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Ethical issues in healthcare and biomedical research are often a matter of public debate. This entry will explore several prominent views on how such debate should be conducted within pluralistic democratic societies. It begins by considering John Rawls’s account of public reason. It then examines how this account applies to the controversial issues of abortion and physician assisted suicide, where one can see why some have objected to this view, especially with regard to the way it requires citizens to bracket their comprehensive moral, religious, and philosophical doctrines. Next, this entry will consider some alternative approaches that endorse more expansive forms of public reason that allow greater room for appeals to comprehensive doctrines. While one might expect that many of the controversial issues in bioethics will continue to be a matter of public debate going forward, it will be seen that a necessary step towards making progress in these debates is to get clear on how such debate should be conducted.


In contemporary democratic societies, ethical issues in healthcare and biomedical research are often a matter of public debate – indeed, frequently heated debate – over the direction of public policy. One might think, for instance, about the debates surrounding abortion, euthanasia, physician-assisted suicide, genetic engineering, research on embryos, assisted reproduction, healthcare distribution, public health initiatives, and so on. It is no surprise that these issues are a matter of public debate since they have widespread implications for how human beings live their lives. However, there are important questions that arise about how public debate should be conducted given the plurality of moral and spiritual perspectives within contemporary democratic societies around the world. In other words: how should citizens conduct public debate when the parties to the debate hold competing conceptions of “the good life”?

Rawlsian Public Reason

One of the most influential and widely discussed views on how such debate should be conducted within contemporary democratic societies is put forward by John Rawls (Rawls 1993 [2005]). Rawls starts by affirming what he calls the “fact of reasonable pluralism,” which is “the fact that a plurality of conflicting reasonable comprehensive doctrines, religious, philosophical and moral, is the result of [a democracy’s] culture of free institutions” (ibid., p. 441). Given this plurality of reasonable comprehensive doctrines with competing conceptions of the good life, the question arises: how can fair terms of social cooperation be established among citizens who are regarded as free and equal? Rawls’s account of public reason is intended to provide an answer to this question. He writes: “A citizen engages in public reason [.. .] when he or she deliberates within a framework of what he or she sincerely regards as the most reasonable political conception of justice, a conception that expresses political values that others, as free and equal citizens might also reasonably be expected to endorse” (ibid., p. 450). Democratic citizens, Rawls maintains, should appeal to public reason whenever they are debating constitutional essentials and matters of basic justice with an aim to enacting public policies.

In seeking to establish his view of “justice as fairness,” Rawls’s own way of proceeding with respect to public reason is to suggest that citizens should think of themselves in the hypothetical scenario of the “original position,” where they adopt what he calls the “veil of ignorance” (ibid., pp. 22–28). In other words, citizens should reason about the fair terms of social cooperation for mutual advantage as if they did not know the details of their particular social position, their natural abilities and proclivities, and their comprehensive doctrine with its particular conception of the good life. The function of the veil of ignorance is to assure that individuals consider their choice of the principles of justice (the fair terms of social cooperation) from a general standpoint that is not biased by the contingencies of their particular social and historical circumstances and to assure that no one has an unfair bargaining advantage. Whether one thinks that this is the best way of proceeding, Rawls believes that public reason will ultimately lead to a liberal political conception of justice, which will have three main features: first, it will identify basic rights, liberties, and opportunities; second, it will assign a priority to these basic rights, liberties, and opportunities over claims pertaining to the general good of society and ideals of the good life; and third, it will ensure all citizens adequate resources for making use of their freedoms in pursuing their particular conceptions of the good life (ibid., p. 450).

