Proponents of casuistry criticize other ethical theories (specifically utilitarianism and Kantianism) as being too impractical for use in bioethics and insist that casuistry is a better, more practical alternative. Casuistry advocates are accurate when making these assertions. Such recognition should only be interpreted as an example of damning with faint praise, though, for casuists typically discount other moral theories (particularly rights theories) that, correctly formulated, are even more practical than casuistry. In addition, casuists are tragically incorrect in their view of a vastly more important issue — the fundamental end of bioethics. They unfortunately believe that practicality is the fundamental end of bioethics, whereas the true end of bioethics (in fact, the true end of any ethical theory) is justice.

Casuistry is a practical ethical theory for, despite diverse perspectives held by the parties involved in any medical ethics dilemma, casuists can always arrive at a definitive conclusion by comparing the new scenario to “shared moral conclusions” and similar “paradigm cases”. On the other hand, utilitarianism and Kantianism are impractical because conflicting views about preferences, actions, and obligations often cannot be resolved via these ethical theories; indecision, confusion, and delay of appropriate medical decision-making are the result. Thus, casuists are correct to claim superiority to utilitarians and Kantians when practicality is the desired end.

Is casuistry the most practical moral theory, however? I think not. I claim that a rationalist ethical theory — a hybrid of rights theory, virtue ethics, and consequentialism — is more practical than casuistry. Such a theory can be based on the fundamental fact of scarcity (in the real world material goods and the means to achieve desired human ends are scarce [a finite supply of the resource] and rivalrous [the resource cannot be utilized by separate actors simultaneously]) AND the desire for a simple, coherent, and justified method to permit the conflict-free use of scarce resources to maximize human flourishing. If property rights are constructed logically from these premises, the resulting rationalist rights theory, not casuistry, is the most practical moral theory.

Practicality is not the fundamental issue when comparing and contrasting ethical theories, however. While practicality is a necessary component of an ethical theory, there are several other commonly recognized and equally important conditions: clarity, coherence, comprehensiveness, simplicity, explanatory power, justificatory power, and output power. If practicality is not the fundamental end of an ethical theory, what is? The fundamental purpose of any ethical theory is to achieve justice. Everyone getting what they deserve is an ancient but succinct definition of distributive justice, which is the type of justice needed in a universe of scarce resources. And, again, I claim that a rationalist theory, rooted in rights theory but influenced by virtue ethics and consequentialism, is easily the best moral theory to which humans can subscribe to maximize justice.

In conclusion, casuistry is more practical than utilitarianism and Kantianism, less practical than a rationalist morality grounded in rights theory, focuses excessively on practicality, and minimizes, to its own disservice, the human desire for justice.