Public Reason, Bioethics, and Public Policy: A Seductive Delusion or Ambitious Aspiration?

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research.

Public Reason Requirements in Bioethical Discourse.

This paper analyzes the use of public reason requirements in bioethical discourse and discusses when such requirements are warranted. By a "public reason requirement," I mean a requirement that those involved in a particular discourse or debate only use reasons that can properly be described as public reasons. The first part of the paper outlines the concept of public reasons as developed by John Rawls and others and discusses some of the general criticisms of the concept and its importance. The second part then distinguishes between two types of public reason requirements in bioethics. One type is what I will call the orthodox public reason requirement since it hews closely to the original Rawlsian conception. The second is what I will call the expansive public reason requirement, which departs quite radically from the Rawlsian conception and applies the requirement not to policy discourse or policymaking, but to the actions of individuals. Both types of requirements will be analyzed, and some problems in applying public reason requirements in bioethics will be identified. It will be argued that the expansive public reason requirement is misguided. The concluding part argues that requirements of civic civility and what Rawls terms an "inclusive view" of public reason should be important in bioethical discourse.

Overlapping consensus in pluralist societies: simulating Rawlsian full reflective equilibrium.

The fact of reasonable pluralism in liberal democracies threatens the stability of such societies. John Rawls proposed a solution to this problem: The different comprehensive moral doctrines endorsed by the citizens overlap on a shared political conception of justice, e.g. his justice as fairness. Optimally, accepting the political conception is for each citizen individually justified by the method of wide reflective equilibrium. If this holds, society is in full reflective equilibrium. Rawls does not in detail investigate the conditions under which a full reflective equilibrium is possible or likely. This paper outlines a new strategy for addressing this open question by using the formal model of reflective equilibrium recently developed by Beisbart et al. First, it is argued that a bounded rationality perspective is appropriate which requires certain changes in the model. Second, the paper rephrases the open question about Rawlsian full reflective equilibrium in terms of the model. The question is narrowed down by focusing on the inferential connections between comprehensive doctrines and political conception. Rawls himself makes a demanding assumption about which connections are necessary for a full reflective equilibrium. Third, the paper presents a simulation study design that is focused on simplicity. The results are discussed, they fit with Rawls's assumption. However, because of the strong idealisations, they provide a useful benchmark rather than a final answer. The paper presents suggestions for more elaborate study designs.

How Do You Like Your Justice, Bent or Unbent?

Principles of justice, David Estlund argues, cannot be falsified by people's unwillingness to satisfy them. In his Utopophobia, Estlund rejects the view that justice must bend to human motivation to deliver practical implications for how institutions ought to function. In this paper, I argue that a substantive argument against such bending of justice principles must challenge the reasons for making these principles sensitive to motivational limitations. Estlund, however, provides no such challenge. His dispute with benders of justice is therefore a verbal one over the true meaning of justice, which need not worry those with the intuition that justice should perform a function that requires bending. By focusing on John Rawls's reasons for bending his justice principles, I point towards a substantive critique of bent justice.

Rawls and Animal Moral Personality.

The relationship between animal rights and contractarian theories of justice such as that of Rawls has long been vexed. In this article, I contribute to the debate over the possibility of inclusion of animals in Rawls's theory of justice by critiquing the rationale he gives for their omission: that they do not possess moral personality. Contrary to Rawls's assumptions, it appears that some animals may possess the moral powers that comprise moral personality, albeit to a lesser extent than most humans. Some animals can act in pursuit of preferences and desires (and communicate them non-verbally), which might be taken as implicitly selecting a conception of the good; further, scientific research demonstrating inequity aversion and social play behaviors suggests that some animals can have a sense of justice relating to their own social groups. I conclude that Rawls's theory needs to acknowledge any animals that can be considered to meet the threshold of moral personality, while the concept of moral personality as a range property may also require reconsideration.

The Dobbs Decision: Can It Be Justified by Public Reason?

