Public Reason and Bioethics

Introduction

A major problem posed by pluralism is that it can hinder democratic decision making since citizens cannot reach agreement on issues without the irreconcilable comprehensive doctrines that underlie their reasoning. Building on the works of previous philosophers, American political philosopher John Rawls put forward the idea of public reason to mitigate the issue of pluralism in public governance. Public reason mainly applies to fundamental questions belonging under the public political forum; this includes the discourse of  government officials, judges, and candidates for office. It asks  that these officials handle issues regarding the public political forum by deliberating according to what  “[any/all] free and equal citizens who are prepared to offer fair terms of cooperation could reasonably accept as sufficient reasons or positions.” (Rawls 1997)

 The appeal to public reason is based on ideal theory and fundamental ideas of free and equal citizens; it requires a commitment to reciprocity and assumes citizens are reasonable and committed to the joint project of democracy. The guiding principle to handling public policy issues ought not to be one’s individual comprehensive doctrine or what one believes is the “whole truth” but rather what one believes is a reason or position that it is reasonable to ask all others to accept or agree to act on (fair terms of cooperation) given everyone has different individual comprehensive doctrines. Therefore, discourse of public reason does not appeal to truths but rather reasonableness, all of this requires toleration. An example of public reason is the United States Constitution as it aims for a more perfect union, justice, liberty, general welfare, equality of opportunity, distribution of taxation.

Public Reason and Bioethics

It has been noted in several contexts that contemporary bioethics involves few appeals to religious themes, a major change from the earlier years when religious thought played a far more important role.  To a large extent, this represents a view that it is inappropriate, in setting public policy on bioethical issues, to appeal to values and principles accepted only by some religious/cultural communities. The Rawls article represents one of the most important presentations of this viewpoint. However, it is important to note that according to Rawls the idea of public reason does not apply to societal “background culture” like an individual’s religious life or media. Consequently, appealing to public reason to defend the absence of religious appeals in bioethics could be less relevant in cases of clinical decision making, and more so in policy bioethics.

Assigned Reading

The following paper was used to inform and ground the discussion:

Rawls, J. (1997). The Idea of Public Reason Revisited. The University of Chicago Law Review, 64(3), 765–807. https://doi.org/10.2307/1600311

Thesis: Public Reasons as a means to solve problems with pluralism and deal with fundamental political questions of public import by avoiding comprehensive doctrines and remaining committed to democratic ideals.

Discussion Questions

Seminar participants were asked to consider the following questions prior to meeting for discussion:

1. What is the theory of public reason and how is it supposed to solve this problem?
2.  Rawls claims that the moral basis for the theory of public reason is a commitment to reciprocity? What is that commitment and does it really support the theory of public reason?
3.  Rawls insists that this is not a secular theory because it rejects the use of comprehensive secular, as well as comprehensive religious, views in setting public policy. Do you think that this claim is true?
4.  What is his distinction between political autonomy and moral autonomy? Why does he support the former without necessarily supporting the latter?
5.  On p. 779, Rawls substantially limits the role of society in dictating the nature of the family. Would he then allow men in families to have certain authority over women? Are there any public reasons for rejecting such a family unit?

Similarly, consider his discussion on p 790 of the care of children. On his account, could Jehovah’s Witnesses refuse blood transfusions for their children?

Reflection Points

In discussion, seminar participants reflected on the following points:

1. Rawls’ public reason argues that the government/state should stay out of ALL FAMILY MATTERS (which reflect different comprehensive moral doctrines) unless certain family situations/decisions are necessary for ensuring political autonomy (equity) or were destructive to the raising of kids to become free and equal citizens (family as a basic structure).
2. Public Reason should NOT restrict or apply to bioethics since it takes place in “the internal life” or “background culture”—most all of [academic] bioethics occurs here and appeals to [divergent] comprehensive doctrines.
3. What Rawls is after is a social agreement that is stable for the right reasons.
4. One cost of public reason is that there is no insistence on the truth. Toleration allows letting go of the whole truth, what matters are the shared norms.
5. Concerns that Rawls may be smuggling a lot of moral doctrine aspects (reciprocity, Kantian stuff) as political conceptions.

References and Additional Resources

Rawls. (1996). Political Liberalism (selections).

Vallier, K. (2011). Against Public Reason Liberalism’s Accessibility Requirement. Journal of Moral Philosophy. 8. 10.1163/174552411X588991.

Quong, J. (2014). What is the point of public reason?. Philos Stud 170, 545–553. https://doi.org/10.1007/s11098-013-0270-z

Leland, R. J., & van Wietmarschen, H. (2012). Reasonableness, Intellectual Modesty, and Reciprocity in Political Justification. Ethics, 122(4), 721–747. https://doi.org/10.1086/666499

Jønch-clausen, K., & Kappel, K. (2016). Scientific Facts and Methods in Public Reason. Res Publica, 22(2), 117-133. http://dx.doi.org/10.1007/s11158-015-9290-1

McConnell, D., & Card, R. F. (2019). Public reason in justifications of conscientious objection in health care. Bioethics, 33(5), 625–632. https://doi.org/10.1111/bioe.12573

Bellolio Badiola, C. (2018). Science as Public Reason: A Restatement. Res Publica 24, 415–432 (2018). https://doi.org/10.1007/s11158-018-09410-3

Greenblum, J., & Hubbard, R. K. (2019). Responding to religious patients: why physicians have no business doing theology. Journal of medical ethics, 45(11), 705–710. https://doi.org/10.1136/medethics-2019-105452