Project Background

In Big Picture Bioethics, we ask the question "can policy-making processes be developed that realise the ideals of democratic policy-making in multicultural states, without reliance upon substantive value commitments?"  Furthermore, if the answer to this question is "no", we ask "what will be the limits of liberalism's capacity to develop policy in societies lacking ethical consensus? Our project's unique approach involves an ethical and political analysis of the making of health policy in ethically contentious domains, taking both bioethics and political philosophy beyond previous boundaries and merging them in a novel way- this is the first time recent conceptual work in political philosophy on the relation between democratic processes and multiculturalism has been brought to bear on policy-making processes in ethically contentious areas of biomedical research and health policy.

Bioethicists are actively involved in governmental policy-making and regulation in a range of ethically contentious areas. However, they rarely address questions of democratic policy-making within pluralist democracies. Most bioethicists eschew the concepts and methodologies of political theory, social philosophy, historical analysis, or legal theory in examining the process of such regulation and policy development. While Gutmann and Thompson (1997) and Charlesworth (1993) examine liberal democratic theory at an abstract level, their analyses do not evaluate processes of policy-making in specific contexts. Macklin's work (1998, 1999) directly addresses resolution of bioethical conflicts in culturally diverse societies without resort to relativism, but does not address the processes by which resolution occurs and has been criticised as 'fundamentalist' (e.g., Baker 1998; cf. Beauchamp 1998). Finally, specific case studies in bioethical conflict examine the historical and philosophical contexts of these conflicts (e.g., ACHRE 1996) but do not provide comparisons between cases or across national settings.

Outside bioethics a considerable literature has developed that questions, criticises, and seeks to defend liberalism's ability to address differences in ethical values. Our approach draws on this scholarship and will contribute to its critical development. A key focus concerns debate between procedural and substantive approaches to public reasoning and policy-making, where authors often use examples from bioethics for illustration. Critics of liberalism question its ability to develop a procedural approach to policy, not based on shared substantive values (e.g., those that might be labelled conservative, see Finnis, (1980), feminist, see Young (1990), or communitarian, see MacIntyre, (1988) or Sandel (1982)). Within multicultural societies, differences in ethical frameworks shaping citizens' understandings of what a reasonable policy can encompass, challenge the adequacy of liberalism to develop legitimate institutions and policies. This is particularly challenging for those liberals who argue that the legitimacy of public policies depends, in principle, on the ability of the policy-maker to justify those policies to any reasonable member of the society (see Waldron 1993, 44).

Recently, procedural approaches to public decision-making have been developed that attempt to address these challenges to liberalism. Kymlicka (1989, 1995) and Ivison (2002) offer approaches to liberalism that attempt to respond to cultural difference and disadvantage. Ivison's 'discursive modus vivendi ' for public reasoning on contentious issues may prove a particularly fruitful device for analysis in our project, as may Dryzek's (2000) vision of a 'deliberative democracy' or Young's 'inclusive democratic communication' (2000).