The foregoing might seem to suggest that citizens should never appeal to their comprehensive doctrines when debating constitutional essentials and matters of basic justice with an aim to enacting public policies. Although Rawls once held this restrictive view, he came to embrace a somewhat less restrictive view, which allows that citizens may “introduce into political discussion at any time [their] comprehensive doctrine, religious or nonreligious, provided that, in due course, [they] give properly public reasons to support the principles and policies [their] comprehensive doctrine is said to support” (ibid., p. 453; see also p. 247). For instance, appeals to religious reasons were common among the abolitionists and civil rights leaders in the United States, yet Rawls says that this can be in accord with public reason insofar as these religious reasons could ultimately be stated in terms of political values acceptable to all, such as “freedom and equality for all” (ibid., pp. 249–251, 464). The goal is that ultimately there will be an “overlapping consensus” around political values that different comprehensive doctrines can support for their own particular reasons. Rawls thinks that appealing to how one’s comprehensive doctrine supports such political values can in fact help to strengthen the commitment to these values among citizens. Nevertheless, it is still the case that the ultimate justification for these political values should not be derived from any particular comprehensive doctrine, but rather it should be derived from the fact that these values are seen as acceptable to citizens with different comprehensive doctrines and can be supported by an overlapping consensus.

But why must citizens, in due course, appeal to public reasons whenever they are debating constitutional essentials and matters of basic justice with an aim to enacting public policies? They should do so because of the “duty of civility,” which enjoins citizens to follow the “criterion of reciprocity”: that is, when they propose what they think are the fair or most reasonable terms of social cooperation, they must also “think it at least reasonable for others to accept them, as free and equal citizens, and not as dominated or manipulated, or under the pressure of an inferior political or social position” (ibid., p. 446). This in turn forms the basis of political legitimacy. The issue of political legitimacy arises because of the use of coercive political power in enforcing constitutional essentials and matters of basic justice. So the question is: how can citizens justify to one another the use of coercive political power that will be a part of any proposed political conception of justice? Rawls’s answer is that citizens must be able to appeal to reasons (political values) that they can reasonably expect others to accept. He writes: “when, on a constitutional essential or matter of basic justice, all appropriate government officials act from and follow public reason, and when all reasonable citizens think of themselves ideally as if they were legislators following public reason, the legal enactment expressing the opinion of the majority is legitimate law” (ibid., p. 446). It follows that if citizens cannot provide reasons that they can reasonably expect others to accept and that would be supported by an overlapping consensus, then they must avoid using coercive political power and instead allow each person the freedom to live as he or she deems fit, so long as he or she does not infringe on the ability of others to do likewise. Rawls acknowledges that those who think that “fundamental political questions should be decided by what they regard as the best reasons according to their own idea of the whole truth [.. .] and not by reasons that might be shared by all citizens as free and equal, will of course reject the idea of public reason” (ibid., p. 447). However, he says: “Political liberalism views this insistence on the whole truth in politics as incompatible with democratic citizenship and the idea of legitimate law” (ibid.).

Two Cases

In order to explore what is at stake in Rawls’s account of public reason, it is helpful to consider its application to two of the most controversial issues in bioethics, which have been and will surely continue to be the site of public debate: namely, abortion and physician-assisted suicide.

Rawls in fact uses the issue of abortion in order to illustrate his account of public reason. He suggests that the issue should be considered in terms of three key political values that one can reasonably expect others to accept: namely, (1) “the due respect for human life,” (2) “the ordered reproduction of political society over time, including the family in some form,” and (3) “the equality of women as equal citizens” (ibid., p. 243, n. 32) Rawls then contends: “any reasonable balance of these three values will give a woman a duly qualified right to decide whether or not to end her pregnancy during the first trimester” (ibid.). The reason that he provides for this claim is that “at this early stage of pregnancy the political value of the equality of women is overriding, and this right [to an abortion in the first trimester] is required to give it substance and force” (ibid.). Rawls goes on to claim that “any comprehensive doctrine that leads to a balance of political values excluding that duly qualified right in the first trimester is to that extent unreasonable,” and indeed “it may also be cruel and oppressive” (ibid., pp. 243–244, n. 32) Moreover, he says, “we would go against the ideal of public reason if we voted from a comprehensive doctrine that denied this right” (ibid., p. 244, n. 32).

Unsurprisingly, Rawls’s claims here have been highly controversial and strongly contested, especially by those who think that a “due respect for human life” means respecting the inviolability of innocent human life from conception to death (Finnis 2000, pp. 75–93; George 2001, pp. 56–61). Indeed, Rawls merely asserts precisely what is at issue in saying that “the political value of the equality of women is overriding,” which is countered by the pro-life claim that the right to life of human embryos and fetuses is overriding. Nothing has been said here to show that the pro-life advocate is being “unreasonable,” and one might also imagine such an advocate likewise claiming that it is the pro-choice position that is “cruel and oppressive” by violating the right to life of innocent human embryos and fetuses, if one grants that such a right to life applies equally to all human beings. So the debate seems to be far from resolved.

