Another notable global ethics approach that has implications for casuistry, in addition to Rawlsian overlapping consensus and international law, is natural law that can communicate across the major global religions and secular populations. Advocated by one of the primary drafters of the UN Universal Declaration of Human Rights, Jacques Maritain (1882–1973) revived in the twentieth-century Thomistic Aristotelianism as the most enduring version of natural law. Maritain deﬁned natural law as the internal disposition of every person that is known through their human reason and orders him or her to their end, which is their freedom, deﬁned as the realization of the person by moral and spiritual perfection (Maritain 1951). He argues that the metaphysical justiﬁcation of this natural law knowable in stages through human reason is from its participation in divine law generated from the divine reason of God. Human rights and duties to do good and avoid evil follow from the ﬁrst principle of natural law.

This approach differs from the other global ethics alternatives and thus is particularly suspect in casuistic discussion given its metaphysical foundation. In addition to its major proponent, the Roman Catholic Church, natural law ﬁnds natural allies in major tenets of other religions (Commission 2012). Among these include Islamic morality of obedience, life ethics in native African religions, Buddhism’s sila or ﬁve ethical precepts, Daoism’s Tao or the Way, Hinduism Dharma and Ahisma, and Confucianism’s harmonious virtues shown by tian dao or Way of Heaven, in addition to secular communities with appeals to the common and individual good. Given how over 90 % of the world’s population identiﬁes with at least one religion (Central Intelligence Agency 2010), this approach that has fundamentally inﬂuenced the contribution of the UN to international law may prove fruitful for continuing the development of global bioethics. Such a development may be aided by a casuistic inﬂuence that considers the moral intuitions of parties from different belief systems and their paradigm cases in a natural law discussion to achieve ethical convergence, even if a committed casuistic in the conversation would not accept the metaphysical foundation for those beliefs.

Conclusion

The exciting technological and digital age growing in the mid-1900s that triggered an explosion of new applied ethics approaches also helped launch the current globalization era. As such the importance of pluralism and diversity in cultures, philosophical systems, and religions challenges ethicists and societies as it did in the 1960s’ birth of the anti-theories of bioethics to respond with clear ethical decisions, transparent and deﬁned procedures, and shared robust ethical decisions.

Casuistry provides a popular approach toward this given its procedural efﬁciency, adaptability for a changing world, and popularity among clinicians, legal professionals, and policymakers with its case-based approach. Yet the weaknesses of casuistry must also be considered as it dehumanizes the ethical process by removing the human moral agent from the equation, falters with ethical convergence in pluralism, and runs the regular danger of relying on moral emotivism by democratic majority.

The adaptation of this approach to the level of global bioethics amid pluralism and conﬂicting moral intuitions may allow its helpful contributions to the Rawlsian conception of justice, international law, natural law, or other global ethics frameworks. The approach therefore of Benatar et al. 2006 may suggest a helpful example methodologically of how a casuistic appeal to common morality may be incorporated within a larger global bioethics approach applied to particular ethical questions. If the time has come for casuistry to consider the case that it must be assumed into a larger system, the proponents of this American product may be able to translate its integration into a lasting service to the broader global bioethics project.

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