As long as we stick to secular bioethics, the basic view of H. Tristram Engelhardt, Jr. is quite clear and simple: given the failure of the Enlightenment to rationally secure a content-filled, lexically ordered secular morality, we are left with a bare-bones sort of ethics of permission between moral strangers (Engelhardt, The foundations of Christian bioethics. Swets & Zeitlinger Publishers, Lisse, 2000). In what follows, I will address three interrelated issues: (1) is the secular, libertarian ethics of permission that Engelhardt sees us left with as impoverished as he and others hold it is – is this really all a secular bioethics can say?; (2) does this libertarian view somehow naturally tend to evolve into the liberal cosmopolitan view as he asserts?; and (3) is there nothing between the libertarian and liberal cosmopolitan views within which those who lack the content-filled sort of vision that Engelhardt aspires to might rest relatively satisfied?