Making a moral argument without moral bullying

The first of a three-part series on what we think, believe, and do, and the moral imperatives that shape our work.

I have long felt that the work of health does not rest only on surfacing the data that explain what causes health, but also on making a moral argument about why we should act on those data. We make our case for approaches we think will support health by communicating both the science and the moral imperative to create a better world. This reflects writing I have done about the intersection of our knowledge and our values: how we should aspire to strike a balance between what we know—what our data tell us—and our commitment to shaping a healthier world based on principles of justice, equity, inclusion, and respect for the dignity and autonomy of all. To my mind, the work of public health is achieved when the data point to a particular course of action and when there is strong acceptance, informed by our values, for taking that course of action. For example, the data are clear about the importance of childhood vaccination, and it seems inarguable that, as a basic value, we should do all we can to ensure children do not acquire deadly diseases like polio or measles. Ideally, then, we should aim to achieve this balance between what the data suggest is correct and what our values tells us is right. The work of health therefore builds on data from population health science, combined with making a moral argument. In some ways, this aligns with our work to move the Overton window and to change what we regard as acceptable. These are all examples of goals that can best be accomplished by making a moral argument, marshaling the facts to make the case for policies that support a healthier world.

In recent months, the notion of making moral arguments in favor of a range of policy goals has been quite visible in the public conversation. This has made me think more carefully about the very notion of making a moral argument and pushed me to consider some key questions: what do we mean by “making a moral argument?” How does one make a moral argument constructively? What does it take to bring people who do not agree with us around to our perspective?

Over the next three essays, I will explore these thoughts a bit, as well as their implications for our work. First, I will this week talk a bit about how we can aspire to persuade those who may disagree with us, by making a moral argument compellingly, without moral bullying. Next week, I will think out loud a bit about the role of evidence and data in the science that informs all we think, say, and do in our pursuit of health, and how these data are inextricable from the moral arguments we make. I will conclude this “trilogy” with a reflection on action—on how moral argument can inform action and how, in a world of much that deserves acting on, action, or sometimes even lack of action, can help us move collectively forward.

Today I will begin with an example which, I think, illustrates the importance of balancing our values and data to make a moral argument for what we believe is right. This example concerns the use of safe injection facilities (SIFs). Data are clear that providing SIFs reduces the risk of disease transmission, but the spread of SIFs has been limited because these facilities are not accepted by many, and harm-reduction approaches have been criticized as being too lax on illicit substance use. In this case, we see a misalignment in values, with passionate voices advocating for the widespread use of SIFs based on the data and equally passionate voices in some communities objecting to SIFs based on what their use may mean for safety, property values, etc. It is worth noting that the latter argument does not necessarily try to refute the former, it simply represents different priorities. One could accept that SIFs do indeed prevent disease transmission while still objecting to them on the grounds that the challenges they may introduce to communities could outweigh their benefits.

It is exactly this kind of case that has pushed me to suggest that it is our responsibility to make a moral argument in favor of approaches that the data say will support health. This means, however, doing something that is increasingly difficult in this polarized moment: working patiently, respectfully, to persuade those who disagree with us. In the example of SIFs, it is on us to note that the data are clear that, yes, SIFs reduce disease and death, that they cost society less, but also that in pushing for the widespread acceptance of SIFs we are doing the right thing by those who are dependent on substances, that SIFs are as much a part of treatment as might be a prescription medication. We can, and should, make this argument without in any way dismissing concerns for the safety of communities or questioning the motives of those who hold them.

But the challenge that arises, particularly in divided times, is: how can we make this moral argument without lapsing into moral bullying?  I should first articulate what I mean by “moral bullying.” The Cambridge Dictionary defines “bully” as: “to use your power or strength to frighten or hurt someone, often over a period of time, and often forcing that person to do something they do not want to do.” It seems to me that moral bullying is when we let our zeal for what we regard as a righteous cause lead us to behave in ways that are coercive, cruel, or simply insensitive to the concerns of the communities with which we engage. Because we feel our cause is just—otherwise we would not be advocating for it—and because there are real threats to health and genuinely bad faith actors working to advance policies that harm health, we can sometimes overlook when we are ourselves behaving badly in opposition to these forces. Or we can simply find our sense of righteousness becomes, over time, a kind of vanity, as we get so preoccupied by a heroic vision of ourselves that we start to see nothing but that, to the exclusion of an honest reckoning with our faults.

For a good example of when moral argument can become moral bullying, I find myself turning to the classic film, Inherit the Wind. The film is based on the 1925 Scopes Monkey Trial, when a schoolteacher in Tennessee was charged with violating a state law that made the teaching of evolution in state-funded schools illegal. The film, which is based on a play of the same name, features the character Matthew Harrison Brady, who is based on William Jennings Bryan, a three-time presidential candidate and former US Secretary of State who served during the trial as prosecutor. Brady/Bryan had been a champion for moral reform in the US, advocating against imperialism and for a range of progressive causes. But, in the film, we see a man whose moral force has curdled into moral bullying, as in the scene where he cruelly berates the plaintiff’s fiancée on the witness stand. He lets his love of the sound of his own voice drown out the conscience that might have stopped him from abusing the vulnerable in pursuit of his cause. The story is in large part the tragedy of how this figure, who had been a great force for good for much of his career, is reduced during the trial to being a moral bully—self-righteous, uncompassionate, and unworthy of the fine example he once set.

