Justifying a moral judgement: top-down, casuistry, reflective equilibrium
- Theory
A moral judgement is justified by applying a theory, comparing with clear cases, or adjusting principles and judgements until they fit.
What it is
Justifying a moral decision means giving reasons others can review. Bioethics has three models. The top-down (deductive) model starts from a theory or principles and deduces rules and conclusions for the case; it is orderly, but it runs into the variety of theories and into cases no principle foresees. The bottom-up model, casuistry (defended by Albert Jonsen and Stephen Toulmin), reasons from paradigm cases already settled and compares the new one by analogy, as law does with precedent. Reflective equilibrium, proposed by John Rawls (A Theory of Justice, 1971), adjusts principles and considered judgements about cases in both directions until they cohere; in its wide version it also takes background theories and alternative arguments into account. Principlism uses an integrated model: principles that are specified and balanced, checked for coherence.
Core ideas
- Deductivism: orderly and transparent, but rigid; depends on which theory is accepted.
- Casuistry: close to the clinic and useful in pluralist societies, where people agree on cases even without agreeing on theories; depends on which cases are chosen as models.
- Narrow reflective equilibrium: fits principles to initial judgements with few changes.
- Wide reflective equilibrium (Rawls and Norman Daniels): also weighs background theories and alternative arguments; everything is revisable.
- Principlism's integrated model: specify and balance principles, and check the coherence of the whole.
Three models of moral justification
| Model | Starting point | Strength | Weakness |
|---|---|---|---|
| Top-down | Theory or principles | Order and transparency | Rigidity; depends on the theory chosen |
| Casuistry | Paradigm cases | Close to the clinic; allows agreement without a shared theory | Depends on which cases are taken as models |
| Reflective equilibrium | Principles and case judgements together | Coherence revisable in both directions | May keep the biases of initial judgements |
In clinical practice
- A committee applying an institutional rule to a case reasons top-down.
- When comparing a new treatment refusal with already-analysed cases of patients with capacity who refuse, the committee uses casuistry.
- If a principle leads to a conclusion that seems clearly unjust in a case, reflective equilibrium asks for the principle or its specification to be revised.
- Recording the reasons in the medical record lets others review the justification.
Criticisms and limits
- Deductivism fails when theories contradict each other or when the case does not fit the rule.
- Casuistry can repeat the biases of the chosen cases and cannot explain why a case is paradigmatic without appealing to principles.
- Reflective equilibrium can be conservative: if initial judgements are biased, coherence does not correct them.
- Critics argue that with wide reflective equilibrium, principles lose the priority principlism gives them.
Test yourself
Think of the answer, then tap the question to see it.
How does the top-down model reason?
It starts from a theory or principles and deduces rules and conclusions for the concrete case.
What is casuistry?
Bottom-up reasoning that compares the new case with paradigm cases already settled, by analogy, as law does with precedent.
Who proposed reflective equilibrium, and in which work?
John Rawls, in A Theory of Justice (1971).
What does wide reflective equilibrium add to the narrow version?
It also considers background theories and alternative arguments, rather than just fitting principles to initial judgements; everything stays revisable.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Bioethics and Moral Reasoning (Stanford Encyclopedia of Philosophy, 2026); Reflective Equilibrium (Stanford Encyclopedia of Philosophy, 2023).
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Representative model, for educational purposes only.