I was skip reading through the recent issues of an European bioethics journal Medicine, Health Care and Philosophy the other day. Being a philosopher with a somewhat methodological lookout on the subject matter, an interesting feature caught my eye: the lack of use of counterfactuals in presenting the points.

The prominent use of counterfactual reasoning had made bioethics somewhat notorious subject in the 1980's and 1990's - everyone acquainted with the subject remembers "the Trolley problem" days. Even still one can find indignant criticisms of the whole subject field that find this particular way of adressing ethical problems the most disturbing feature in the academic discipline: it is - as the argument often goes - detached from the ethical complexities of the real world, or something of a like.

One can, of course, find a little truth to this criticism. It's not really that easy to use counterfactuals as the main stem of the argument, far from it. And - on the opposite side - it's far too easy to misinterpret them, even if they are robust and formally well constructed. It's hard for the people in general to get a point, if the method for the point making is using a far-fetched comparison. We all are familiar with situations, where we make a point by "iffing" like "Imagine if everybody acted like you did, it'd be really bad!" and we get a response "...But everybody doesn't act like that!". Using the "if" is guaranteed to have our point missed.

But what, then, is a counterfactual? It can be a lot of things. A proper argument, an elaboration, a thought experiment, or a rhetorical device used for "pumping intuitions" to name a few uses.

As a proper argument it can be used, for instance, as a consistency challenge. If you take these premises - let's say - "more lives saved the better" and "people are generally of equal moral character", and you are faced with a supposed situation where you'd need to make a life-and-death choice between an innocent child and a small group of fatally ill people, somehow terrifying and murderous criminals, or something of a like. You have a trade-off between something intuitively valuable and intuitively nasty, unpleasant or, indifferent. Now rational consistency demands we make the pro-nasty choice, whereas our moral intuitions in the back of our heads somehow nag us about this choice. It seems either our premises are somehow flawed and we need more gradients for moral significance, or we need to scold our intuitions to match our rational commitments more strongly. Either-or.

The counterfactual does not imply we ought to seek into this kind of situation. It does not even imply us to imagine ourselves realistically acting in the face of this kind of choice, yanking the levers, pushing the buttons and pulling the plugs in a traumatizing panic. It just points out a simple (sic!) philosophical problem: here are our explicit rational commitments or our general moral carpet statements, and there are our moral intuitions. They don't seem mix very well. Now what to do about it? The argument could be presented in a more straightforward and less stylish manner, but then again these kinds of elaborations show and don't just tell.

Counterfactuals are, of course, used as "intuition pumps" as well. That is, not as proper arguments but as rhetorical tools for rigging the description to persuade. This means that by our counterfactual device we pull an analogy between, let's say, making an abortion and brutally murdering an innocent human being. By framing the issue this way we "pump" our audience's intuitions the way we want them to react.

The distinction between these two, the argumentative and the rhetoric use, is of course not that straightforward. This is why, I believe, nowdays counterfactuals are being used as a method more sparingly in the European biotethics at least.

Even though the use of counterfactuals in bioethics are often criticized from the practice oriented clinical perspective as alienating, far-fetched and over-hypothetical, one might do well to go through a little thought experiment that might put some healthy respect for the “iffing” in philosophy. What would our thinking be like without counterfactuals? Would thinking (as we now know it) be possible at all?

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	Having an eye out for the "if"