Let us now turn back to a real public health example, once again considering the case for SIFs. I earlier suggested the value of respectful persuasion in making the case for the use of SIFs. But there is, of course, another approach we might be tempted to take. In this hypothetical approach, rather than engage with critics of SIFs, we say that these critics are bad people. We then refuse to engage with their criticism, arguing that to do so would be to give a platform to their badness, amplifying hateful views. We may not initially mean to take this approach, but we become so frustrated with their refusal to accept our conclusions that we turn away from the better angels of our nature and become angry, bullying. The twist to this story is that, in embracing this approach, we still “win” in the sense that SIFs are adopted. Rather than seek to persuade those who disagree with us, we succeed in marginalizing their voices, instead turning to sympathetic actors in the media and local legislature to pass the policy we want around SIFs. Most of the legislators, already inclined to support us, override the objections of other legislators who take the minority view, and the local, largely progressive, media amplifies our assertions that SIFs are good and that anyone who questions this has bad motives and should not be listened to. Rather than rely on persuasion, we use power, wielded in a bullying, moralistic way. And it works.

But does it really? We have seen in not so far off times how this may backfire. By way of example, during the pandemic, we sometimes used similar methods and we often got our way. Yet each of these victories came at a cost. Public health and science generally now face a crisis of trust, with many disengaging from what we have to say. We have seen these declines in trust across many populations, including across the political spectrum, suggesting that when we bully, when we give up on respectful persuasion, we undermine the long-term integrity of our efforts.

Therefore, we too can run the risk of falling short of who we are at our best, as our moral arguments become moral bullying. This can be a hard reality to face. As we move forward, however, we need to take seriously the possibility that we could find ourselves, at times, acting like bullies, and do all we can to prevent this behavior in ourselves as much as we would prevent it in others. This urges, I think, some reflection on how we can make a moral argument without moral bullying. I offer three thoughts that emerge, as all this writing does, from trying to reflect on this puzzle, hoping that sharing thoughts is helpful to others.

First, I do not think we should make any moral argument without carefully examining the fundamentals of what we are trying to say and why we are trying to say it. Why do we think the way we do? What are we trying to optimize for? If we are pushing for acceptance of SIFs, what are we prioritizing, and what are we de-prioritizing? I note that in the obstreperous space of public conversation these questions are often reduced to caricatures, to assertions that any conceding of ground is somehow itself immoral. Of course I disagree, and I think it is critical that we genuinely interrogate why we are doing what we are doing, and what we are trying to achieve for any such argument we are trying to make. This means being aware of our biases, fully centering the goal of our work—ensuring a dignified life for all—and making sure that what we argue for advances this. That also does not mean giving quarter when we are clear that what we are doing is right. For example, SIFs save lives and often are the only way to keep those with addiction to illicit substances from harm. To that end, there is a strong moral argument to be made in favor of their use, and we should make it. We should also always be able to notice when we are enjoying a bit too much the emotional catharsis that can come with strongly arguing for what we believe is right. There is a feeling that can accompany making such arguments that is deeply satisfying. To the extent that this feeling supports the thoughtful advance of moral arguments, it is to be welcomed. But when it becomes an end pursued for its own sake, it risks being counterproductive and, potentially, a gateway to behavior reminiscent of Matthew Harrison Brady in Inherit the Wind. 

Second, we must approach any moral argumentation with empathy for those who disagree and disagree strongly. Towards this end, I much encourage the reading of this piece by Rachel Kadish, who encourages her students to write from the perspective of people the students disagree with, to encourage empathy. She points out that when she does this in her class, students can have a difficult time giving empathy to those who strongly feel differently than they do, and that is perhaps the heart of the challenge. We cannot understand how others might feel about a given issue without first trying to understand them at the level of our common humanity. If our goal is to change minds, that is where we must start—not so much with how others think, but with how they feel as a reflection of their fundamental humanity. A humanity which—we should never forget—we all share.

Third, we need to learn how to make an argument over the long-term, how to do the incremental hard work of building a moral argument slowly, by bringing along those who disagree, who may indeed be likely to see our argumentation as “coercive” if pushed too much too quickly. This requires discipline and focus on our part, the former to temper our enthusiasm to act too quickly, the latter to maintain our effort. We can see the virtue of this approach in the success of the movement for the acceptance and legalization of same-sex marriage in the US. For years, advocates of same-sex marriage worked patiently to advance the case that gay couples deserved the dignity and security of being able to legally marry. To many of these advocates, this likely seemed obvious, self-evident, and to engage civilly with those who felt differently—to have to argue in favor of the self-evident—took tremendous discipline. Yet they persisted, eventually winning not just a favorable decision by the Supreme Court, but, ultimately, the bipartisan passage of a law codifying same-sex marriage. We would do well to apply a similar approach in our engagement with other issues.

At the end of the day, we have little choice but to advance both science and argument to implement the work of public health. The question is how to do both. Here I try to suggest how we may do the latter, working to apply moral force without letting that force get out of hand. In next week’s piece, I will discuss some approaches to the former. I look forward to continuing the conversation.

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Also this week.

Some personal news.