Abstract

There is a widespread feeling that health is special; the rules that are usually used in other policy areas are not applied in health policy. Health economists, for example, tend to be reluctant to offer economists’ usual prescription of competition and consumer choice, even though they have largely failed to justify this reluctance by showing that health economics involves special features such as public goods, externalities, adverse selection, poor consumer information, or unusually severe consequences. Similarly, while some philosophers argue for bioethical conclusions based on very general ethical intuitions,1 many others rely on moral intuitions that are specific to health and medicine to draw conclusions that are meant to apply mainly in health and medicine. For example, many authors appear to start from the strong moral intuition that it typically seems wrong to deny poor people access to health care, and then seek moral principles that can both account for such intuitions and justify the claim that people have some sort of right to health care.2 In metaethics, opinions on moral intuitions range from an extreme intuitionism, which accepts all case-specific moral intuitions at face value as reliable moral guides, to an extreme foundationalism, which rejects such intuitions as evidence regarding correct general moral principles. Between these extremes, opinions vary on how severe the errors in our moral intuitions are. The practice of bioethics seems to favor the extreme intuitionist end of this spectrum, and thus implicitly expects mild errors.3 In contrast, this essay will suggest that common practice in bioethics has seriously underestimated the errors in our moral intuitions. In this essay, I consider the evolutionary origin of our moral intuitions, but avoid the extreme positions of moral skepticism and “whatever evolved must be good,” both of which are commonly associated with evolution-