John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito's emphasis on "ordered liberty" seems completely at odds with the "disordered liberty" regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until birth as an "unborn human being" begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women.

Zero-rating and prioritization in Europe during the Covid-19 pandemic: a Rawlsian perspective on net neutrality.

In recent years two business practices, namely zero-rating (ZR) and prioritization (PR), have been widely discussed and debated. The debate is mostly built around the idea that these two practices violate the so-called net neutrality (NN) principle, which requires that all Internet data packages are treated equally. There is no unanimous consensus among scholars about NN and the adopted regulations are heterogeneous across countries, variable over time, and often contentious. In any case, the current judgements and regulations do not take into consideration exceptional circumstances, like the Covid-19 pandemic, in which an Internet connection becomes essential to carry on fundamental socio-economic activities. Focusing on the European case, in this paper we claim that, in a context such as a global pandemic, the practices of ZR and PR have to be re-examined. We do so through the perspective of the social contract theory developed by John Rawls. Our main conclusion is that, during a conjunctural crisis, where an Internet connection becomes an essential tool, ZR and PP should both be allowed. Our contribution goes towards the direction of adding a provisio to the standard European Internet regulation, allowing ZR and PR in specific contexts.

Moral experts as members of ethics commissions as seen through the prism of comprehensive doctrines.

Ethics commissions provide expert advice to governments on what policies to implement regarding pressing ethical issues, most often in bioethics. These commissions distinguish themselves by having members from the professions we are most likely to think of as moral experts, if we believe that these exist. The relationship between moral experts and the composition of ethics commissions is worthy of further exploration, especially because of the highly controversial nature of whether moral expertise exists and, if so, how, and whether, we can identify moral experts. Moreover, it has been argued that the emergence of ethics commissions and how they have been composed have led to a "thinner" debate. In the first part of the article, the problem regarding checks for identifying moral experts is discussed. I argue that one way to handle this difficulty is through the application of Rawls' concept of comprehensive doctrines. These doctrines have inherent standards that function similarly to independent checks, making it possible to identify moral experts from within such different doctrines. Using this approach makes it manageable to appoint moral experts to ethics commissions. In the second part, I consider the implications of seeing moral expertise through the prism of comprehensive doctrines for the composition of ethics commissions. One natural conclusion is that we should select moral experts representing different reasonable comprehensive doctrines to serve as members of ethics commissions. I consider six challenges to my proposal and demonstrate why these lack merit, and I point out some practical concerns that need further inquiry.

Healthy Eating Policy: Racial Liberalism, Global Connections and Contested Science.

The challenges to designing and implementing ethically and politically meaningful eating policies are many and complex. This article provides a brief overview of Anne Barnhill and Matteo Bonotti's Healthy Eating Policy and Political Philosophy: A Public Reason Approach while also critically engaging with the place of racial justice, global interconnectedness, and debates over science in thinking about ethics and politics of public health nutrition and policy. I do not aim to burden Barnhill and Bonotti with the responsibility to fully address these issues, but considering the interconnection of these issues and the ever pressing effects of climate change on local and global food systems, we collectively need to turn to these difficult and pressing questions about what a just food system looks like, what concerns are centred, and who is left out. I group these engagements with Barnhill and Bonotti under three headings: racial liberalism, global food system, and contested nutrition science. I conclude with some remarks about locality.

Legitimacy-not Justice-and the Case for Judicial Review.

Sceptics of judicial review-from Jeremy Waldron to those in the Judicial Power Project-have tended to attribute to their opponents an erroneous prioritisation of 'justice' over 'legitimacy'. They claim that those who make the case for judicial review do so on the grounds that 'judges know best', and that judicial review therefore helps promote the overall justness of a state's social order-rather than on the grounds that it helps enhance the overall legitimacy of a state's authority. This article interrogates that line of attack. It explores its roots in political theory, particularly the idea that those guilty of it (such as Aileen Kavanagh) follow in John Rawls's supposed prioritisation of justice over legitimacy. And it turns to republican and later-Rawlsian thinking on these two concepts to see whether it may offer a sound basis upon which the case for judicial review can be made … legitimately.

