Asked his opinion on the political issues of the day, Saul Bellow, the American novelist, would sometimes say that he was in favour of all the good things and opposed to all the bad ones. Bellow’s lovely little quip has been on my mind a good deal of late. Take the recent statement by the American Academy of Paediatricians (AAP) in favour of the minimal cutting – ‘nicking’ is their preferred phrase, but that surely calls up other associations – of healthy female genitalia to meet the ‘cultural’ requirements of certain ethnic groups. Female genital mutilation is illegal in the UK and it is unlikely therefore to present British doctors with ethical dilemmas. Colleagues of mine, however, who have practised in the Horn of Africa, where genital mutilation is widespread, have had different experiences. They have been begged to do the procedure. If doctors don’t do it – using surgical techniques and sterile equipment – it’ll be done in a backstreet with a rusty nail. This is a genuine dilemma. Banning FGM stems from the desire to protect the health, and the sexual and reproductive freedom, of women. And yet in certain circumstances, a doctor undertaking the procedure could be doing just that. It looks like a tragic choice. There doesn’t seem to be any getting away from the fact that doing the right thing here is also doing the wrong thing, whatever we decide to do. The AAPs statement should be read as an attempt to ease some of the tension in this dilemma. Confronted with a genuine dilemma, it is impossible, to return to Bellow, to be simultaneously in favour of all the good things and opposed to all the bad ones.

We all know that life contains tragic choices. Where they confront society -and confront society they must – Parliament is the appropriate venue for their adjudication. It was Parliament, after all, that banned FGM in the UK. Thinking about colleagues confronting real dilemmas brought to mind the recent election. The prospect of a hung Parliament may have stirred a few dormant political passions, but one of its uniformly depressing features was the complete refusal by any party, or any of its representatives, publicly to state that even something so inevitable as a choice between desirables might be required. I did not hear a single statement of intention in mainstream media that a reasonable person could possibly disagree with. A fairer society! Of course. Efficiency! Where are the public champions of inefficiency? Greater opportunity for all! Where are the cries for less? But it is worth thinking for a moment even about a phrase as inoffensive as ‘greater opportunity for all’. Surely it contains an internal contradiction. The massive redistribution of wealth required by any push towards equality of opportunity must mean that the opportunities of some – the wealthy – must be restricted.

In my admittedly limited experience politicians are very far from stupid. They are aware of the choices that need to be made and will discuss them with great vigour in private. Put very crudely, political debate in the UK, at least until recently, would see the right promoting greater individual freedom, particularly economic freedom, and the left championing equality, the latter always promising that greater equality would, in the end, lead to an increase in overall freedom. Such a politics required a strong commitment to some underlying values and a willingness to defend them vigorously. Brown, for all his faults, looked very much like a conviction politician using the blunt tools of politics to try and push a refractory world in the direction of his beliefs.

There are no doubt many reasons for the current poverty of public political debate but fear of the media must play some part in it. Contemporary political debate largely consists of the elegant art of saying nothing in order to offend, well, nobody. A free press is often thought of as a defining feature of an open society. And yet, paradoxically, the very conditions that permit liberty of expression are working to stifle it. We are in danger of a press incapable of trading in anything but banalities. George Orwell had a word to describe the kind of language such a press would use: Newspeak. Just as the word ‘small’ is being eliminated from coffee shops across the world, so the idea that some goods are incompatible is disappearing from mainstream political debate.

There may of course be other reasons for the blandness of mainstream political debate. Perhaps we have achieved universal consensus on the ends of life, that all sensible people agree that a semi-detached house, two holidays a year and a weekly trip to the supermarket are the consummation of all our political longing. Perhaps the only remaining question is how everyone can achieve them, that the management of things, as Saint Simon prophesied, has finally replaced the government of persons. But even the briefest scan of the contemporary political horizon suggests that this cannot be so. Here is Isaiah Berlin:

“The world that we encounter in ordinary experience is one in which we are faced with ends equally ultimate, and claims equally absolute, the realization of some of which must inevitably involve the sacrifice of others – the possibility of conflict – and of tragedy, can never wholly be eliminated from human life, personal or social.”

If Berlin is right, and I believe that he is, politics will remain the arena in which we debate the profoundest problems that confront us. And it is for this reason that we need a language, and a seriousness, that is equal to them, a language that acknowledges, at the very minimum, that we cannot always be in favour of all the good things and opposed to all the bad ones.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.