In response to criticisms, Rawls later came to say that in the above passage he was not intending to provide an argument for abortion rights, but merely to illustrate and confirm a statement about how comprehensive doctrines can violate the ideal of public reason when they fail to endorse a reasonable balance of political values. He acknowledges that the passage does express his opinion but says that his stated opinion is not an argument (though the passage does have the appearance of an argument). Showing greater modesty, he writes: “a more detailed interpretation of those [three political] values may, when properly developed in public reason, yield a reasonable argument. I don’t say the most reasonable or decisive argument; I don’t know what that would be, or even if it exists” (Rawls 1993 [2005], p. 479, n. 80). As an example of such an argument, Rawls cites an article by Judith Jarvis Thomson (Thomson 1995), though he mentions that he would add several (unspecified) addenda to it.

Thomson’s argument is based on three main ideas: “First, restrictive regulation severely constrains women’s liberty. Second, severe constraints on liberty may not be imposed in the name of considerations that the constrained are not unreasonable in rejecting. And third, the many women who reject the claim that the fetus [in the non-technical sense that includes all prenatal human life] has a right to life from the moment of conception are not unreasonable in doing so” (Thomson 1995). She adds that all of these ideas seem very plausible to her and so it follows that she favors a pro-choice position. It should be noted that this argument is essentially a Rawlsian one: it is concerned with the legitimate use of coercive political power, where this is thought to be legitimate only when citizens can provide reasons for it that they can reasonably expect others to accept. Hence Thomson’s argument for abortion rights depends crucially upon the claim that pro-choice women are “not unreasonable” to reject the claim that “the fetus has a right to life from the moment of conception.” However, the problem is that pro-life advocates argue that it is in fact unreasonable to reject that claim, especially if one goes in for the “political value” of personhood at all, which includes a right not to be killed (at least if a person is innocent).

For instance, Patrick Lee and Robert P. George argue against dualistic views that maintain that human embryos and fetuses are not persons because they lack higher mental functioning. They contend that such views are based on a false premise: these views implicitly identify “the human person with a consciousness which inhabits (or is somehow associated with) and uses a body; the truth, however, is that we human persons are particular kinds of physical organisms. [.. .] [You] and I came to be at conception; we once were embryos, then fetuses, then infants, just as we were once toddlers, preadolescent children, adolescents, and young adults” (Lee and George 2005, pp. 15–16). There is not a difference in kind here, but only a difference in the degree to which a human being has realized the natural capacities that are definitive of the kind of being that humans are. So they conclude: “To have destroyed the human organism that you are or I am even at an early stage of our lives would have been to have killed you or me” (ibid., p. 16).

There are some who also reject the dualist view but claim that human beings only become bearers of rights at a later point when they have developed their human capacities to a sufficient degree. However, Lee and George argue that any view that regards personhood as a property that one comes to acquire sometime after conception, rather than something one has simply in virtue of being human, suffers from a line drawing problem. First, it is at least several months after birth until human beings perform mental acts that nonhuman animals do not perform and thus “if full moral respect were due only to those who possess a nearly immediately exercisable capacity for characteristically human mental functions, it would follow that 6-week old infants do not deserve full moral respect” (ibid., p. 18). Second, the difference between an immediately exercisable capacity for characteristically human mental functions and the basic natural capacity for developing the ability to perform such functions must be understood in terms of a developmental continuum. Thus, any line one draws for personhood that is not at conception – say, at brain functioning or sentience or viability or birth – is going to be arbitrary: “Between the ovum and the approaching thousands of sperm, on the one hand, and the embryonic human being, on the other hand, there is a clear difference in kind. But between the embryonic human being and that same human being at any later stage of its maturation, there is only a difference of degree” (ibid.). Finally, “if human beings were worthy of full moral respect (as subjects of rights) only because of [certain acquired] qualities, and not in virtue of the kind of being they are, then, since such qualities come in varying degrees, no account could be given of why basic rights are not possessed by human beings in varying degrees. The proposition that all human beings are created equal would be relegated to the status of a superstition” (ibid., p. 19).

In Thomson’s more well-known article on abortion, “A Defense of Abortion,” she in fact contends that even if it is granted that human embryos and fetuses are persons and thus have a right to life, nevertheless, they do not have a right to use a woman’s body to sustain their lives (Thomson 1971). Thomson argues for this conclusion by appealing to a now-famous analogy. She describes a hypothetical scenario in which one becomes kidnapped and then hooked up to a famous unconscious violinist with a potentially fatal kidney ailment in order to provide life support, which is required for 9 months, after which time the violinist will be recovered. Thomson thinks that in this case, one should not be required to stay plugged into the violinist, even though becoming unplugged before the 9 months is over would mean that the violinist would die. Although the violinist is a person and has a right to life, he does not have a right to use another person’s body in order to sustain his life. Now, the analogy here might seem to apply only to cases of pregnancy due to rape, but Thomson goes on to argue that it applies to all unwanted pregnancies. In any case, Thomson’s violinist argument has been the subject of much debate. For instance, some argue that there is a crucial difference between unplugging the violinist and aborting a human embryo or fetus. In the former case, one is merely allowing the violinist to die of the underlying pathology and does not intend to kill him even though one foresees that death will result as a “side effect” from the unplugging. By contrast, abortion typically involves intentional killing and in a manner that is a direct act of violence against a human life, which is quite different from mere “unplugging.” The right to life, it is argued, involves a right – qua innocent human being – not to be intentionally killed, though it allows for causing or allowing a foreseeable death so long as one does not intend the death, the death is a side effect of one’s action, and there is strong enough justifying reason for one’s action (as in the case of taking a terminally ill patient off of burdensome life support). Apart from the issue of intending versus foreseeing death, it is also argued that parents have a special responsibility to their biological children – even without voluntarily assuming this responsibility (something that Thomson denies) – which they do not have to a stranger. Moreover, it is claimed that the burdens of pregnancy pale in comparison to the harm inflicted on the embryo or fetus in being killed (see Lee and George 2005, pp. 20–24).

It is not possible here to pursue all of the issues that arise in this debate in full detail, but from the foregoing, one can see how public debate might proceed on the issue of abortion. In his revised view, Rawls acknowledges that the abortion debate, even with the use of public reason, is not likely to produce unanimity. Thus, citizens will simply need to vote on the matter, and the outcome of this vote is to be regarded as a legitimate law that is binding on all citizens, provided the vote was done in accord with public reason. For those who continue to disagree with such a law and argue against it, Rawls says: “they need not exercise the right to abortion. They can recognize the right as belonging to legitimate law enacted in accordance with legitimate political institutions and public reason, and therefore not resist it with force. Forceful resistance is unreasonable: it would mean attempting to impose by force their own comprehensive doctrine that a majority of other citizens who follow public reason, not unreasonably, do not accept” (Rawls 1993 [2005], p. 480). But is Rawls’s view here in fact reasonable?

John Finnis, for instance, thinks it is not. He writes: “The anti-abortion citizens are claiming, with some good arguments, that abortion is rather like slave-owning: a radical, basic injustice imposed on people deprived of the protections of citizenship. The response, ‘You free citizens need not exercise the right to [own slaves] [abort your children] in your own case, so you can and must recognize our law as legitimate as it applies to the rest of us,’ is mere impudence or thoughtlessness” (Finnis 2000, p. 89). Michael Sandel also questions the reasonableness of requiring citizens to bracket their comprehensive moral, religious, and philosophical doctrines – that is, their view of the “whole truth”– on such a grave moral question in public debate. Whether it is reasonable, he contends, depends on which of those doctrines is true. For instance, if the Catholic/natural law view that personhood begins at conception is true, then “bracketing the moral-theological question [of] when [personhood] begins is far less reasonable than it would be on rival moral and religious assumptions” (Sandel 2005, p. 225). Although Rawls asserts that “political values normally outweigh whatever nonpolitical values conflict with them,” Sandel says that if the Catholic/natural law view of the moral status of the embryo and fetus is correct and abortion is tantamount to murder, then “it is not clear why the political values of toleration and women’s equality [construed as it is by liberals], important though they are, should prevail” (John Rawls 1993 [2005], p. 146; Sandel 2005, p. 226). Thus, Sandel maintains: “the case for abortion rights cannot be neutral with respect to that moral and religious controversy. It must engage rather than avoid the comprehensive moral and religious doctrines at stake” (Sandel 2005, p. 226). The next section will examine the viability of this more expansive account of public reason and consider whether insistence on the whole truth in politics is really incompatible with democratic citizenship and the idea of legitimate law, as Rawls maintains. But before turning to that issue, it is helpful to examine a second case: physician-assisted suicide.

Rawls and five other prominent liberal political philosophers – Ronald Dworkin, Thomas Nagel, Robert Nozick, Thomas Scanlon, and Judith Jarvis Thomson – filed a now-famous brief (“The Philosophers’ Brief”) with the US Supreme Court at a time when the Court was considering two cases involving state bans on physician-assisted suicide (the Court in fact upheld these bans and rejected appeals for a constitutional right to physician-assisted suicide). In their brief, the authors argue for a constitutional right to physician-assisted suicide by contending that the cases under consideration “do not invite or require the Court to make [.. .] ethical or religious judgments about how people should approach or confront their death or about when it is ethically appropriate to hasten one’s own death or to ask others for help in doing so. On the contrary, they ask the Court to recognize that individuals have a constitutionally protected interest in making those grave judgments for themselves, free from the imposition of any religious or philosophical orthodoxy by court or legislature” (Dworkin et al. 1997). The authors go on to say: “Death is, for each of us, among the most significant events of life. [.. .] Most of us see death [.. .] as the final act of life’s drama, and we want that last act to reflect our own convictions, those we have tried to live by, not the convictions of others forced on us in our most vulnerable moments” (ibid.). They conclude that each person has a right to make the “most intimate and personal choices central to personal dignity and autonomy,” which includes “the right to exercise some control over the time and manner of one’s death” (ibid.). In short, the basic idea here is that the Court should be neutral with respect to competing conceptions of the meaning and value of human life and thus allow individuals the autonomy to make these decisions for themselves according to their conscience. In Rawlsian terms, public reasoning should proceed here by bracketing comprehensive moral, religious, and philosophical doctrines and by appealing to the political value of individual autonomy in light of the fact of reasonable pluralism.

However, some have questioned whether such a view is in fact really neutral with respect to competing conceptions of the meaning and value of human life. For instance, Sandel contends that the brief actually does affirm a view of what makes life worth living: namely, “the best way to live and die is to do so deliberately, autonomously, in a way that enables us to view our lives as our own creations. The best lives are led by those who see themselves not as participants in a drama larger than themselves but as authors of the drama itself” (Sandel 2005, p. 114). One’s life is seen here as one’s own possession and Sandel notes that this is “at odds with a wide range of moral outlooks that view life as a gift, of which we are custodians with certain duties. Such outlooks reject the idea that a person’s life is open to unlimited use, even by the person whose life it is” (ibid., pp. 114–115). The authors of the brief might respond by saying that people who want to see their life as a gift and as part of a larger drama remain free to do so. But Sandel contends that a constitutional right to physician-assisted suicide “would not simply expand the range of options, but would encourage the tendency to view life less as a gift and more as a possession. It might heighten the prestige we accord autonomous, independent lives and depreciate the claims of those seen to be dependent” (ibid., p. 116). He worries that this could affect attitudes and treatment of the young, the old, the disabled, the infirm, and the poor. It should also be noted that the life as a gift view is often linked to a belief in the “sanctity” (i.e., inviolability) of human life, which requires, among other things, that one never intentionally kills an innocent human being, whether it be others or one’s self (see Keown 2002, Chap. 4). Here the demands of the sanctity of human life are seen as overriding all considerations about quality of life and autonomy. For anyone who affirms such a view, it is unlikely that they will see it as reasonable to bracket this view when considering the direction of public policy.

Alternative Approaches

So what alternatives are there to the Rawlsian account of public reason? One is the natural law view of ethics, which is endorsed by several of the aforementioned philosophers, namely, Finnis, George, and Lee. Natural law ethics is a comprehensive doctrine that in fact claims to engage in public reason, that is, it claims to appeal to reasons (or values) that can be accepted by any citizen as free and equal. If this is so, then it can be said to fulfill what Rawls calls the “duty of civility.”

Finnis, for instance, appeals to self-evident basic goods that he thinks are constitutive of human well-being and fulfillment and towards which he believes we are naturally directed as things “to be pursued”: namely, life, knowledge, play, aesthetic experience, sociability (or friendship), practical reasonableness, and religion (Finnis 1980, pp. 85–90). Each of these goods demands respect but which a person will pursue at a given moment in time and in what manner is something that each person must work out in the course of his or her particular life through practical reason. Nevertheless, there are certain general requirements of practical reasonableness that everyone must follow: for instance, cultivating the virtues and avoiding acts of injustice, such as the intentional killing of an innocent human life.

Those who endorse natural law ethics seem to be among those who Rawls has in mind when he speaks of “rationalist believers,” that is, those who believe that they can establish their views through reason, and who, he thinks, must deny the “fact of reasonable pluralism” (Rawls 1993 [2005], pp. 152–153). Rawls believes that they are mistaken to deny this “fact,” and this is why he thinks that the fair terms of social cooperation (the principles of justice) should not be based on knowledge claims about an independent moral order – as in the case of Martin Luther King, Jr., who made appeals to the “arc of the moral universe” in articulating his view of justice – but rather they should be based on a mutually beneficial agreement that is arrived at from behind the “veil of ignorance,” as articulated by his account of justice as fairness (see ibid., pp. 22–23, 97). It is mistaken to deny the “fact of reasonable pluralism,” Rawls thinks, because it is “unrealistic—or worse, it arouses mutual suspicion and hostility—to suppose that all our differences are rooted solely in ignorance and perversity, or else in the rivalries for power, status, or economic gain” (ibid., p. 58).

In response, Finnis says that one must distinguish between kinds of differences in viewpoints. There are a number of reasonable differences, he says, that “arise from differences of sentiments, of prior commitment, and of belief about likely future outcomes. In such cases there is no uniquely correct opinion, though there are many incorrect opinions” (Finnis 2000, p. 83). However, he contends: “in relation to some matters, including at least some matters of basic rights, there are correct moral beliefs, accessible to all. In relation to such matters, differing opinions can only be rooted in ignorance or some subrational influence, and it is impossible to say that there is more than one ‘fully reasonable’ or ‘perfectly reasonable’ belief” (ibid., pp. 83–84). Abortion and physician-assisted suicide are examples of cases where Finnis believes that some beliefs are more reasonable than others, indeed, where some views are simply mistaken and others are correct. Public reasoning, he contends, “should be directed to overcoming the relevant mistakes, and public deliberations should be directed to avoiding them in practice” (ibid., p. 84; see also pp. 86–93; George 2001, pp. 53–55). The problem with Rawls’s critique of the rationalist believer, for Finnis, is that he seeks to declare that the rationalist believer is mistaken without examining the merits of his or her arguments, and this is due to Rawls’s understanding of political legitimacy, which does not allow for ultimate justification of constitutional essentials and matters of basic justice to be based on any specific comprehensive moral, religious, or philosophical doctrine (Finnis 2000, pp. 79–80; see also George 2001, pp. 52–53). Because Rawls preemptively censors or short-circuits precisely the kind of reasoned public debates that citizens need to be having on matters of great importance, Finnis says that his view of political legitimacy is itself “illegitimate, unreasonable, and uncivil” (Finnis 2000, p. 81).

Even if one is not as confident as Finnis about the powers of reason to definitively show which moral beliefs are correct and which are incorrect, there may still be good reason to allow greater room for appeals to comprehensive moral, religious, and philosophical doctrines in public debate and to believe that this can be compatible with legitimate law and with democratic citizenship involving mutual respect between free and equal citizens (thus fulfilling the “duty of civility”). This is especially desirable if one agrees with Sandel’s view that on certain grave moral questions it is not reasonable to bracket one’s comprehensive moral, religious, or philosophical doctrine and that there is no truly neutral position on these questions. Hence, he says that we should “engage rather than avoid the comprehensive moral and religious doctrines at stake” (Sandel 2005, p. 226). According to Sandel, it is important to distinguish two conceptions of mutual respect between free and equal democratic citizens. One is the “liberal conception” according to which “we respect our fellow citizens’ moral and religious convictions by ignoring them (for political purposes), by leaving them undisturbed, or by carrying on political debate without reference to them. To admit moral and religious ideals into political debate about justice would undermine mutual respect in this sense” (ibid., p. 246). However, there is also what he calls a “deliberative conception” of respect according to which “we respect our fellow [citizens’] moral and religious convictions by engaging, or attending to them— sometimes by challenging and contesting them, sometimes by listening and learning from them— especially if those convictions bear on important political questions” (ibid., pp. 246–247). Sandel believes that this deliberative conception of respect is the more suitable ideal for pluralistic societies and it is better able to cultivate, rather than stifle, the “moral energies of a vital democratic life” (ibid., p. 246; see also Weithman 2002).

Such deliberative engagement with one’s fellow citizens’ comprehensive doctrines could proceed along the lines of what Charles Taylor describes as the “ad hominem” model of practical reasoning, which, as the name suggests, appeals “to the person,” especially to his or her deepest moral (and perhaps spiritual) sense of things. With respect to trying to convince others of one’s perspective, Taylor writes: “I can only convince you by my description of the good if I speak for you, either by articulating what underlies your existing moral intuitions or perhaps by my description moving you to the point of making it your own” (Taylor 1989, p. 77). Whether it is intrapersonal or interpersonal, practical reasoning on Taylor’s account is “a reasoning in transitions. It aims to establish, not that some position is correct absolutely, but rather that some position is superior to some other. It is concerned [.. .] with comparative propositions” (ibid., p. 72). The most common form of this is where such a transition is brought about by “error-reducing moves,” for instance, “by the identification of contradiction, the dissipation of confusion, or by rescuing from (usually motivated) neglect a consideration whose significance [one] cannot contest” (Taylor 1995, p. 53). The ultimate court of appeal here is what Taylor calls the “best account principle”: “What better measure of reality do we have in human affairs than those terms which on critical reflection and after correction of the errors we can detect make the best sense of our lives? ‘Making the best sense’ here includes not only offering the best, most realistic orientation about the good but also allowing us best to understand and make sense of the actions and feelings of ourselves and others” (Taylor 1989, p. 57).

For instance, citizens might engage in ad hominem practical reasoning about how to best conceive of human dignity (or the sanctity of human life) and what follows from this conception (as is relevant, say, to the abortion and physician-assisted suicide debates). They may ask: what ontological account of the world and the place of human beings within it – for instance, theistic or naturalistic – can best make sense of and inform the experience of human dignity and what it morally requires? Some might then come to realize that they do not have an adequate “moral ontology” to support their “moral phenomenology” and so they must either abandon the moral phenomenology (the sense of human dignity) or seek out a more adequate ontological basis. Or some might find that articulating what their sense of human dignity consists in – for instance, being made in the image of God, or being supreme evolutionary achievements, or whatever else – empowers them (gives them “moral energies”) to show greater respect and concern for human beings and also enables them to see more clearly what such human dignity morally requires (see Taylor 1989, pp. 3–11, 91–97, 515–521; Taylor 2003, pp. 316–320). But even if citizens disagree on the deeper reasons that inform their conceptions of human dignity, for political purposes they might still try to form an overlapping consensus around some such conception. Provided they go in for the concept, citizens could then try to establish – via ad hominem practical reasoning – a consensus around what seems to be the most coherent view (see Taylor 2011, Chaps. 6, 13–14).


This entry has considered a dominant model of how to conduct public debate: namely, John Rawls’s account of public reason. It then examined how this account applies to the controversial issues of abortion and physician-assisted suicide, where one can see why some have objected to this view, especially with regard to the way it requires citizens to bracket their comprehensive moral, religious, and philosophical doctrines. Next, this entry considered some alternative approaches that endorse more expansive forms of public reason that allow greater room for appeals to comprehensive doctrines. While one might expect that many of the controversial issues in bioethics will continue to be a matter of public debate going forward, this entry has shown that a necessary step towards making progress in these debates is to get clear on how such debate should be conducted within pluralistic democratic societies.

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