Rights redistribution and COVID-19 lockdown policy.

What is the tenet upon which the public policy of lockdown by fiat experienced during the COVID-19 pandemic is based on? The work approaches this question about the rationale of the mandatory shelter-in-place policy as an interpersonal exchange of rights, but where the exchange occurs coercively instead of voluntarily. It compares, in positive political economy terms, the normative principles of utilitarianism and Rawlsianism, and shows that lockdown by fiat is a policy that is closer to a maximin equity criterion rather than to a utilitarian one. The work moreover shows, also with the aid of a thought experiment and with factual applications, that the fiat redistribution of rights to liberty in favor of rights to health-from those least affected to those most affected by COVID-19-is, in the main, a policy choice that is to be expected under certain constraints.

Re-engineering contested concepts. A reflective-equilibrium approach.

Social scientists, political scientists and philosophers debate key concepts such as democracy, power and autonomy. Contested concepts like these pose questions: Are terms such as "democracy" hopelessly ambiguous? How can two theorists defend alternative accounts of democracy without talking past each other? How can we understand debates in which theorists disagree about what democracy is? This paper first discusses the popular strategy to answer these questions by appealing to Rawls's distinction between concepts and conceptions. According to this approach, defenders of rival conceptions of, e.g. justice can disagree without talking past each other because they share the concept of justice. It is argued that this idea is attractive but limited in application and that it fails to do justice to the dynamic and normative aspects of concept formation. Reflective equilibrium is then suggested as an alternative approach. It replaces the static contrast between a conceptual 'core' and competing conceptions by a dynamic perspective of concept formation as a partly normative undertaking: pre-theoretic language use and commitments can provide a shared starting point for developing alternative accounts which yield different concepts of, e.g. justice. This perspective provides a new understanding of how it is possible that different theorists defend rival accounts of, e.g. justice, without talking past each other.

Public Reason in a Pandemic: John Rawls on Truth in the Age of COVID-19.

In "Justice as Fairness: Political not Metaphysical," John Rawls suggests an approach to a public conception of justice that eschews any dependence on metaphysical conceptions of justice in favor of a political conception of justice. This means that if there is a metaphysical conception of justice that actually obtains, then Rawls' theory would not (and could not) be sensitive to it. Rawls himself admitted in Political Liberalism that "the political conception does without the truth." Similarly, in Law of Peoples, Rawls endorses a political conception of justice to govern the society of peoples that is not concerned with truth, but instead concerned with being sufficiently neutral so as to avoid conflict with any reasonable comprehensive doctrines. The odd result is that this neutrality excludes any conception of truth at all. Therefore, in times of crisis that demand incisive decision making based on scientific, economic or moral considerations, public reason will stall because it can contain no coherent conception of truth.

The ethical challenges facing the widespread adoption of digital healthcare technology.

With the rise of telemedicine, wearable healthcare, and the greater leverage of 'big data' for precision medicine, various challenges present themselves to organisations, physicians, and patients. Beyond the practical, financial, and clinical considerations, we must not ignore the ethical imperative for fair and just applications to improve the field of healthcare for all. Given the increasing personalisation of medicine and the role technology will play at the interface of healthcare delivery, a thorough understanding of the challenges presented is critical for future physicians who will navigate a novel environment. This article aims to explore the ethical challenges that the adoption of digital healthcare technology presents, contextualised at multiple levels. Potential solutions are suggested to initiate a discussion about the future of medicine and digital healthcare.

The Socio-Political Roles of Neuroethics and the Case of Klotho.

An increasing amount of very diverse scholarship self-identifies as belonging to the field of neuroethics, illuminating a need to provide some reference points for what that field actually entails. We argue that neuroethics is a single field with distinct perspectives, roles, and subspecialties. We propose that-in addition to the three traditional perspectives delineated by Eric Racine-a fourth, socio-political perspective, must be recognized in neuroethics. The socio-political perspective in neuroethics focuses on the interplay between the behavioral as well as the brain sciences and the socio-political system; this interplay includes social regulation in addition to all other realistic elements of social and political neurodiscourses. Thus, defining what-if any-roles the socio-political perspective in neuroethics might have is a pressing issue. Doing so could provide guidance for defining the criteria for prospective ethical evaluations in neuroethics. A promising approach to doing this could be by describing the roles of neuroethics in terms of the more concrete examples of the roles of political philosophy in general, as in the tradition of John Rawls. We take klotho, the supposed "longevity protein," as a modern neuroethics case to exemplify the obstacles faced in securing neuroethics' legitimacy and how the Rawlsian framework we propose may be applied to handle cases such as this. Ultimately, the socio-political perspective in neuroethics should not be swayed by the media hype and ought to offer useful ethical guidance and articulation of genuine ethical concerns to policy makers and the public alike.

Justice, Bioethics, and Covid-19.

Both articles in the November-December 2021 issue of the Hastings Center Report reflect bioethics' growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement-an approach that replaces personal autonomy with group benefit as the primary criterion for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance.

Health Justice and Rawls's Theory at Fifty: Will New Thinking about Health and Inequality Influence the Most Influential Account of Justice?

This year marks the centenary of John Rawls's birth and the fiftieth anniversary of the publication of A Theory of Justice. The influence of Rawls's landmark book on the general fields of moral and political philosophy is undisputed and well-documented. It has also left a significant imprint on debates surrounding health policy, health care, and health inequalities. This article traces the changing ways in which Rawls's theory influenced debates about justice in health over the last five decades. Just as Rawls's ideas have shaped debates about health, however, these debates can help us critically appraise the theory and its limitations. In that spirit, the article sketches three areas where a focus on health reveals challenges to the Rawlsian framework: the issue of priority setting among competing goods, the theory's egalitarian commitments, and its focus on the distribution of goods.

John Rawls, Godfather of Bioethics.

At a time when ethical and political philosophy were thought passé, John Rawls gave serious attention to ethical questions, providing them with a renewed academic legitimacy. This helped fields of practical ethics such as bioethics become established in higher education and in public affairs. This essay addresses the influence Rawls has had on bioethics through both the style and the substance of his ethical argumentation. The essay argues that his distinctive rhetorical strategy and tone attempted to rein in the scope of normative commitments in order to make an equilibrium between refined understandings of freedom and equality possible and sustainable. Bioethics has been strongly influenced by this approach to maintaining social stability in a liberal society that has become highly stratified and culturally diverse. Bioethics continues to echo the Rawlsian call for a calmly reasoned political life but finds that call increasingly difficult to answer.

Distributive justice, equality and the enhancement of human cognition: A commentary on fairness and 'cognitive doping'.

What implications might the use of techniques to enhance human cognition have for the kind of polities or civil societies we inhabit? What might political philosophy, if anything, have to tell us about the desirability of using drugs to increase our intellectual powers? Much of the focus in contemporary debates about human enhancement has been upon the ethical desirability of endeavouring to enhance our capacities: should we be meddling with 'human nature', as it were? Therapeutic uses of drugs are regarded as acceptable but enhancement is frowned upon in much of this literature. This rejection of enhancement is especially prevalent in the area of sport where there is a great deal of opposition to doping. Herein I take a somewhat different approach and explore enhancement as a problem in political philosophy and, more specifically, as a problem of distributive justice. Should the enhancement of human intellectual functioning be rejected on distributive grounds of equality? Alternatively, might it be plausibly be argued that distributive justice requires such enhancement? In this paper I shall outline two contemporary theories of justice-namely, the Egalitarianism and the Rawlsian Prioritarianism-and then consider what these principles might tell us about the political legitimacy (or otherwise) of 'doping for intellect'.

Procedural Moral Enhancement.

While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important - reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people's moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement.